Impact evaluation of an Independent Mental Health Advocacy (IMHA) service in a high secure hospital: a co-produced survey measuring self-reported changes to patient self-determination

DOIhttps://doi.org/10.1108/MHSI-12-2017-0054
Date12 February 2018
Published date12 February 2018
Pages53-60
AuthorSusan Eades
Subject MatterHealth & social care,Mental health,Social inclusion
Impact evaluation of an Independent
Mental Health Advocacy (IMHA) service
in a high secure hospital: a co-produced
survey measuring self-reported changes
to patient self-determination
Susan Eades
Abstract
Purpose The purpose of this paper is to measure any impact that IMHA support had on patients
self-determination.
Design/methodology/approach The study used a questionnaire design, co-produced with patients to
ensure question relevance, accessibility and ease of use. The theoretical framework used by the study was
Deci & Ryans empirically validated self-determination theory (SDT) as it is predictive, across cultures and
domains (including healthcare), of psychological well-being and self-determined action following the
satisfaction of three fundamental human needs for autonomy, competence and relatedness.
Findings Followingadvocacy support, increasedself-determination,was found in 70 percent of the patients
surveyed. In thisstudy, increased self-determination was inferredby patientssubjective responsesto survey
questions which measured satisfaction with contextual aspects of autonomy, competence and relatedness.
The extensiveSDT research hasidentified that the satisfactionof these needs isessential for psychologicalwell-
being and a prerequisite for self-determined and motivated action. Research has also linked psychological
needs fulfilment to the personal recovery journey forthose diagnosed with a mentalillness.
Originality/value Although limited, qualitativeresearch evidence has identifiedthat IMHA support helps to
empowertheir partners (referredto in the text as patients or patient partners)to be more self-determined.This is
an importantfinding, particularlyfor those patient partnersdetained under the MentalHealth Act, given the often
disempowering and autonomy reducing nature of mental illness and the characteristics of detained
environments. However, a gap in the literature exists for quantitative outcome data identifying the specific
impactthat IMHA support has for patients.Obtaining measurableoutcome data which seek to understandhow
and why Independent Mental HealthAdvocacy support impacts itspatient partners is essentialfor developing
and validating outcome measures that can lead to best practice improvements in IMHA service delivery.
Furthermore, this knowledge is pivotal in optimizing IMHA servicespotential for empowering patients and
providing commissioners with the much-needed evidence for effective commissioningof such services.
Keywords Self-determination, Forensic patients, High secure hospitals, IMHA service evaluation,
Independent Mental Health Advocacy, Outcome evaluation
Paper type Research paper
Introduction
Broadmoor Hospital and Independent Mental Health Advocacy (IMHA)
Broadmoor Hospital is one of the three high secure forensic mental health hospitals in England,
the other two being Rampton Hospital in Nottinghamshire and Ashworth Hospital in Merseyside.
Since 2001, West London Mental Health Trust (WLMHT) has been the provider of mental health
services to patients who have been detained under various sections of the Mental Health Act.
In October of this year, Prime
Minister Theresa May announced
a full review of the Mental Health
Act (1983), which will report back
at the end of 2018. Part of the
background to the review of the
Act, is that it should ensure the
right of detained patients to
treatment and support that is
dignified and respectful of their
autonomy as far as possible.
Susan Eades is the
Independent Advocacy
Services Manager for the
charity seAp, Broadmoor
Hospital, Crowthorne, UK.
DOI 10.1108/MHSI-12-2017-0054 VOL. 22 NO. 1 2018, pp. 53-60, © Emerald Publishing Limited, ISSN 2042-8308
j
MENTALHEALTH AND SOCIAL INCLUSION
j
PAG E 53

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