In order to successfully advocate on behalf of your clients – you will need to plan what you are going to do, in order to make sure you haven’t missed any important aspects of your advocacy work. So there is an advocacy cycle that you can follow. Give out pieces for advocacy cycle.
Case Study 1 Robert has been Mary’s advocate for the past 6 years. During that time Mary has been in and out of a number of hospitals and has now settled happily into an institution that provides her own room. Robert has been able to observe Mary’s behaviour and interaction with others in a range of settings and has learned to interpret her gestures and body language (Mary has no formal communication). When a second resident is moved into the room, Robert notices that Mary becomes very agitated and upset when they are in the same room together. She is becoming aggressive towards the other resident and has broken several household items. Robert explains to the Manager that Mary does this when she is unhappy or feels threatened by people around her. He recommends that a review of the situation be carried out immediately. Goal – to ensure that the clients needs for peace of mind are recognised Issue – The resident’s (Mary) needs have not been recognised Objective – To conduct a review of the situation in order to improve Mary’s situation Non-instructed advocacy Case Study 2 A social worker visits James in the mental hospital. Whilst observing James in the dining room, the advocate notices that James is given only one piece of nsima whilst all the other residents get two. When the social worker asks staff about this, she is told that James is a slow eater and takes longer to eat than the other residents. Hence, there is insufficient time for James to eat 2 pieces of nsima before the dining room is cleared. The social worker immediately take this up with the catering manager and requests that James be given a) extra time in the dining room b) support to eat more quickly or c) the option to take his food out of the dining room so he can eat it in his own time. The social worker argues that James is being treated less favourably than his peers are as a result of his disability. The catering manager agrees to try the various options put forward by the advocate. When Henry tells James about what he has done, James is pleased that they are going to look into a solution to this problem. Goal – To ensure fairness of food allocations/nutritional requirements of all patients Issue – Discrimination in food allocations due to reasons beyond the control of the client Objective – To enable James to have the same allowance of food as all other residents Suggests non-instructed, but could perhaps have worked with James to encourage him to be a self-advocate. Case Study 3 Salim has learning disabilities regularly attended a support group run by a local CBO that encourages interaction with other young people and teaches basic skills, such as maths and writing, to help integration into the community. He is Muslim and lives with his large family, which is financially supported by his elder brother’s job selling vegetables on the market. An advocate recently found out that Salim is no longer attending the support group. Having spoken with Salim and his family, the advocate learned that the lunch provided by the support group only served meat which it was against Salim’s religion to eat and they refused to provide an alternative. As a result he was forced to withdraw from the group and assist his family at home and on the market stall, in order to generate enough income for him to be fed. Having generated an plan of action with Salim, both Salim and the advocate went to meet with the support group coordinator. Salim gave the reasons why he left the group and why he thought it was unfair that he received different treatment to others. The support group coordinator said they did not realize their actions were perceived as discriminatory – they did not serve an alternative for Salim as at first they did not realize he had specific dietary requirements and secondly, they did not have the time to produce separate meals. It was therefore suggested that either a) Salim is allowed to bring his own food and in return the equivalent cost saved from producing his meal is paid to him or b) a rescheduling of the cooking times in order to accommodate Salim. Goal – Equality and no discrimination on religious grounds Issue – Salim not being fed and therefore missing out on the support group Objective – ensure Salim has equal access to support group and services provided to others (meal) at no expense (personally or financially) to him Self advocacy and Peer/Expert Advocacy Case Study 4 Rose has been working as a clinical officer for 5 years in the same mental health hospital. One day she notices that a Doctor has prescribed the most effective medication for her patient’s condition. However a few year’s previously Joseph, the patient, had a bad reaction to it. Rose tells Joseph that this is a drug he had a bad reaction to and asks him if he would like alternative options, even though they may be less effective. Joseph says he would like to no more, so Ruth goes to speak to the Doctor in private, rather than confront him in front of other colleagues. She explains that she remembers an incidence where Joseph had a bad reaction to the prescribed medication, which is why he was taken off it. She recommends that the Doctor look at alternative medications for Joseph and give him a choice as to which treatment he takes. As a result, the Doctor returns to Joseph and explains to him alternative options for treatment that are available to him. Joseph is empowered to make choices about his treatment, supported by expert advice. Goal – Empowerment of patient Issue – Non-participatory approach and lack of involvement of patient and his history in distribution of medication Objective – Empower patient to make personal medical choices. Objective 2 – Encourage Doctor to acknowledge patient choices Expert - instructed
Read through slide. There are some questions that may be helpful to keep in mind during this stage – HANDOUT Go through Engagement Questions Go through Planning Questions
Example action questions to ask: 1 What have you/the client identified as the next steps in the action plan? 2 What communication strategies have you explored with the client around communicating about their rights with other professionals? 3 How will you build on their confidence so that they can take a lead on the advocacy work where possible? 5 How will you make sure you only take action when directed by the person? 6 Putting your plan into action – do exactly what you agreed to do (not more or less) 8 How will you keep the person central to the process and feedback to each other on agreed actions? 9 For non-instructed advocates implement your activity plan and constantly look back at the ways in which each step of your plan is affecting your client. Are there any revisions that need to be made.
1 What were the outcomes of the steps you agreed? 2 Is the advocacy issue resolved? 3 What could be improved upon in future work? 4 Did the person remain central to the advocacy process at all times? 5 For non-instructed advocates consider question 4 and how your action plan was implemented, what worked and what you would do differently next time.
An Introduction to Advocating for the Rights of Mental Health Clients
“ Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need.”
“ Advocacy is … a deliberate process of speaking out on issues of concern in order to exert some influence on behalf of ideas or persons.”
"Advocacy is an ongoing process aiming at a change of attitudes, actions, policies and laws by influencing people and organisations with power, systems and structures at different levels for the betterment of people affected by the issue.“
Advocating with or on behalf of clients empowers the individual and can have a hugely beneficial effect on the improvement of mental health as their rights, opinions and ideas are taken seriously by those working with them.
Empowerment and advocacy can help reduce the duration of impatient treatment and the number of visits to health services.
Why do we advocate on behalf of our clients? Continued.
To build self-esteem
To enhance coping skills
To build social support networks
To improve family relationships
To improve mental health legislation
To improve public awareness and decrease stigma
To uphold human rights
Why do we advocate on behalf of our clients? Continued.
Recognition of an infringement on a human right: Human rights are based on a set of core values which directly relate to advocacy:
Professional duty of care
If we notice that a client is not being treated according to these values – we must advocate for change.
In profession groups, make a list of all the attributes that you have which other professions don’t have. Think of your professional skills; interaction with clients; interactions with other staff and departments etc.
Advocating on behalf of an individual or a group who has been able to present their concerns and issues to the advocate.
Advocating based on the knowledge of an injustice on behalf of an individual or a group who has not been able to present their concerns. This is only used when patients cannot vocalise their opinions as a result of their condition.
Advocating for issues that affect you personally. This can be difficult to achieve and many people find it is better to be supported by other people or groups in order to have a stronger message. This also helps give clarity to an issue where otherwise personal emotions could get involved. For some mental health clients, this will not be possible, which is why we need to work with them to advocate for their rights.
This is when someone who has a greater knowledge of the system or situation advocates alongside the client. They can draw on their own experiences to understand and empathise with the person you are working with. Former clients add a great insight into what the client is experiencing and can make suggestions for action based on this shared knowledge. As health workers you have an in-depth knowledge of the system in which you are working and can help to advocate for change more affectively than if the client was a solely a Self-Advocate.
This is where a group of people with similar experiences meet together to put forward shared views. Local mental health service-user groups, support groups and patient councils are all examples of group advocacy. As a health worker you can support the establishment of such Group Advocacy activities, by advocating for them!
This is when an individual or an organisation is professionally focused on advocacy. It may be an organisation that advocates on behalf of other like-minded organisations (i.e. Malawi Health Equity Network) or an outsourced service to others (i.e. like me!). In this case it primarily provides short-term work rather than long-term support.
People with specialist knowledge and training, such as lawyers and legislative specialists are sometimes called “legal advocates”. Legal advocates differ from other mental health advocates in that they represent people in formal settings, such as courts, tribunals or complaints procedures. A legal advocate will often given advice and express their opinion about the best course of action. You may wish to consult a legal advocate if there are continual human rights abuses that you are not able to address at an institutional level.
Also known as “best interests” advocacy, this is where an advocate represents what he or she feels a person’s wishes would be, if they were able to express them. Non-instructed advocacy is not appropriate in mental health advocacy if clients are able to express their needs and opinions. However if they have dementia or other severe mental disabilities which make it impossible to communicate feelings, then this would be an appropriate form of advocacy to use.
Advocacy and Related Concepts Advocacy Information, Education, Communication (IEC) Community Mobilisation Networks and Partnerships Fundraising and Resource Mobilisation Overcoming Stigma and Discrimination What can it change? Policy; Policy implementation; Law; Practices on Mental Health Awareness and behaviour of Mental Health issues Capacity of communities to identify and address Mental Health problems in their area Isolation and duplication Levels of resource available for mental health work Level of stigma and discrimination against people with mental health issues Target Group Decision-makers; Leaders; Policy-makers; People in Positions of Influence A specific group – age, gender, community etc Members of a community Individuals or groups who have a similar agenda Local government, donors, private sector, communities People who stigmatise or discriminate Does the target group have influence over others? Yes No No No No No Typical indicators of success Changes in policy; laws and practices Statistical change in condition (i.e. % of mental health patients in the community attending a support group); Changes in attitudes A community problem is solved; Higher participation in community meetings Members of the network/partnership achieve more than they could have done if working alone Government or donors increase funding; Private sector makes financial or resource donation; Local community members offer facilities to use for meetings etc Fewer mental health patients victimised in communities; Less cases of depression and anxiety as a result of discrimination; Increased community support for rehabilitation of clients etc
An objective is the specific task that you want achieved through your advocacy work.
For example: Caregivers with responsibility for bathing patients allocate additional time in their daily schedule to bathe difficult and disruptive clients, so that they receive the same standards as other clients.
This involves engaging with your client and their position – understanding their perspective and needs.
This is the stage where you must strongly draw on your professional expertise and that of appropriate colleagues.
This is establishing a programme of what needs to be done in order to achieve the objectives.
Forming an Activity Plan Objective: Caregivers with responsibility for bathing patients allocate additional time in their daily schedule to bathe difficult and disruptive clients, so that they receive the same standards as other clients. Activity Timeframe Lead Persons Co-Actors Status Communicate with client on their perspective on the issue; what has been done to address the issue to date and agree ways forward By 5 th November Myself Client Done Speak to caregivers to understand their reasons for spending less time with these clients By 30 th November Myself Caregivers Done Liaise with management responsible for timetabling activities to allocate more time for bathing By 5 th December Myself Management Due Draft a refined timetable based around bathing requirements and present to management for review By 15 th December Myself Admin staff; Management Due
Using your case study experience, plan your advocacy work.
Ask yourselves the Engagement and Planning Questions. What value do they contribute to your advocacy work?
Produce an Activity Plan for your objectives. Make it as specific as possible in order to ensure all aspects of the Engagement and Planning questions are answered and to make it easier when you come to implement the plan.
A good process of monitoring and evaluating your work will not only make sure that you achieve what you set out to, but will also develop you into an even better advocate in the future! You will learn from the challenges and adapt your approach the next time.