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An Introduction to An Introduction to Advocating for the Advocating for the
Rights of Mental Health Rights of Mental Health ClientsClients
Workshop ObjectivesWorkshop Objectives To develop an understanding of To develop an understanding of
advocacy and develop a definition of advocacy and develop a definition of advocacyadvocacy
To raise awareness of the different To raise awareness of the different types of advocacy worktypes of advocacy work
To understand how advocacy can be To understand how advocacy can be used by staff at St John of God to used by staff at St John of God to improve the situation of their clientsimprove the situation of their clients
To learn about the advocacy process To learn about the advocacy process and how to use itand how to use it
Contents of WorkshopContents of Workshop Workshop ObjectivesWorkshop Objectives What is advocacy? Advocacy What is advocacy? Advocacy
DefinitionsDefinitions Why do we advocate on behalf of our Why do we advocate on behalf of our
clients? Why us?clients? Why us? Different Approaches to AdvocacyDifferent Approaches to Advocacy Advocacy PlanningAdvocacy Planning Implementing AdvocacyImplementing Advocacy
What is Advocacy?What is Advocacy?
TASKTASK Brainstorm words that we associate Brainstorm words that we associate
with advocacy.with advocacy. In groups, come up with a definition In groups, come up with a definition
of advocacy, drawing upon these of advocacy, drawing upon these associated words.associated words.
Advocacy DefinitionsAdvocacy Definitions“Advocacy is taking action to help people say
what they want, secure their rights, represent their interests and obtain services they need.”
“Advocacy is … a deliberate process of speaking out on issues of concern in order to exert some influence on behalf of ideas or persons.”
"Advocacy is an ongoing process aiming at a change of attitudes, actions, policies and laws by influencing people and organisations with power, systems and structures at different levels for the betterment of people affected by the issue.“
Advocacy Definitions continued.Advocacy Definitions continued."Advocacy is a process to bring about change in
the policies, laws and practices of influential individuals, groups and institutions.“
“Advocacy is an organised process that involves a coordinated effort of people to change policies, practices, ideas and values that perpetuate inequalities, prejudices and exclusion.”
“Advocacy is speaking up, drawing a community’s attention to an important issue, and directing decision-makers towards a solution. Advocacy is working with others to make a difference.”
Why do we advocate on behalf of Why do we advocate on behalf of our clients? our clients? Advocating with or on behalf of clients Advocating with or on behalf of clients
empowers the individual and can have a empowers the individual and can have a hugely beneficial effect on the hugely beneficial effect on the improvement of mental health as their improvement of mental health as their rights, opinions and ideas are taken rights, opinions and ideas are taken seriously by those working with them.seriously by those working with them.
Empowerment and advocacy can help Empowerment and advocacy can help reduce the duration of impatient reduce the duration of impatient treatment and the number of visits to treatment and the number of visits to health services.health services.
Why do we advocate on behalf of Why do we advocate on behalf of our clients? Continued.our clients? Continued. To build self-esteemTo build self-esteem To enhance coping skillsTo enhance coping skills To build social support networksTo build social support networks To improve family relationshipsTo improve family relationships To improve mental health legislationTo improve mental health legislation To improve public awareness and To improve public awareness and
decrease stigmadecrease stigma To uphold human rightsTo uphold human rights
Why do we advocate on behalf of Why do we advocate on behalf of our clients? Continued.our clients? Continued. Recognition of an infringement on a human right:
Human rights are based on a set of core values which directly relate to advocacy: Fairness Respect Equality Dignity Autonomy
Professional duty of careIf we notice that a client is not being treated according to these values – we must advocate
for change.
Why us? Why us? We understand the reasons we get We understand the reasons we get
involved in advocacy – because of our involved in advocacy – because of our professional responsibility and desire to professional responsibility and desire to improve society.improve society.
Further self analysis helps to identify our Further self analysis helps to identify our strengths and weaknesses as advocates strengths and weaknesses as advocates and clarify the power dynamics of our and clarify the power dynamics of our institution and our roles as advocates.institution and our roles as advocates.
What we learn can be used to change the What we learn can be used to change the wider power relations affecting our wider power relations affecting our advocating on behalf of our clients.advocating on behalf of our clients.
Why us? Continued.Why us? Continued.
TASKTASK In profession groups, make a list of In profession groups, make a list of
all the attributes that you have which all the attributes that you have which other professions don’t have. Think other professions don’t have. Think of your professional skills; interaction of your professional skills; interaction with clients; interactions with other with clients; interactions with other staff and departments etc.staff and departments etc.
Different Approaches to Different Approaches to AdvocacyAdvocacy Instructed AdvocacyInstructed Advocacy
Advocating on behalf of an individual or a group Advocating on behalf of an individual or a group who has been able to present their concerns and who has been able to present their concerns and issues to the advocate.issues to the advocate.
Non-Instructed AdvocacyNon-Instructed Advocacy Advocating based on the knowledge of an injustice Advocating based on the knowledge of an injustice
on behalf of an individual or a group who has not on behalf of an individual or a group who has not been able to present their concerns. This is only been able to present their concerns. This is only used when patients cannot vocalise their opinions used when patients cannot vocalise their opinions as a result of their condition.as a result of their condition.
IF YOU CANNOT ADVOCATE IF YOU CANNOT ADVOCATE WITHWITH YOUR CLIENT, YOUR CLIENT, YOU CAN ADVOCATE YOU CAN ADVOCATE ON BEHALFON BEHALF OF THEM. OF THEM.
Instructed Advocacy Instructed Advocacy ApproachesApproaches SELF-ADVOCACYSELF-ADVOCACY
Advocating for issues that affect you personally. This can be Advocating for issues that affect you personally. This can be difficult to achieve and many people find it is better to be difficult to achieve and many people find it is better to be supported by other people or groups in order to have a supported by other people or groups in order to have a stronger message. This also helps give clarity to an issue stronger message. This also helps give clarity to an issue where otherwise personal emotions could get involved. For where otherwise personal emotions could get involved. For some mental health clients, this will not be possible, which is some mental health clients, this will not be possible, which is why we need to work with them to advocate for their rights.why we need to work with them to advocate for their rights.
PEER/EXPERT ADVOCACYPEER/EXPERT ADVOCACY This is when someone who has a greater knowledge of the This is when someone who has a greater knowledge of the
system or situation advocates alongside the client. They can system or situation advocates alongside the client. They can draw on their own experiences to understand and empathise draw on their own experiences to understand and empathise with the person you are working with. Former clients add a with the person you are working with. Former clients add a great insight into what the client is experiencing and can great insight into what the client is experiencing and can make suggestions for action based on this shared knowledge. make suggestions for action based on this shared knowledge. As health workers you have an in-depth knowledge of the As health workers you have an in-depth knowledge of the system in which you are working and can help to advocate system in which you are working and can help to advocate for change more affectively than if the client was a solely a for change more affectively than if the client was a solely a Self-Advocate.Self-Advocate.
Instructed Advocacy Instructed Advocacy Approaches continuedApproaches continued GROUP ADVOCACYGROUP ADVOCACY
This is where a group of people with similar This is where a group of people with similar experiences meet together to put forward shared experiences meet together to put forward shared views. Local mental health service-user groups, views. Local mental health service-user groups, support groups and patient councils are all examples support groups and patient councils are all examples of group advocacy. As a health worker you can of group advocacy. As a health worker you can support the establishment of such Group Advocacy support the establishment of such Group Advocacy activities, by advocating for them!activities, by advocating for them!
FORMAL/PROFESSIONAL ADVOCACYFORMAL/PROFESSIONAL ADVOCACY This is when an individual or an organisation is This is when an individual or an organisation is
professionally focused on advocacy. It may be an professionally focused on advocacy. It may be an organisation that advocates on behalf of other like-organisation that advocates on behalf of other like-minded organisations (i.e. Malawi Health Equity minded organisations (i.e. Malawi Health Equity Network) or an outsourced service to others (i.e. like Network) or an outsourced service to others (i.e. like me!). In this case it primarily provides short-term me!). In this case it primarily provides short-term work rather than long-term support. work rather than long-term support.
Instructed Advocacy Instructed Advocacy Approaches continuedApproaches continued LEGAL ADVOCACYLEGAL ADVOCACY
People with specialist knowledge and training, People with specialist knowledge and training, such as lawyers and legislative specialists are such as lawyers and legislative specialists are sometimes called “legal advocates”. Legal sometimes called “legal advocates”. Legal advocates differ from other mental health advocates differ from other mental health advocates in that they represent people in advocates in that they represent people in formal settings, such as courts, tribunals or formal settings, such as courts, tribunals or complaints procedures. A legal advocate will complaints procedures. A legal advocate will often given advice and express their opinion often given advice and express their opinion about the best course of action. You may wish about the best course of action. You may wish to consult a legal advocate if there are to consult a legal advocate if there are continual human rights abuses that you are continual human rights abuses that you are not able to address at an institutional level.not able to address at an institutional level.
Non-Instructed Advocacy Non-Instructed Advocacy ApproachesApproaches NON-INSTRUCTED ADVOCACYNON-INSTRUCTED ADVOCACY
Also known as “best interests” advocacy, this is Also known as “best interests” advocacy, this is where an advocate represents what he or she where an advocate represents what he or she feels a person’s wishes would be, if they were feels a person’s wishes would be, if they were able to express them. Non-instructed advocacy able to express them. Non-instructed advocacy is not appropriate in mental health advocacy if is not appropriate in mental health advocacy if clients are able to express their needs and clients are able to express their needs and opinions. However if they have dementia or opinions. However if they have dementia or other severe mental disabilities which make it other severe mental disabilities which make it impossible to communicate feelings, then this impossible to communicate feelings, then this would be an appropriate form of advocacy to would be an appropriate form of advocacy to use.use.
Advocacy and Related ConceptsAdvocacy and Related ConceptsAdvocacy Information,
Education, Communication
(IEC)
Community Mobilisation
Networks and Partnerships
Fundraising and Resource
Mobilisation
Overcoming Stigma and
Discrimination
What can it change?
Policy; Policy implementation; Law; Practices on
Mental Health
Awareness and behaviour of Mental
Health issues
Capacity of communities to
identify and address Mental
Health problems in their area
Isolation and duplication
Levels of resource available for
mental health work
Level of stigma and
discrimination against people
with mental health issues
Target Group
Decision-makers; Leaders; Policy-
makers; People in Positions of Influence
A specific group – age, gender,
community etc
Members of a community
Individuals or groups who have a similar agenda
Local government, donors, private
sector, communities
People who stigmatise or discriminate
Does the target group have
influence over
others?
Yes No No No No No
Typical indicators of success
Changes in policy; laws and practices
Statistical change in condition (i.e. % of
mental health patients in the
community attending a support group); Changes in
attitudes
A community problem is solved;
Higher participation in
community meetings
Members of the network/partnership achieve more than they could
have done if working alone
Government or donors increase funding; Private sector makes financial or
resource donation; Local community members offer
facilities to use for meetings etc
Fewer mental health patients victimised in communities; Less cases of
depression and anxiety as a
result of discrimination;
Increased community support for
rehabilitation of clients etc
Advocacy Planning CycleAdvocacy Planning Cycle
TASKTASK In groups, put the different In groups, put the different
components of the Advocacy components of the Advocacy Planning Cycle in order.Planning Cycle in order.
Advocacy Planning CycleAdvocacy Planning Cycle1.
Issues and Goals
Relationship and review with the client
3. Engagementand Planning
2. Objectives
5.Review
6.Close
4.Action
Identifying the Issue and GoalIdentifying the Issue and Goal Advocacy IssueAdvocacy Issue
An issue is a specific aspect of a problem to be An issue is a specific aspect of a problem to be addressed with advocacy. addressed with advocacy.
For example: The client is not bathed as For example: The client is not bathed as regularly as other clients.regularly as other clients.
Advocacy GoalAdvocacy Goal A goal is the overall effort that you want to A goal is the overall effort that you want to
achieve.achieve. For example: Ensure the dignity of all For example: Ensure the dignity of all
clients, by making hygiene standards a clients, by making hygiene standards a priority in the responsibility of care. priority in the responsibility of care.
Identifying the ObjectivesIdentifying the Objectives Advocacy ObjectivesAdvocacy Objectives
An objective is the specific task that you An objective is the specific task that you want achieved through your advocacy want achieved through your advocacy work.work.
For example: Caregivers with responsibility For example: Caregivers with responsibility for bathing patients allocate additional time for bathing patients allocate additional time in their daily schedule to bathe difficult and in their daily schedule to bathe difficult and disruptive clients, so that they receive the disruptive clients, so that they receive the same standards as other clients.same standards as other clients.
Identifying Goals, Issues, Identifying Goals, Issues, ObjectivesObjectivesTASKTASK Read through these case studiesRead through these case studies
Identify the goal, issue and objectivesIdentify the goal, issue and objectives Which advocacy approach was used? Is this the Which advocacy approach was used? Is this the
best course of action?best course of action? In pairs, discuss some real life issues that you are In pairs, discuss some real life issues that you are
experiencing which you could advocate on.experiencing which you could advocate on. What is the issue?What is the issue? What is the goal?What is the goal? What is/are the objectives?What is/are the objectives? Which is the most appropriate advocacy approach Which is the most appropriate advocacy approach
to use?to use? Select one of your experiences and present to the Select one of your experiences and present to the
other groups.other groups.
Engagement and PlanningEngagement and Planning EngagementEngagement
This involves engaging with your client and This involves engaging with your client and their position – understanding their perspective their position – understanding their perspective and needs. and needs.
This is the stage where you must strongly draw This is the stage where you must strongly draw on your professional expertise and that of on your professional expertise and that of appropriate colleagues.appropriate colleagues.
PlanningPlanning This is establishing a programme of what needs This is establishing a programme of what needs
to be done in order to achieve the objectives.to be done in order to achieve the objectives.
Forming an Activity PlanForming an Activity Plan
ActivityActivity TimeframeTimeframe Lead Lead PersonsPersons
Co-ActorsCo-Actors StatuStatuss
Communicate with client on Communicate with client on their perspective on the issue; their perspective on the issue; what has been done to address what has been done to address the issue to date and agree the issue to date and agree ways forwardways forward
By 5By 5thth NovemberNovember
MyselfMyself ClientClient DoneDone
Speak to caregivers to Speak to caregivers to understand their reasons for understand their reasons for spending less time with these spending less time with these clientsclients
By 30By 30thth NovemberNovember
MyselfMyself CaregiversCaregivers DoneDone
Liaise with management Liaise with management responsible for timetabling responsible for timetabling activities to allocate more time activities to allocate more time for bathingfor bathing
By 5By 5thth DecemberDecember
MyselfMyself ManagemeManagementnt
DueDue
Draft a refined timetable based Draft a refined timetable based around bathing requirements around bathing requirements and present to management and present to management for reviewfor review
By 15By 15thth DecemberDecember
MyselfMyself Admin Admin staff; staff; ManagemeManagementnt
DueDue
Objective: Caregivers with responsibility for bathing patients allocate Objective: Caregivers with responsibility for bathing patients allocate additional time in their daily schedule to bathe difficult and disruptive clients, additional time in their daily schedule to bathe difficult and disruptive clients, so that they receive the same standards as other clients.so that they receive the same standards as other clients.
Planning ContinuedPlanning ContinuedTASKTASK Using your case study experience, plan Using your case study experience, plan
your advocacy work.your advocacy work. Ask yourselves the Engagement and Planning Ask yourselves the Engagement and Planning
Questions. What value do they contribute to Questions. What value do they contribute to your advocacy work? your advocacy work?
Produce an Activity Plan for your objectives. Produce an Activity Plan for your objectives. Make it as specific as possible in order to ensure Make it as specific as possible in order to ensure all aspects of the Engagement and Planning all aspects of the Engagement and Planning questions are answered and to make it easier questions are answered and to make it easier when you come to implement the plan.when you come to implement the plan.
ActionAction This is the stage where you implement the This is the stage where you implement the
plan that you (and your client) have agreed.plan that you (and your client) have agreed. You should implement the activity plan as You should implement the activity plan as
precisely as possible in order to make sure precisely as possible in order to make sure you achieve your objectivesyou achieve your objectives
Where possible, make sure that the client is Where possible, make sure that the client is involved in all steps of the process. If they involved in all steps of the process. If they are not involved as self-advocates you must are not involved as self-advocates you must regularly communicate your progress to regularly communicate your progress to them. them.
Remember who you are advocating for.Remember who you are advocating for.
ReviewReview A good process of monitoring and A good process of monitoring and
evaluating your work will not only evaluating your work will not only make sure that you achieve what you make sure that you achieve what you set out to, but will also develop you set out to, but will also develop you into an even better advocate in the into an even better advocate in the future! You will learn from the future! You will learn from the challenges and adapt your approach challenges and adapt your approach the next time.the next time.
