Advocacy Support during COVID-19

advocacy
How you can receive advocacy support during COVID-19.

VoiceAbility is the lead partner for Advocacy in Suffolk. You are eligible to receive support if you come under one of the following areas.

Independent Mental Health Advocate (IMHA)

  • Detained under the Mental Health Act OR
  • Subject to a Community Treatment Order or a Guardianship OR
  • Being considered for psychosurgery or ECT under Sections 57 / 58 MHA (83) OR
  • A conditionally discharged restricted patient.

Independent Mental Capacity Advocate (IMCA)

  • The person is assessed to ‘lack capacity’ to make a specific decision, which means:
  • The person has an impairment or disturbance of the mind (e.g. a brain injury, dementia, Autism, learning disabilities, mental health problems) AND
  • They are unable to either understand or retain information for long enough to make a decision, weigh-up information to make a decision or communicate their decision AND
  • There are no family or friends considered appropriate to be consulted in relation to the best interest decision.

VoiceAbility can be contacted Monday – Friday 9.00-5.00 on telephone number 01473 857631, email at tvspartnership@voiceability.org or visit their website for a full list of Advocacy services provided by VoiceAbility.  Suffolk User Forum are part of advocacy contract and supply informal advocacy including informal/voluntary patients, to the acute mental health wards in the East and West of Suffolk. You can contact James Monday-Thursday 10:00am to 12.00 noon on telephone 07956 528638 or email advocacy@suffolkuserforum.co.uk.

Frequently asked questions – Advocacy Support:

I am an inpatient on an acute mental health ward, can I still receive advocacy?

Yes, if you are a patient on Section 2, Section 3 you can receive advocacy support by either contacting VoiceAbility or James from Suffolk User Forum. If you are an informal/voluntary patient, then please contact James at Suffolk User Forum. Advocacy is currently delivered via the phone or video link due to the COVID-19 restrictions put in place.

Can I exercise more than once a day if I need to due to a significant health condition?

You can leave your home for medical need. If you (or a person in your care), have a specific health condition that requires you to leave the home to maintain your health – including if that involves travel beyond your local area – then you can do so. This could, for example, include where individuals with learning disabilities or autism require specific exercise in an open space two or three times each day – ideally in line with a care plan agreed with a medical professional. If you do not have a care you can use any formal notification which identifies the individual as having needs which may require more frequent exercise. This could include things like:

  • A letter confirming a relevant diagnosis.
  • An individual’s Disability Living Allowance or Personal Independence Payment letter.

 

This would also apply to those people experiencing dementia, additional mental health needs or other neurological conditions, where a pragmatic stance is needed to avoid an increase in anxiety and cause further stress.

The Government recently clarified guidance on their website on being outside the home for individuals with learning disabilities or autism. For more information please see the government frequently asked questions on what you can or can’t do.

As indicated in the guidance, we advise that individuals remain as close to their homes as possible and utilise additional exercise on a needs-led basis to minimise risks and continue to follow all guidance relating to social distancing.  This includes:

  • Staying 2 metres (6ft) away from other people (within the community setting) at all times.
  • Washing their hands before they leave the property and upon return to the property (and wherever else necessary).
  • Not meeting others whilst out in the community.

Has the law changed on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)?

We have seen letters sent by GP practices to care home residents, imposing blanket Do Not Attempt CPR (DNACPR) notices or informing them that if they become ill a hospital admission will not be sought.

Clinicians have a duty to consult with patients, or members of their family, before completing a DNACPR notice and placing this on their records. This is the case unless the clinician thinks the patient or family member will be so distressed by being consulted that it might cause them physical or psychological harm. Nothing in the coronavirus legislation repeals this case law. The BMA, RCGPs and CQC have released a statement that affirms this and makes clear that advanced planning and DNACPR decisions must only be made on an individual basis.

Here is a helpful template letter you can send to your GP from Voiceability.

Healthwatch Suffolk also list have all of the latest updates on end of life care and DNACPR.

Can I still have an advocacy support during COVID-19?

The rights to an advocate under the Mental Health Act 1983, Mental Capacity Act 2005 and Care Act 2014 have not been changed. There has also been no change to the duty to make advocacy available in relation to health complaints.

Are advocates able to carry out their role during COVID-19?

Yes, advocates are finding ways to carry out their roles. Wherever practicable contact is being made using telephone, text or video link.

Advocates have a legal duty to meet with a client privately whenever this is reasonably requested (Mental Health Act) or practicable and appropriate (Care Act, Mental Capacity Act). It follows that service providers must facilitate this to the extent possible.

Does the Care Act still apply?

Yes, the Coronavirus Act and Care Act easements guidance do allow a local authority to trigger ‘easements’ to the Care Act. If a local authority does so, it would result in the Care Act duties to assess and meet eligible needs of adults, young people transitioning to adult services and carers being downgraded to powers.

Government guidance is clear that local authorities should only trigger easements if it is essential that they do so, due to the pressure from coronavirus. The local authority must go through a process to decide this, including approval by the Director of Adult Social Service: it is not automatic. The decision is taken as a whole local authority, not on an individual client basis.

This also means that different local authorities may make different decisions at different times. The government’s stated expectation is that even after triggering the easements, local authorities will do everything that they can reasonably do to continue to meet need as they would under the Care Act.

In addition, local authorities will still be expected to carry out proportionate, person centered care planning and they must meet needs wherever required to avoid a breach of a person’s human rights.

There are important Care Act duties that remain intact irrespective of ‘easements’.

These include duties to:

  • Promote individual well-being (S1)
  • Provide suitable information and advice (S4)
  • Involve the person when revising care and support plans (S 27(2))
  • Safeguarding (S42 to S47)
  • Refer for and provide advocacy (S67 and S68).

Can I still make an NHS complaint?

Yes, NHS England & NHS Improvement have announced an ‘optional pause’ to NHS complaint processes for three months. The guidance makes clear that advocacy providers should still accept referrals, and support people to raise concerns or make a complaint as providers will continue to accept and triage complaints.

The Parliamentary and Health Service Ombudsman (PHSO) has stopped accepting new NHS complaints from 26th March 2020 onwards and have postponed work on open cases.

Local authority complaints and escalation procedures remain the same as under the Care Act. Additionally, the easement guidance state that local authorities need to ensure that there is a clear, transparent and quick way for people to raise any concerns that their human rights are being breached.

Can I still visit friends and family in hospital/residential home?

NHS Guidance on 8th April suspends all visitors to inpatient, diagnostic and outpatient areas, with some notable exceptions which are listed. These include parents or appropriate adults visiting children and to support someone with a mental health issue such as dementia, a learning disability or autism, where not being present would cause the patient to be distressed.

Government guidance on care homes does not now explicitly mention visitors, but visits to care homes would be prevented by the Regulations other than in the exceptional circumstances. Caselaw established since the pandemic highlights that local authorities and care homes should communicate with residents and their families to find creative solutions for enabling meaningful contact between residents, their family and friends.

People living in supported living and their own homes must follow the same legal requirements and should follow the same guidance as everyone else. This would usually preclude visits to and from friends or family outside their household.

Can I still have section 17 under the Mental Health Act?

Hospitals can stop section 17 leave during the pandemic under the Health Protection (Coronavirus, Restrictions) (England) Regulations 2020. They are however urged by the Royal College of Psychiatrists in their guidance and by others to exercise ‘reasonableness’ and come up with creative solutions for enabling leave to take place.