"Advocacy Support Cymru - self referral issues"

About: Advocacy Support Cymru

(as the patient),

I self-referred to ASC to request support with an NHS Concerns meeting, relating to secondary mental health service provision. Unfortunately, due to waiting lists, ASC is unable to offer the support I need within the required timescale. The Team Leader rang within three working days to let me know the decision, and kindly offered to keep my file open in case of future need.

This is not a complaint, but I am offering feedback on the following two issues here simply because ASC specifically invites comments through this website.

(I) Greater clarity is needed on ASC website about "Who We Support"

My request for Community Advocacy Support was refused because I gave only three weeks notice of the date on which support was needed. The reason for this short notice though, was that I had only just been made aware of the possibility of Community Advocacy through another voluntary sector organisation CAVAMH.

I had actually looked online for support around 4-5 weeks prior to making my application to ASC, but had not been able to find the relevant information about Community Advocacy Support on the ASC website.

Please may I suggest, for the benefit of future clients, that you might consider tightening up the "Who We Support" section, to bring to the top of the page a list of the four main types of advocacy that you provide, with hyperlinks to the relevant sections that follow.

Suggested revised text:

"We support a wide range of people in a variety of settings:

1. Qualifying Patients for Independent Mental Health Advocacy in Wales

2. Independent Mental Capacity Advocacy (IMCA)

3. Relevant Persons Representative

4. Community Advocacy from ASC

If you are unsure which service is the right one for you, you can download our referral pathway flowchart, or ring us on 029 2054 0444 and we will be happy to help. "

(http: //www. ascymru. org. uk/english/who-we-support)

(ii) Request for review of Lone Worker Risk Assessment policy for Community Advocacy clients

The referral form for Community Advocacy asks:

"Are there any issues which may pose a risk to an advocate lone working with this person? Yes / No

If you are referring yourself we will ask you for the name of a Mental Health professional who can answer the above question. "

I understand the need to protect lone workers, but was rather horrified to have to consent to an intrusive background check to be made to the CMHT about which I had raised a concern. In the event, this didn't happen because you are not able to provide a service at all. However, I would like to ask for your consideration to the matter anyway, for the sake of future service users.

For my part, I am a fully competent adult with no history of planning or attempting to cause harm to myself or others. I just happen to need secondary services because of a particular condition which falls within that service. My condition does not pose a threat to others. I do understand concerns about personal safety because, as a woman with a history of mental health problems, I am myself statistically at greater personal risk of being harmed than the general population. But I wonder if there are any alternative means by which you could protect both your workers and clients, in cases where clients find this policy to be problematic?

For example:

* By offering meetings to take place at your offices and/or in public spaces?

* By making background checks via GP Surgeries or another more neutral source, rather than mental health teams, where the client feels this to be more appropriate?

* Or maybe someone else might have a better solution?

I don't know what the answer is, but I feel so strongly about this that I thought it might be worth putting it out there as something for future consideration.

Thanks in advance for considering these issues, and best wishes for the future.

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Responses

Response from Advocacy Support Cymru We are preparing to make a change

Thank you for this feedback, we appreciate the time and effort that has gone into it and feel it's going to be of real value to us. All of the advocates and service managers have seen your comments, but we will need time to consider them properly. We want to review the issues mentioned and consider possible developments/changes that we may be able to make.

When we have had a chance to do this we will post another response letting you know our thoughts.

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Response from Advocacy Support Cymru We have made a change

We just wanted to let you know that we have made the changes you suggested to our website, which we agree is an improvement.

http://www.ascymru.org.uk/english/who-we-support#comm

We are aware that our current website is in need of overall improvement ( it is quite out of date and difficult to update ), and we have already started a process to develop and implement a brand new one. We want this to be much more accessible and user friendly, and your suggestions will also feed into that process.

The management team will be meeting to discuss the other part of your feedback re: assessing risk for lone advocates later in the month, after which we will be able to respond to your comments on that issue.

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Response from Claire Powell, Training Officer / Advocate, Advocacy Support Cymru

We have met as a Management Team to look at the Community Advocacy Risk Assessment process in light of the issues you raised. This has been a very useful process for us.

We are clear after this review that we need to maintain our current risk assessment process.

Most people referring themselves have an opportunity to talk to our Duty Advocate who is able to explain the process. In this way we can reassure people that the background checks we make are as non intrusive as possible. We ask for a nominated professional to approach and will only do this with consent. We explain the process to people as follows;

•In the first place we ask the nominated professional if the person poses a risk to a lone worker in the community. We specifically ask for only a "Yes" or "No" response to this and make it clear to the professional that we don't want any more information at that stage.

•If the answer is "No" we ask no further questions and will carry on to offer a service (once eligibility is confirmed and depending on the Waiting List situation).

•If the answer is "Yes" then we would ask an additional question about how this risk could best be managed, for example by working 2:1 (two advocates to one client). We do not ask for any details about the individuals history.

•We would then report back to the individual explaining what we have been told and seek their agreement for a risk management plan.

Having looked at the referral form on the website we can see that without an opportunity to have this conversation with someone from ASC, it is possible to see the Risk Assessment as more intrusive and less flexible than it is. As a result we have added some wording to the form. Where it currently says Mental Health Professional, we have changed this to Health or Social Care Professional and we have given examples of who this could be, including GPs (this has always been our practice but we could see that it wasn't explicit).

The community lone working risk assessment is not predicated on the Mental Health status of the individual, we do understand that we are no more likely to be at risk from someone with Mental Health issues than from anyone else. However, we do have a responsibility to keep our staff safe and as we are working with people whom we know nothing about, in a community setting, we need to have some basic risk management information.

We do feel that having contact with a person in ASC is crucial to being able to offer explanation and reassurance to people about these processes, but we also acknowledge that not everyone will ring us. We are hoping that when our new website is developed we can do away with the referral form and offer a contact form, which will allow people to get in touch in order that we can facilitate a direct discussion, whether that be by phone, e-mail or in any way that suits them. We will then at least be able to explain what information we need and why.

In the meantime we are sticking with the referral form, but as well as adding some wording to it we have added a flow chart on the website that describes the risk assessment process in more detail.

Thank you again for your feedback, we have genuinely appreciated it.

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Update posted by What Would Aneurin Bevan Think?) (the patient)

Thank you. I appreciate very much that you took my concern seriously and gave it proper consideration. :)

I think, ultimately, that this is the sort of matter on which it is inevitable that there will be a range of views, because we will necessarily see the world from different perspectives, depending on our role and relationship to the services in question.

I delayed my response on this because I reached have reached a point where I feel the ASC service is not a good fit for me, but I do not want to let that get in the way of thanking you for your genuine efforts to help. Ultimately, I cannot cross the impasse that I perceive here, as a decent, law-abiding citizen who has never represented a threat to another human being in my life. I have reached a stage where I would rather not receive help at all than concede to a "background check" because of my status as a secondary mental health patient.

At the same time, I respect your right to protect your staff and I think it is best left as "one of those things" that is just not easily resolved.

For my part, I've been able to access help from a local elected representative and, given that my local health board prioritises politician's concerns over others, it probably makes more sense for me to take this route anyway. I still think you do a grand job and if there is any point in future that we can be of mutual service to each other I would be open to discussing issues of common interest and concern.

Thanks and best wishes for the future. :)