five - Best Value but not best interests: can service users instruct mental health advocates?

Summary

Introduction

This chapter seeks to explore a dilemma. This is the dilemma faced by independent evaluators when they elicit views from service users which lead the evaluator to question the ethos of voluntary sector provision in mental health advocacy. A model of instructed advocacy that seeks to support mental health service users who wish to be heard dominates the mental health advocacy field. This model assumes that service users are sufficiently empowered to be able to recognise and articulate their needs and therefore to give instructions. However, the literature shows that instructed advocacy does not work well for many vulnerable and disempowered groups. Such groups need personal advocacy that comprises more support and befriending before they are able to instruct advocates. However, these forms of advocacy are inherently more expensive and less likely to be funded than instructed advocacy, which is seen as ‘Best Value’ in the current economic climate and consumer culture (Henderson and Pochin, 2001).

It is notoriously difficult to elicit the views of disempowered service users and to do so in a psychiatric hospital environment, with its climate of fear, is particularly problematic. I have personal experience of conducting observations and interviews with service users in the hospital environment with follow-up interviews after discharge. In some instances service users’ views were at odds with the providers of mental health advocacy about the quality of psychiatric services. This has led to conflict between the evaluator and advocacy providers about how oppressive practices in psychiatric settings should be challenged. This chapter intends to stimulate discussion about the role of the evaluator in representing service users’ views and how to proceed if the independence of the voluntary sector organisation has been compromised.

Henderson and Pochin (2001) have argued that the tendency for voluntary organisations to be caught up in ‘contract culture’ has allowed ‘the Best Value approach’ to influence both advocacy provision and its evaluation. They argue that this approach is fundamentally flawed and that it can corrupt the principles of advocacy because it fails to acknowledge the difficulty of finding unambiguous and measurable outcomes of success in advocacy. They argue that the outcomes aimed for and the processes by which they may be achieved are much more complex than the Best Value approach allows for.