10 Top tips for commissioners: Commissioning Independent Mental Health Advocacy (IMHA) services in England

Published: March 2015

Key messages

  • Understand the role and responsibilities of IMHA and other forms of advocacy.
  • Take a co-production approach to commissioning, which fully involves people who use services and carers.
  • Develop IMHA services that meet the needs of communities by conducting an annual needs assessment and an equality impact assessment.
  • Develop IMHA services that deliver meaningful outcomes for IMHA partners.
  • Work with individuals and groups from diverse communities to ensure that IMHA services are culturally sensitive and diverse.
  • Support a whole systems approach to advocacy, linking IMHA to other forms of advocacy to ensure continuity of support to IMHA partners.
  • Ensure that IMHA services offer both instructed and non-instructed IMHA.
  • Make arrangements for IMHA for people placed out of area.
  • Work with health service commissioners to ensure effective IMHA delivery.

Introduction

This briefing aims to support local authority and health service commissioners to commission good quality IMHA services in the light of recent changes to commissioning arrangements. Under the Health and Social Care Act 2012, responsibility for commissioning IMHA moved to local authorities. This came into force in April 2013.

The commissioning of IMHA is taking place in a complex environment. There is a challenging economic climate, in which commissioners need to support good quality services as well as make savings. In addition commissioning IMHA requires joint working between local authorities, mental health service providers and other partners.

While approaches to commissioning IMHA services have become more systematic since its introduction in 2009, commissioning based on needs assessment and equality impact assessment is still rare. People who use services, including qualifying patients, are often not directly involved in the commissioning process or in monitoring contracts.

The importance of effective commissioning

Effective commissioning is essential to the development of good quality IMHA services that meet the needs of people 10 Top tips for commissioners who use them. It plays a central role in driving up quality, facilitating integrated service delivery and making the best use of resources to deliver better outcomes for IMHA partners.

10 Top tips

The following 10 top tips are designed to help commissioners develop good quality IMHA services that meet people’s needs. They are not meant to be an exhaustive list but highlight key areas you should consider in the commissioning process and in developing service specifications.

Role and responsibilities of IMHA

1. Understand the role and responsibilities of IMHA and other forms of advocacy.

Commissioners need to be knowledgeable about and understand advocacy, in particular the IMHA role, and the duty to provide IMHA which was introduced in 2007 following amendments to the 1983 Mental Health Act.

IMHA services were introduced to safeguard the rights of people detained under the Mental Health Act (referred to as ‘qualifying patients’). IMHA services aim to enable people to understand their rights and safeguards under the Mental Health Act, and to participate in decisions about their care and treatment.

An Independent Mental Health Advocate is a statutory role, with specific responsibilities.

These include:

People are eligible to use IMHA services in England if they are:

Co-production

2. Take a co-production approach to commissioning, which fully involves people who use services and carers.

Commissioners should:

Strategic needs assessment and asset mapping

3. Develop IMHA services that meet the needs of local communities by conducting population needs assessment and an equality impact assessment

Commissioners should:

Outcome-based commissioning, quality and cost

4. Develop IMHA services that deliver meaningful outcomes for IMHA partners.

Commissioners should:

Meeting diverse needs

5. Work with individuals and groups from marginalised communities to ensure that IMHA services are culturally sensitive and diverse.

Standard approaches to service delivery can limit the ability of IMHA services to respond to people’s needs in culturally sensitive ways. People from some communities may perceive IMHA services as discriminatory or unsafe, leading to their reluctance to engage.

The 2015 Mental Health Act Code of Practice says that local authorities should ensure that IMHAs understand equality issues and that there are sufficient IMHAs with a specialised understanding of the needs of particular groups.

This means commissioners should take the following into account when drawing up tenders, service specifications and contracts for IMHA provision:

Engaging with IMHA providers

6. Work with IMHA services to ensure that IMHA provision meets the needs of IMHA partners.

This means commissioners should:

IMHA and other forms of advocacy

7. Support a whole systems approach to advocacy, linking IMHA to other forms of advocacy to ensure continuity of support to IMHA partners.

IMHA and Independent Mental Capacity Advocate (IMCA) services are statutory forms of advocacy. The role of IMCA is to support and represent people deemed to lack capacity in important decisions about serious medical treatment and changes of residence as specified in the Mental Capacity Act 2005. People qualify for IMCA when there is no-one else suitable to support them. Some people who qualify for IMHA might also qualify for IMCA. In addition as a consequence of the Care Act 2014, from April 2015 there will be a new right to independent advocacy to support people who satisfy specific criteria with social care assessment, planning, safeguarding and appeals processes.

Non-statutory forms of advocacy include generic mental health advocacy, peer advocacy and citizen advocacy. There is no legal obligation for local authorities or other agencies to provide these types of advocacy, though evidence shows they support wellbeing and bring about positive outcomes for people who use mental health services.

The provision of other forms of advocacy enables a holistic approach to peoples’ needs, increased service flexibility and better outcomes.

Commissioners should ensure that:

Non-instructed advocacy

8. Ensure that IMHA services offer both instructed and non-instructed IMHA to meet the needs of those unable to tell the advocate what they want, such as older people with dementia and people with severe learning difficulties.

Commissioners should ensure that:

Out of area placements

9. Make arrangements for IMHA for people placed in hospitals outside their area of residency.

 

The local authority for the area in which the hospital is located is responsible for commissioning IMHA for patients who are placed there but are not normally resident in that Local authority. Qualifying patients placed out of area experience difficulties associated with service continuity.

Commissioners therefore need to:

Links with health service commissioners

10. Work with health service commissioners to ensure effective IMHA delivery

Local authority commissioners need to:

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

  • Download: 10 top tips for commissioners: Commissioning Independent Mental Health Advocacy (IMHA) services in England