It took me ages to realise that I could actually do something about things instead of just having stuff done to me.

(Beresford, 2013)

As many service users have reported, undergoing compulsory psychiatric treatment is a major event which has serious effects on a person’s life. It can be confusing, overwhelming and disempowering. Having someone on your side during this difficult and distressing experience can be very helpful. An IMHA can ensure that the service user’s opinion on all matters affecting them is heard, understood and considered. IMHA services are available to most people who are detained in hospital or subject to community treatment orders (CTOs). However, as research on IMHA practices shows, there are many other issues that influence whether IMHAs actually reach everyone eligible and build trusting and helpful advocacy partnerships. (Newbigging et al, 2012) This briefing discusses specific barriers and difficulties that prevent some groups of service users from accessing IMHA even though they qualify for this support. It is important for IMHA providers to recognise these barriers and understand how they operate, and how they can be removed so that everyone who is eligible for IMHA has access.

People who are eligible to use IMHA services in England are:

  • people detained under the Mental Health Act 1983 amended in 2007 (even if on leave of absence from the hospital), but excluding people who are detained under certain short term sections (4, 5, 135, and 136)
  • conditionally discharged restricted patients
  • people subject to guardianship
  • people subject to supervised community treatment orders (CTOs).
  • Other patients, who are informal, are eligible for IMHA services if they are being considered for section 57 or section 58A treatment (i.e. treatments requiring consent and a second opinion). This includes people under the age of 18 who are being considered for electroconvulsive therapy (ECT).