SCIE Resource guide 10: Commissioning and providing mental health advocacy for African and Caribbean men

Commissioning for best practice

From the SCIE Knowledge Review 15, the following approach to commissioning advocacy is recommended:

• Designing services grounded in identified need and reflecting local demography.
• Adopting a strategic approach to the development of mental health advocacy, based on the whole system.
• Ensuring equality of access to high-quality and effective mental health advocacy through investment in building capacity.
• Understanding and valuing diverse ways of providing mental health advocacy.
• Providing sustainable funding for advocacy.
• Engaging service users and communities in the commissioning process.

Reflecting local needs

Funding and commissioning of advocacy provision needs to be demonstrably linked to assessed need and reflect local demography and ethnic diversity. The organisational arrangements for the provision of mental health advocacy with African and Caribbean communites will therefore differ, for example between city, urban and rural areas, as the population of African and Caribbean communities varies.

This implies:

• In urban areas where there are larger African and Caribbean communities, it would make sense for mental health advocacy to be provided as part of African and Caribbean mental health services.
• Where the population is much smaller but there are other larger BME communities, advocacy could be provided as part of a BME mental health service or a BME advocacy-focused organisation.
• In rural areas where the population and demand from African and Caribbean communities is likely to be small, mental health advocacy could be provided as part of a generic mental health advocacy service. Alternatively the area could be covered by outreach from and African and Caribbean mental health advocacy service in a neighbouring urban area.

In arriving at a decision, commissioners will need to map provision to need and available resources. They will need to demonstrate a clear relationship between demographic profile, needs and the service provided. However, a focus solely on numbers must be avoided and whatever the population size, arrangements will need to be in place to ensure culturally appropriate provision for African and Caribbean men. This is particularly pertinent to secure services, where African and Caribbean men in general might be over-represented but will find themselves in the minority.

The diversity of needs, demand on mental health services, and the over-representation of African and Caribbean men and women (and indeed under-representation of other groups) within mental health services and pathways into services also need to be considered. The engagement of communities and mental health service users in this process is essential.

A strategic approach

This will involve viewing advocacy provision as a whole system and moving away from an approach driven by the availability of current services. It means:

• Identifying needs in partnership with the diversity of service users.
• Understanding the pattern of current provision; its strengths weaknesses and gaps.
• Commissioning advocacy to deliver agreed outcomes.
• Supporting and formalising partnerships between advocacy providers, including those for other care groups.
• Developing good co-ordination and clear routes through from one service to another so that the service user is not left to navigate a bewildering array of options.
• Considering co-location of services.
• Investment in the development of second-tier organisations to support development of the advocacy sector.

Equality of access

Equality of access to effective mental health advocacy for African and Caribbean men requires:

• Increased investment in the black and community voluntary sector (BCVS) to develop and strengthen mental health advocacy either as part of an African-Caribbean or a BME focused mental health service.
• Investment in the development of organisations that do not directly provide advocacy but aim to build capacity in the development of advocacy (i.e. second tier organisations) for African and Caribbean communities in BCVS and the mainstream advocacy sector.
• Clear arrangements specified in contracts and/or service level agreements to facilitate and evaluate access.
• The creation and introduction of appropriate standards to guide service developments.

Valuing diverse models for provision

It is evident that the organic development of advocacy within BCVS has preserved a holistic and collective model of advocacy. It is important that this model is not disadvantaged or dismissed in any future moves to formalise advocacy in the context of the new statutory duties and the development of more systematic commissioning arrangements.

Sustainable funding

The capacity of advocacy organisations to enhance capacity and sustain themselves is currently severely limited by insecurities around long-term funding. In line with current policy and recognised good practice (12), contracts need to be established on a three year basis. See the Social Perspectives Network website for further information on money and commitment.

As well as direct service provision, contracts need to include funding for:

• management and governance arrangements
• training, supervision and capacity-building for advocates and advocacy service managers
• service user involvement and community engagement
• monitoring and evaluation

Alongside this, the service specifications for mental health services should include the requirement that staff receive training to understand the legislative and policy context for advocacy, its contribution, and their role in facilitating access and supporting its development.

Service user and community engagement

The engagement of service users and communities will facilitate the development of more appropriate and better-quality services that are more likely to achieve the identified outcomes. This needs to be underpinned by transparency and clarity about decision-making. African and Caribbean service users and their communities have a particular contribution to make in:

• identifying needs
• developing strategies for and facilitating access
• service design and location
• monitoring and evaluation.

Link: Community Engagement Project, Centre for Ethnicity & Health, University of Central Lancashire.