Unequal uptake of IMHA – research findings
'The right to be heard' (Newbigging et al, 2012), a two-year research study looking at the quality of IMHA services, involved consultation with 289 different stakeholders in group or individual interviews including 90 people eligible for IMHA. Across the different areas in the study, the research found that IMHA was only used by between 20 and 55 per cent of the number of qualifying patients who were entitled to access statutory advocacy support (Newbigging et al, 2012). The researchers also considered some of the circumstances contributing to this situation and identified seven groups of qualifying patients who remain particularly underserved by IMHA. They include:
- people from black, Asian and minority ethnic (BAME) communities
- people with learning difficulties
- older people with dementia
- people who have hearing impairments or are D/deaf
- young people
- people placed out of their area of residence
- people on CTOs.
People from these groups have much lower uptake of IMHA. Many participants in this study expressed concern that people from these groups are also likely to be the ones who most need this service. The reasons why they did not access IMHA included not understanding its purpose and how it can be helpful. In addition, some qualifying patients did not even know that the service existed.
This report considers how equality issues affecting people from these groups get in the way of accessing effective IMHA support. This is not meant to imply the similarity of these groups, nor of the people in them. Addressing each and every individual situation and working in a person-centred manner remain central tasks for advocates. However, to provide a good quality service, it is essential to have a sound understanding of the specific issues faced by different groups. Working in an inclusive way means being able to see the bigger picture and consider the broader circumstances of service users’ lives beyond their patient role.
I just keep myself to myself and stay in my room a lot because I am the only black female patient here.Non-IMHA user (Acute ward) (Newbigging et al, 2012)
'The right to be heard' (Newbigging et al, 2012) revealed the failure of many IMHA providers as well as commissioners, to take steps to understand the make-up of the local populations they serve. This is a step that is essential to developing and delivering an equal and inclusive service. There has been a general increase in the use of both detention in hospital and CTOs. (Health and Social Care Information Centre, 2014). Several reports have demonstrated that these measures are imposed more frequently on members of BAME communities (Centre for Social Justice 2011, Care Quality Commission 2010, Healthcare Commission 2008). The evidence from these reports and recent mental health policy (HM Government 2011) clearly calls out for an equality analysis of IMHA provision to ensure that no one is deprived of IMHA access. Furthermore, most organisations do not collect and monitor equality data in sufficient detail to understand who is accessing IMHA and identify potential gaps. This kind of a comparison requires specific information about, for example, age, ethnicity, sexual orientation and impairment. This curtails the development of IMHA which serves different groups equally and effectively meets their specific needs.