Mental health advocacy outcomes from service user perspectives
| DOI | https://doi.org/10.1108/MHRJ-10-2017-0049 |
| Date | 10 December 2018 |
| Pages | 280-292 |
| Published date | 10 December 2018 |
| Author | Julie Ridley,Karen Newbigging,Cathy Street |
| Subject Matter | Health & social care,Mental health |
Mental health advocacy outcomes from
service user perspectives
Julie Ridley, Karen Newbigging and Cathy Street
Abstract
Purpose –The purpose of this paper is to address a knowledge g ap on advocacy outcomes fr om
mental health service users’perspective, and the implications for evaluating advocacy impact.
The studies discussed highlight challenges for measuring the outcomes of advocacy, but underline the
importance of doing so, and of involving service users alongside other stakeholders in co-designing
evaluation systems.
Design/methodology/approach –The paper uses findings from three qualitative studies of independent
advocacy involving focus groups and interviews with: 30 African and African Caribbean men who were
mental health service users; 90 “qualifying patients”in a study of Independent Mental Health Advocate
services; and nine young women in children and adolescent mental health services (CAMHS).
Findings –A comparative analysis and synthesis of findings from three studies identifies
four common dimensions: how mental health advocacy is conceptualised and understood; how service
users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacyoutcomes.
Advocacy outcomes were conceptualised as increasing involvement, changing care and
treatment and supporting personal development. There was evidence of advocacy acting to empower
mental health service u sers, and of broader impacts on service regimes and policies. However, there was
limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen
as important.
Originality/value –Few researchers have focused primarily on the perspectives of people using
independent mental health advocacy, or on the experience of “advocacy as empowerment”, and none
have done so across diverse gr oups. This analysis adds insight into the i mpact of independent advocacy.
Data from empirical studies attest to the important role independent advocacy plays in modern mental
health systems.
Keywords Impact, Outcomes, Mental health policy, Qualitative research, Advocacy, Service user views
Paper type Research paper
Introduction
Advocacy is commonly framed as supporting people to “have a voice”and is conceived of as a
way to achieve social justice (Action for Advocacy, 2002). In a mental health context, advocacy
has its foundations in mental health activism and the critique of psychiatry, which led in 2007 to
establishing a right to independent advocacy under English mental health law. Its significance in
safeguarding human rights and promoting the empowerment of people experiencing mental ill
health has been recognised internationally by the World Health Organisation (WHO, 2003).
Research suggests advocacy can be “life changing”and its outcomes wide ranging for both
children and adultssupported by health and social care services (Thomas et al., 2016). However,
reviews of the literature highlightgaps in the evidence base demonstrating its impact (Newbigging
et al., 2007; Macadamet al., 2013; Perry, 2013). Despitewidely held belief in the transformational
power of advocacy,and reporting of positive individualstories (NDTi, 2016a, b), thereis a failure to
demonstrate its impact systematically. There is also little understanding of impact from the
perspective of peopleusing services, with studies mainly considering outcomes from advocates’,
professionals’and family carers’perspectives (Perry, 2013; Bocioaga, 2014; Lonbay and
Brandon, 2017).
Received 31 October 2017
Revised 16 November 2017
2 May 2018
7 September 2018
Accepted 25 September 2018
This paper builds on the work of the
project research teams involved in
the three studies which included
academic and peer researchers:
Professor Mick McKeown,
Dr Beverley French, Evette A.
Hunkins-Hutchinson, Laura Able,
June Sadd, Karen Machin,
Kaaren Cruse, Steph De la Haye,
Michelle Kiansumba, Paul Grey,
Doreen Joseph, Zemikael
Habte-Mariam, Dina Poursanidou,
Professor Nigel Thomas,
Dr Anne Crowley, Dan Moxon and
Puja Joshi.The funding for Study 1
was from the Social Care Institute for
Excellence (SCIE) through a
competitive tender process. The
study protocol and regular updates
were provided to SCIE who
provided feedback. Study 2 was
funded by the Department of Health
Policy Research Programme,
through a competitive tender
process. Regular updates were
provided to the commissioning lead,
who also facilitated dissemination
through policy channels. Funding for
Study 3 was from the Office of the
Children’s Commissioner for
England (OCC) through a
competitive tender process, as part
of its wider review of the provision of
advocacy for children and young
people. Regular updates were
provided to the commissioning lead
and the advisory group convened by
theOCC,whoalsoprovided
feedback on research measures and
reports. The OCC retains intellectual
property of the data.
Julie Ridley is basedat the Centre
for Citizenshipand Community,
Schoolof Social Work, Universityof
Central Lancashire, Preston, UK.
Karen Newbigging is based at the
Health Services Management
Centre, The University of
Birmingham, Birmingham, UK.
Cathy Street is Director at Cathy
Street & Associates, Esher, UK.
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VOL. 23 NO. 4 2018, pp. 280-292, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-10-2017-0049
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