Abstract
<p align="LEFT">Advocacy in compulsory mental health settings is complex and contested, incorporating legal, non-legal, representational and best interests advocacy. This paper presents an approach to non-legal representational advocacy used by Independent Mental Health Advocacy (IMHA), in Victoria, Australia, drawing on in-depth qualitative interviews with advocates and other key stakeholders. After outlining the Victorian context and the IMHA model, this paper shows how IMHA privileges the consumer voice using representational advocacy, which is rights-based and works for systemic change. Using a supported decision-making model, the paper highlights the enablers and challenges which exist, before discussing the implications in terms of rights, power, capacity building and systemic change. The participants saw IMHA as working to address one of the most troubling tensions in mental health care, between the perceived need for coercion and the need to support people to make their own decisions. Representational advocacy provides a clear, easily transferable and tested framework for engaging in supported decision-making processes with people in the mental health system.</p>
Highlights
Advocacy in compulsory mental health settings is a complex and contested affair, incorporating legal, non-legal, representational and best interests advocacy with a raft of other concepts in diverse contexts. 1 For many who are subject to compulsory treatment, the experience is frightening, disempowering and can lead to lasting trauma, and advocacy can offer a supportive and empowering salve to distress
This paper presents an approach to non-legal representational advocacy used by Independent Mental Health Advocacy (IMHA), in Victoria, Australia, drawing on in-depth qualitative interviews with advocates and other key stakeholders
As is to be expected, all Australian States and Territories have mental health legislation which allows for people who meet certain criteria to receive compulsory treatment, but only two, Victoria and Western Australia, have independent representational non-legal advocacy
Summary
Advocacy in compulsory mental health settings is a complex and contested affair, incorporating legal, non-legal, representational and best interests advocacy with a raft of other concepts in diverse contexts. 1 For many who are subject to compulsory treatment, the experience is frightening, disempowering and can lead to lasting trauma, and advocacy can offer a supportive and empowering salve to distress. Debate has raged between those who prioritise the ‘rights’ of consumers – often lawyers, and those who prioritise their ‘interests’ – often psychiatrists.[2] Over time, this debate has evolved into a complex and nuanced dialog, with mental health legislation across the globe taking away people’s right to make their own decisions, while seeking to protect their right to participate in those decisions. This occurs with both legal and non-legal advocates trying to balance rights to health, to personal and community safety, to self-determined recovery and to dignity. The shift is towards a rights based representational advocacy approach, where professionals assist people to make whatever decisions they can, using supported decision-making approaches
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