Independent Mental Health Act Advocacy

Elizabeth* was detained under Section 3 of the Mental Health Act. She had been in hospital for a year, following various trials and seemingly ineffective treatments. Elizabeth’s multi-disciplinary team (MDT) at the hospital were considering electro-convulsive treatment.

The advocate had already worked with Elizabeth as her Independent Mental Health Act Advocate (IMHA) and during the first COVID-19 lockdown they were asked to explore Elizabeth’s views about the proposed treatment. The advocate researched the treatment and asked questions of the MDT to ensure Elizabeth had all the information she needed in relation to the treatment and to ensure this was being proposed as a last resort.

Elizabeth was a non-native English speaker so to ensure that she was involved in the process as much as possible, the advocate arranged for an interpreter to join their Skype meeting – normally such meetings would happen face to face but due to COVID-19 restrictions, this was not an option. With the help of the interpreter, the advocate explained Elizabeth’s rights and explored the procedure including the pros and cons of this type of treatment. The advocate then gathered Elizabeth’s views, wishes and feeling around electro-convulsive treatment.

How we supported Elizabeth

The advocate kept in regular contact with Elizabeth to build a trusting and honest relationship. This allowed Elizabeth the time and space to consider the treatment and formulate a view on it based on information made available to her in in her own language. The advocate worked with the MDT to advocate that a person-centred approach be taken throughout this decision-making process - this included professionals agreeing to speak with Elizabeth on a one to one basis outside of meetings and allowing her time to process information.

Elizabeth was against the treatment and was able to explain her reasons for this. The advocate supported Elizabeth in relaying her view to staff and outlined the ways in which Elizabeth had recalled information, weighed up aspects of the decision and showed understanding of the procedure and her rights.

A meeting was called and during this time, the responsible clinician explained the procedure to Elizabeth in more detail. This explanation included why the treatment was being proposed, the effects, practicalities and risks associated with treatment and the necessary general anaesthesia, and the alleged benefits and burdens of the procedure as well as what the Mental Health Act says about it. During this meeting it was felt that Elizabeth had capacity in relation to this decision, and as she was refusing to have the treatment, this could not be forced on her.

*Names have been changed to protect the identity of the people we support

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