Independent Mental Health Advocates (IMHAs)

Under Section 130A of the Mental Health Act 1983, "qualifying patients" — those with a right to an IMHA — include:

• Patients detained under Sections 2, 3, 4, 35, 36, 37, 38, 45A, 47, or 48 of the MHA 1983
• Patients subject to a Community Treatment Order (CTO) under Section 17A
• Patients subject to guardianship under Sections 7 or 37
• Informal patients who are being considered for certain treatments that require special consent (such as ECT, psychosurgery, or medicine beyond 3 months)

Patients who are voluntary (informal) and not in any of the above categories do not have a statutory right to an IMHA under the MHA 1983, though general advocacy services may be available in some areas.

An IMHA can:

• Help you understand your rights under the MHA 1983 — including the right to appeal, the right to a nearest relative, and your rights around treatment
• Attend ward rounds, CPA (Care Programme Approach) meetings, and other clinical discussions with you (or on your behalf with your consent)
• Accompany you to Mental Health Tribunal hearings and other formal processes
• Help you access your medical records and other information about your care
• Help you communicate your wishes, views, and concerns to clinical staff and decision-makers
• Assist you in making a complaint about your care or treatment
• Help you understand your medication and treatment options

An IMHA does not make decisions on your behalf — they support you to be heard and to make informed decisions. They are entirely independent of the clinical team.

The hospital must inform you of your right to an IMHA in writing upon admission, and must inform you how to contact the IMHA service. Steps to access an IMHA:

1. Ask a member of nursing or ward staff to contact the IMHA service on your behalf, or ask them for the contact details so you can do so yourself.
2. If you are on a CTO, your care coordinator or community nurse can arrange IMHA contact.
3. IMHAs can also be contacted directly — the hospital should have contact details for the commissioned IMHA provider for your area.
4. Friends or relatives can contact the IMHA service on your behalf with your consent.

If you are being denied access to an IMHA, this is a breach of your statutory rights and should be raised formally as a complaint with the hospital managers or the Care Quality Commission.

IMHAs and solicitors provide complementary but distinct forms of support:

• An IMHA provides general support and advocacy throughout your detention or CTO — attending ward rounds, helping you understand your rights, and supporting you to communicate your views. They are available from the start of your detention.
• A solicitor provides legal representation, particularly for Mental Health Tribunal proceedings. Legal aid is automatically available for Tribunal work. Solicitors give legal advice and represent your case at the hearing.
• You should have both — an IMHA for day-to-day support and a solicitor for Tribunal representation. They work together in your interests.

If you want to make a complaint, an IMHA can support you through the hospital complaints procedure; a solicitor or the Citizens Advice Consumer Service can advise on more formal legal steps.

One of the most practical — yet underused — aspects of IMHA support is attendance at clinical meetings. The MHA 1983 Code of Practice 2015 (Chapter 6) is clear that IMHAs should be given a genuine opportunity to attend ward rounds, Care Programme Approach (CPA) meetings, and any other multi-disciplinary discussions that concern the patient's care, treatment, or discharge.

In practice, patients often find it difficult to speak up in these settings — particularly when they are outnumbered by clinical staff, when they are unwell, or when they feel their concerns have previously been dismissed. An IMHA can:

• Meet with you before the ward round or CPA to understand your concerns, priorities, and questions, so these can be properly raised.
• Ensure your views are communicated clearly and accurately to the clinical team, especially if communication is difficult due to your mental state or language barriers.
• Challenge clinical decisions or proposed treatments that appear to depart from your wishes or from good practice standards, and ask for reasons to be given.
• Help you understand the written care plan and flag anything that does not reflect what was discussed or agreed.
• Raise concerns about your proposed discharge — including whether adequate Section 117 aftercare has been planned.

IMHAs also play an important role in relation to consent to treatment. Where a Responsible Clinician proposes to continue medication without your consent beyond three months (requiring a Second Opinion Appointed Doctor review under Section 58 MHA), an IMHA can help you understand the process, attend the SOAD visit alongside you, and ensure your views about side effects and treatment alternatives are clearly put before the SOAD.

The Care Quality Commission (CQC) monitors the use of IMHA services as part of its inspection regime for mental health wards. If IMHA access is being restricted, delayed, or not properly offered on your ward, you can report this to the CQC directly at cqc.org.uk/give-feedback-on-care. NHS England commissions IMHA services from independent providers — the main providers in England include Pohwer, VoiceAbility, and Advocacy Focus. Contact details should be displayed on every qualifying ward.