Read our submission to the Review of Mental Health Law in Scotland

Submitted on 29th May 2020

This response has been drawn from the views and experiences of Independent Advocacy workers working with individuals who are subject to compulsory measures under the Act. We had hoped to consult with the individuals themselves but due to restrictions currently in place, timescales did not allow. We hope to have an opportunity to submit responses from individuals who have been subject to the Act at a later date in the process.

The Mental Health (Care and Treatment) (Scotland) Act 2003 (“the Act”) came into force in 2005 – how well does it work at the moment? Are there certain things that hinder the Act from working effectively? What would improve things?

The Act brought with it many improvements over what existed previously, its focus on the rights and inclusion of individuals, were very welcomed, as was the addition of a statutory right to independent advocacy, and a focus on participation at all stages. The principles and safeguards that were included were a massive step forward and aimed to provide support and care in the most informal way possible, putting the individuals wishes, and those of their carer’s, at the centre of the process. It has provided a robust system of response to people who may require care and support, often at very difficult, traumatic and distressing times in their lives. But, it allows for some of our most basic human rights to be limited, sometimes for years, and therefore carries a significant burden of responsibility to be proportionate, fair and accountable. Therefore, there is a need to update not just the Act itself but also how the principles of the Act are applied in practice.

In order for some of the rights that were included in the Act to be realised, and have true meaning, there should be more parity amongst all those involved in the decision making process. For example, true participation should include elements of influence and control over the decisions that are affecting someone, not simply just being able to be heard. Including these principles and rights in the day to day application of the Act, is one of the challenges that individuals and practitioners face. In more recent times the principles seem to have been overshadowed by the criteria, and often are only tested during tribunal proceedings.

Participation

We have seen large variations in practice over time, and rather than ensuring equal treatment, the Act depends on good practitioners, clinicians, and conveners to apply consistency. For example, it is often a tribunal convenor who sets the tone for proceedings, and can have a major role in how things progress and how much people participate.

Lack of funding has also had a detrimental impact on the functioning of the Act. Over time, we have seen the pressures on services continually increase resulting in a reduction in service. We see professionals being unable to attend tribunal hearings, which still go ahead, and at times this has affected patient appeals, more than applications. It is particularly felt around 2-year review tribunals where extension & variation of Community Treatment Orders is sought.

We have also experienced a reduced availability of clinicians over time, to include patients and their independent advocacy workers in the care planning processes. There is a danger of this barrier leading to people becoming apathetic towards involvement in the process and disengaging with the process. This is more likely when their will and preferences are overridden, sometimes including their Advance Statements, with little in the way of external accountability, other than notifying a third party.

These pressures have also impacted on independent advocacy services, and our availability over time has been affected. Like many other services we see an increase in referrals year on year, with no increase in funding. Referrals to independent advocacy under the act, can be very variable, and often rely on the practices of individual workers. In addition, many independent advocacy services are having to prioritise statutory work over informal work, which was never the intention of the Millan committee, who envisaged access to independent advocacy to include informal care.

The current arrangements include a duty to ‘secure the availability’, and ‘take appropriate steps to ensure…the opportunity of making use of’ independent advocacy services. We feel that this is open to wide interpretation and we would like to see a simpler duty to refer in any future act, along with provisions for independent advocacy to those receiving informal care.

Supported Decision Making

The Act allows for substituted decision makers to override someone’s will and preferences and is done from a best interest standpoint. At times, we see very valid personal preferences being substituted with little or no standards in place around the best interest decision. There is an impetus for wholescale systemic change away from substitute decision making systems. We would like to see the Act brought into alignment with the UNCRPD, specifically around support to exercise legal capacity.

Independent advocacy is ideally placed with regard to enhancing the supported decision making process. Independent advocacy workers will commonly spend time supporting people to understand their choices, gain information, and make independent decisions, to try and reduce barriers that may exist around them.

Although we would like to see a more formal approach to supported decision making in any future acts, we feel that it should not be limited to an independent advocacy relationship. Evidencing the support around decisions by all practitioners, should be included as part of the principles or criteria when considering interventions.

Diagnostic focus

Independent advocacy partners often feedback to us that the Act seems to be diagnostically led, and focussed on symptoms. At times, this can feel parallel to the reason why the compulsion, or intervention, is being sought, which is often focussed on someone’s functioning. It can add to some people’s distress and experience of trauma when subject to the Act. It may also lead to an over reliance on medical evidence, or opposing medical evidence, which can lead to increasing power imbalances, and does impact on therapeutic relationships. At times, when practitioners are having to give evidence around risks, we often see quite historic risks being discussed in the context of diagnosis, which could arguably be unrelated to the current circumstance and need for intervention.

In other countries care can be overseen by different types of clinicians, not solely medical practitioners, a move to using responsible clinicians may also support a more biopsychosocial approach to care.

At worst, we have seen people excluded from support because they do not fit any diagnostic criteria, despite having considerable mental distress, who have gone on to complete suicide. It is vital that the focus of a future Act is shifted away from diagnosis and moved towards assessing individual capacity to function safely, and the need for intervention around this.

Reciprocity

The Act provides for support and treatment, but at times this is heavily contingent on

resources. Pharmacological treatments are always available under the Act, but we would like to see options around non-pharmacological treatment choices included. We see considerable resource issues when it comes to care packages, support services, housing availability, and access to psychological services. The principle of reciprocity is seriously undermined at times, and there is currently no ability under the Act to enforce it.

Lack of funding in services often results in decisions being made based on what services are available rather than meeting individual need. This can result in compulsory admissions being prolonged due to problems finding suitable support services to discharge to or individuals being discharged without adequate support.

Recorded matters can only go so far in furthering these issues, and we repeatedly see recorded matters about resources return to tribunals unmet, sometimes over years. There is no provision for recorded matters for individuals subject to Compulsion orders, which further impacts on reciprocity for these individuals. The tribunal is unable to take further action on this, and often everyone is stuck with no resolution.

We would like to see any future acts include provisions to fulfil this principle, potentially to include a new appeal if resources are not available, akin to an excessive security appeal. This would allow individuals who are genuinely ‘stuck’ due to resources to have orders made, and to be enforced, or otherwise have further legal recourse.

MHO availability

We have seen increasing demands placed on MHO’s over time, with considerable pressure coming from the Adults with Incapacity Act, due to private Guardianships. This has understandably had an impact on their ability to fulfil their duties as they have done previously.

There is a trend for lower rates of MHO consent for Emergency Detention Certificates throughout the timeline of the Act, and a general overall trend over the past 10 years of decreased MHO availability. This can be particularly noticeable during the first few weeks of a STDC, and it is not uncommon for a newly allocated MHO to meet someone for the first time in relation to a STDC appeal.

Are there groups of people whose particular needs are not well served by the current legislation? What would improve things?

Some groups may benefit from further safeguards, and particularly those who are subject to detention for long periods of time. This can have significant impacts on someone’s normal social functioning and ability to participate in society. We see good practices, in well funded units, which are able to provide longer term occupational, and recreational therapies, focussed on the individual’s wishes, which includes vocational activity. Unfortunately, we see other areas, with less funding where this is not possible.

Commonly in this group the use of compulsion may only be reviewed by the tribunal every 2 years. It would be helpful to see additional safeguarding criteria included at these stages. One of the principles in the Adults with Incapacity Act s1(5), places an onus on those exercising functions, to encourage the adult to exercise whatever skills they may have, and to develop new ones. We feel that this could be further developed to include other groups, and to be strengthened to a level where it can be legally tested.

We were encouraged when appeals against conditions of Medium Security commenced, as a number of our independent advocacy partners had been frustrated at the lack of remedy for their circumstances. We continue to see similar frustrations currently in people who are subject to conditions of lower security, again with no remedy or recourse to appeal.

Individuals subject to both the Act, and the Criminal Procedures (Scotland) Act, have at times questioned whether they are having a fair hearing. This is particularly relevant when an examination of facts is considered, due to an assessment of someone’s ability to participate in proceedings. This does not happen under the civil applications, where a curator is appointed, and the individual is still able to participate, and be heard during proceedings. We would like to see increased involvement of the individual and independent advocacy in these settings.

We continue to see individuals who are impacted by restrictions, but who are informal. In the worst cases it has been argued that deprivations on liberty have not been backed by a legal framework. This is not just reserved for people living in care settings, but can extend to people living at home subject to measures in their own homes

The Act has a set of legal tests to justify making someone subject to compulsion. Would you suggest any changes to these?

The difference in criteria between people on civil orders, and those on compulsion orders, needs to be reviewed. The lower level of proof is arguably discriminatory and it seems that unifying the criteria for both situations would resolve this. Where there is an option for a Sheriff to grant a Guardianship Order as part of their disposal, there is not one for a Compulsory Treatment Order, this could provide a more appropriate, less restrictive option, on disposal.

In relation to Restriction Orders, the issue of the unlimited timescale can seem overly restrictive in some cases. On the face of it, it seems as though the CORO is less restrictive than those subject to custodial sentences, who may go before a parole board and be released on licence. For some of those subject to COROs it can be difficult to understand how the restrictions remain as necessary, especially when people have lived in the community for many years without offending and where the passage of time since the index offence far exceeds any criminal justice disposal or tariff. We would like to see the tests around the continued   necessity strengthened.

We would like to see more importance given to the current principles of the act, potentially to become criteria or tests in their own right.

The Act requires a local authority to provide services for people with a mental disorder who are not in hospital, which should be designed to minimise the effect of mental disorder on people and enable them to live as full a life as possible (sections 25 and 26 of the Act). Do you think this requirement is currently met?

There is strong anecdotal evidence that, due to lack of funding, support services are overwhelmed by the number of referrals.

Independent advocacy workers report seeing increasing numbers of individuals discharged to poor social circumstances, unchanged from time of admission, or alarmingly, to worse circumstances than at admission.

It is often the case that those who are assessed as having a moderate level of need in the community, and are not subject to compulsion, are likely to have a severely reduced package of care and support that is not appropriate to their needs. This can often be no more than 2-6 hours of housing support each week   from voluntary sector providers. In addition, support is typically funded for a maximum of 6 months in the first instance and is often not extended, regardless of the unchanged support needs of the individual. This cycle of short-termism creates a system where the needs of the individual are far from central to decision making processes, as all decisions are made based around availability and cost of services.

The lack of funding in support services has led to an environment where support services are struggling to fulfil support packages and retain staff. Low wages are normal, with support services reporting that vacancies can be difficult to fill and long-term absence is common. This impacts on continuity of care and many have become fatigued by such a “revolving door” system and have disengaged completely from this undignified approach to support. There is the risk that this will result in many individuals going onto experience a deterioration in their mental health and becoming less likely to seek support and re-engage with services.

We are concerned at recent developments, where the Act is used as a ‘passport’ to services. We have worked with informal patients who have been placed on orders, in order to get them access to treatment, and with individuals subject to compulsion, asking to stay on orders, as they would otherwise lose their support. This goes against the principle of informal care, on a backdrop of an increasing use of compulsion. At times there can be issues around funding related to this, as compelled support is not means tested, but informal care can be.

Reliance upon self-financing for informal support packages in Edinburgh has created a two-tier support sector. Which unfairly discriminates against an individual whose needs are not assessed as being critical. This leads to a fear of recovery and has at times led to situations where individuals who have previously opposed CTOs, refuse to contest them, as they could not afford to pay for the care that they receive on an order. We would welcome free support to all, informal or otherwise.

Does the law need to have more of a focus on promoting people’s social, economic and cultural rights, such as rights relating to housing, education, work and standards of living and health? If so, how?

We would welcome any changes that would bring about increased access to these rights. The removal of mental health services from The Patients Rights (Treatment Time Guarantee)(Scotland) regulations, which would have allowed a maximum wait of 18 weeks from referral to treatment, can only be discriminatory when it comes to a right to health, and a right to mental integrity. Access to priority housing, supported accommodation and residential care has to become more enforceable through legislation. We have seen good use of legislation in the forensic system, through excessive security appeals, which has led to increased resources becoming available over time.

Do you think the law could do more to raise awareness of, and encourage respect for the rights and dignity of people with mental health needs

We were pleased to see the Scottish Government campaign and commitment to training 5000 non mental health front line staff in recognising psychological trauma, with the additional aim to promote a wider awareness to include trauma informed workplaces. Training on this level with a wider scope around mental wellbeing, support and public awareness of mental health legislation would be  very helpful

Based on your experience, are there any difficulties with the way the 3 pieces of legislation work separately or the way they work together? What improvements might be made to overcome those difficulties?

There are times when the 3 acts can work well together, and in particular there is a mechanism to enquire and support people who may need it in a variety of difficult circumstances, under different timescales. It can often be very helpful to have different decision makers using different legislation, as the potential for conflicts of interests is high under these situations.

Independent advocacy has been explicitly included in all 3 acts, but in practice we see very different referral rates and patterns across the acts. We would prefer to see the same duty to refer in all the acts, to simplify, and improve access to independent advocacy.

When individuals are subject to various acts at the same time, the legislative burden is too great. This proves to exclude people from engaging and participating, and it is not uncommon for individuals to ‘give up’ during long legal processes.

Sadly, we find that there is considerably less uptake by individuals to involve themselves with Court processes under AWIA, despite major efforts by the Courts to develop practice and improve access. It is very hard for some people to read and digest MHTS applications and reports, but almost impossible for individuals to fully understand what might be included in a set of papers for a Guardianship application. The MHTS tribunals are, by their very nature, setup to be more inclusive but they are also limited. We would prefer to see an overarching tribunal service with more ability to enforce orders such as directions, recorded matters, and issues that relate to resource availability.

The inclusion of non means tested legal advice, assistance and representation for Mental Health Tribunals was a major step forward in accessing a fair hearing, but the fact this is not mirrored with all of the AWIA cases has led to people not opposing applications, when they wanted to. In the most extreme cases we have worked with individuals subject to a financial guardianship, who wished to oppose it, and would have needed to get financial agreement from their guardian, in order to pay for legal representation to challenge the guardians current role. This conflict is not seen under the MHA, where an individual can contact the tribunal directly, on their own, with no other support, and a hearing can be convened at no cost to them.

Overall, Unification of the 3 acts would be another major step forward, and we have seen examples where the 3 acts can work ‘against’ someone. For example if a court is waiting on a tribunal decision, or vice versa, to make a decision themselves. It would also mitigate the use of the MHA as an emergency intervention, when AWI guardianships are what is required. It could also allow for a common care coordinating role to be developed, which is often needed with very complex care which currently utilises 2 or 3 acts together but can be managed by a number of different professionals.

Is there anything else you wish to tell the Review?

We have found that the use of DWP appointeeships to manage funds is very commonplace, but it is not possible to appeal them, or have any external oversight. We have also never had a response from DWP in relation to concerned individuals wanting a review of these arrangements.

Given this falls out of the scope of the current 3 acts, but plays a significant role in restricting or managing someone who is deemed incapable, we would like to see some way of providing oversight of these arrangements included in any future acts that involve management of funds. We often see people who are worried that no longer being subject to the Act will affect their eligibility for welfare benefits at the same rates, as they believe their needs will be assessed as being lower.

Coronavirus UPDATE 26 March

Our offices at the Royal Edinburgh Hospital and 332 Leith Walk are now closed and all our staff are working from home. Please call 0131 537 6004 if you want advocacy in the Royal Edinburgh Hospital. For all other community issues call 0131 554 5307 (Leith Walk). Your call will either be diverted to one of our workers or we’ll pick up your voicemail message as soon as we can.

We’re doing our best to keep up to date with the rapidly evolving guidance and practice around the Mental Health Act, Guardianship and Adult Protection.

For those of you who need support to complete a benefit form or to draft a reconsideration, Arlene can offer a telephone appointment with you on 07920207569 or can offer support by email at [email protected]

For our Problematic Substance Use service please call Scott on 07918127366 or email: [email protected] to find out more or to make a phone appointment.

Collective advocacy meetings will not be taking place until further notice.  We’ll keep you updated about online opportunities to take part in collective advocacy in our newsletter which goes out once a month.  If you’re not on the email list for your newsletter and would like to be added to it, please contact [email protected]

Thank you for your patience during these challenging times.

AdvoCard

CORONAVIRUS UPDATE

We understand that this is a difficult time for many of you who use our service. We are trying to find ways to provide as much support as we can to those who need it.

From today, we will not be offering face to face appointments at our Leith Walk office. This will continue until further notice.

However, we will still be around if you need to call us and we will try to work with as many people over the phone as we can.

For those of you who need support to complete a benefit form or to draft a reconsideration, Arlene can offer a telephone appointment with you on 07920207569 or can offer support by email at [email protected]

Collective advocacy meetings will not be taking place until further notice.  We’ll keep you updated about online opportunities to take part in collective advocacy in our newsletter which goes out once a month.  If you’re not on the email list for your newsletter and would like to be added to it, please contact [email protected]

We can also still attend appointments if you have been detained in hospital or if you have an upcoming tribunal.

If you are worried and need our help we can still be contacted on 0131 554 5307

Coronavirus

We’re doing everything we can to minimise the risk of infection to everyone involved with our services.

You can help us by:

– letting us know if you’re unwell with cold or flu-like symptoms (continuous cough and/or high temperature);

– you’ve had an appointment with us recently or;

– you’ve got one coming up


This will help us keep all our visitors, employees, trainees and volunteers as safe and well-informed as we can.


We may offer alternatives to face-to-face appointments in the coming days, such as email, text and telephone appointments.


We appreciate your cooperation.


AdvoCard

Read our consultation response to the Scottish Government Consultation on Advocacy Standards

AdvoCard is a user led independent advocacy service for individuals who identify as having a mental health condition. We are based in Edinburgh and provide advocacy support in 3 specific areas – hospital-based advocacy for those who are currently inpatients of the Royal Edinburgh hospital or have been detained on wards in other Edinburgh based hospitals, prison-based advocacy for inmates of HMP Edinburgh and community-based advocacy for those out-with these institutions. As part of our community team we provide a dedicated service for welfare reform and social security advocacy. This service has been in place for 6 years now and in the last year dealt with 725 referrals, a 577% increase in referrals from year one.

In order to prepare our response, we held several focus groups where individuals who have used the current Welfare Reform advocacy service at AdvoCard were asked to provide feedback on the draft advocacy standards.

In order to reach as many people as possible we held focus group meetings at our offices and at three different mental health services in Edinburgh.

In total we spoke to 65 people over the four groups. At each meeting, we discussed the proposed changes to the new benefits that are being devolved to Scotland and the type of support that people felt that they would need to help them through those changes. We then discussed the proposed standards in relation to the type of support that people felt that they would need. This response reflects the issues and concerns raised during these meetings along with observations that we have made as an organisation currently providing independent advocacy in social security.

Do you agree with the definition of advocacy?

AdvoCard agree with the definition of advocacy in these standards. When people refer to our social security service their main priority is to engage support to make sure that they are heard, that they are listened to and that they are given the chance to say exactly how their conditions affect them. In our focus groups there were no issues raised with the definition, with many of the people agreeing that this is an accurate reflection of what an advocacy worker should do.

It was also agreed that the distinction between advice and advocacy was an important factor. Many services often confuse advocacy with advice, particularly when it comes to support with social security and it is important that this distinction is made here to avoid confusion not only for those who may refer to the service but also for services that may seek to provide advocacy in the future.  

However, whilst we support the overarching definition of advocacy as laid out here, we do share the concerns of the SIAA that the definition refers to “advocacy” and “advocacy worker” rather than “independent advocacy” and “independent advocacy worker”. We feel that as the standards apply to the provision of “independent advocacy services” that the term should be used consistency throughout the standards to avoid confusion.     

Is anything missing from this definition and, if so, what?

We are concerned with the statement – You are entitled to the support of an advocacy worker if you have a disability and, because of your disability, you need help with the Scottish social security system.

Whilst it is appreciated that the Scottish Government do not intend to limit the definition of what the term disability means, many of the people who use our service and those who attended the focus groups do not identify their mental health conditions as a disability. This may result in them not being aware that they are entitled to use advocacy support. More clarity is need to address this.  

 Do you agree with the principle of “independence”?

Whilst we appreciate that the definition in the standards meets the definition as described in the Social Security Scotland Act, neither AdvoCard nor the people who have used our service, agree that adhering to this definition in the standards will provide the best possible service for those who will have cause to engage with Independent Advocacy.

At our focus groups we discussed what it means to be an Independent Advocacy Service working to SIAA standards and principles and what it would also mean as defined by the Social Security (Scotland) Act 2018. We explained to people that the definition of advocacy used here means that agencies that provide employment support, benefit advice, social support etc can all provide “independent” advocacy for the purposes of social security.

Most people were alarmed at this. Although it was explained that the terms of the Act did not require any service to be completely independent it was felt that the standards and principles should be used to tighten the definition of what it means to be independent. Many of the people present were involved in the campaign to have the right to access independent advocacy included in the Act and commented that this is not what they were campaigning for.  Some commented that they were concerned about conflict of interest and the likelihood of impartiality from advocacy workers.

 “It’s important that the person helping you is on your side and not just doing what their service decides is right for you.”

Currently, independent advocacy organisations work to SIAA’s ‘Principles, Standards and Code of Practice’, which defines an independent advocacy organisation as one that, “…. only provides independent advocacy. All the activities it undertakes are about providing, promoting, supporting and defending independent advocacy. Its independence means that it does not provide any other services and so it is structurally, financially and psychologically separate from other organisations and interests”.

For those who use our service the issue of being financially and psychologically separate is an important one. At our focus groups, concern was raised that organisations that provide other services will not be able to maintain independence no matter what guidelines and safety features are put in place. It was felt that the members of staff providing advocacy within that organisation would be affected by organisational culture, service requirements and maintaining relationships with other team members who provide other areas of support such as advice or employment support. Therefore, they may struggle to maintain their level of psychological independence from the organisation and may try to steer the direction of work with the person seeking advocacy towards one that fits with their organisational culture and benefits their organisational outcomes. There is also a danger that a person may have used the organisation for another purpose, such as advice, and been unhappy with the service so therefore feels that they cannot access the service for advocacy as they are too closely related.

Is anything missing from the standards and if so, what?

We support the SIAA call for a definition of independence that will ensure meaningful independence, rather than independence in name only. This requires a far more nuanced assessment of what makes a person or organisation independent than the current definition of, ‘a person other than the Scottish Ministers’.

Do you agree with the principle of “person centred”?

Yes, AdvoCard, and those who use our service, strongly support the principle of a person-centred approach to advocacy. The addition of a standard for a person-centred approach is seen as a welcome addition and an important factor in ensuring that any work carried out is always done at the express wishes of the person, regardless of organisational opinion. This was seen as particularly important in the area of benefit uptake and income maximisation. It has been suggested that by engaging with advocacy that the person may be supported to engage with the social security system and which will in turn aid benefit uptake and income maximisation. In many cases this may prove true, however, a person centred approach as described here must allow for circumstances where the person no longer wishes to engage with the social security system for their own personal reasons, regardless of their entitlement to claim a benefit, they may wish to withdraw a claim or chose simply not pursue their entitlement. A truly person-centred approach to advocacy will ensure that the persons wishes are respected and that the person is supported to do what is best for them.

Do you agree with the standards?

Yes, we agree with the standards as they are written.

Is anything missing from the standards and if so, what?

AdvoCard support SIAA’s concern that multiple sets of standards for independent advocacy, the SIAA standards, the Social Security standards and the Child Hearing standards, runs counter to a person-centred approach. Those who use our advocacy service also use our service for other reasons such as housing issues, children and family issues, problems with treatment and diagnosis etc. Having different organisations providing different types of advocacy working to different standards will be confusing for the individual and does little to place them at the heart of the process as claimed in the principles.

Do you agree with the principle of “accessible”?

We agree with principle of accessibility and, as an independent advocacy organisation already work to ensure that our service is accessible to all that need to use our service. We provide face to face advocacy through office-based appointments, home visits and external appointments at other agencies such as support groups etc. We also provide telephone-based appointments if necessary. With regards to additional services required, we have access to interpreters in sign language and foreign language interpreters, however these come with additional costs that are met through our own limited budget. In order to ensure continued accessibility, it is vital that the Scottish government commit to the provision of adequate funding to cover the additional costs of ensuring absolute accessibility.

Do you agree with the standards?

We do not believe that the last four standards under this principle relate to accessibility and feel that they would be much better situated elsewhere in the document, perhaps within the definition of advocacy, within the section on the principle of independence and within the section on the principle of quality assurance.

We also have concern about the principle that states, ‘If you tell your advocacy worker that you may be at risk of harm or that you want to harm yourself or someone else they will discuss this with you but may need to share this information with others without your consent’.  There is not enough information here to highlight under what circumstances an advocacy worker would decide to share information without consent. Deciding what constitutes risk of harm cannot be left to the advocacy worker alone and must be in line with current safeguarding guidelines.

This standard could be improved by a) the addition of a sentence stating that the advocacy worker will always speak with you before breaching your confidentiality and b) explicit use of the word safeguarding to describe these situations. It is critical that both independent advocates and people using independent advocacy know and understand that confidentiality will only ever be breached within the context of safeguarding.

Do you agree with having a principle of “trained”?

We agree that it is important that advocacy workers are trained in both advocacy and in social security legislation and guidance

Feedback from our focus groups showed agreement that advocacy workers should be trained and experienced in providing advocacy. They should also have a good working knowledge of the Social Security System and a good understanding of individual rights under the social security act. In addition to this, many also suggested that the advocacy worker should be trained and experienced in working with the specific group that they are providing advocacy for. For example, training in mental health conditions, autism, learning difficulties etc. There was also a suggestion that all workers should receive Applied Suicide Intervention Skills Training as there is a need to discuss suicide and self-harm at face to face benefit assessments. 

Some of the comments that we received were

“I need someone who knows the right questions to ask me. I don’t like talking about my illness so if you don’t ask I won’t tell you.”

“The (…advocacy worker…) needs to know what’s going on with the benefits or what help will they be?”

 “If they don’t know what my rights are how will I know?”

“They need to have mental health training, or learning disabilities if they are working with people with learning disabilities or how will they know how to work with us?”

Do you agree with the standards?

Whilst we do agree with the standards, we do not feel that principles 1 and 4 are specific enough

Whilst we agree with the intention, we feel that these principles do very little to detail the level of training and knowledge required and leave this to the interpretation of the service provider. This can result in disparities across services. These principles would be strengthened by including the level of training required.

Do you agree with having a principle of “quality assured”?

AdvoCard agree with quality assured as a principle. In order to ensure high quality services, it is important to have robust, transparent systems in place for monitoring and evaluating the service.

Do you agree with the standards?

Of all the standards we felt that the principles of quality assurance were the most problematic. Whilst we agree with the standards, we feel that the wording could be strengthened in several places to ensure consistency across services.

1 – Advocacy workers will keep accurate and up to date written records of action taken, progress made and outcomes achieved. – reference should be made to what is considered an outcome and what the written records will be used for.

2. Advocacy services will have systems for receiving, addressing and monitoring feedback and complaints and you will be told about these. – to ensure consistency there needs to be an agreed system for feedback and complaints that will be used

throughout all advocacy services involved in the provision of advocacy in the social security and reference must be made to this in the principle.

3. Feedback and complaints forms will be available in accessible formats, without having to be requested. – this does not go far enough. To ensure a high level of service advocacy services must proactively seek feedback through various forums.

4. Advocacy services will take all feedback and complaints seriously and will respond promptly. – “promptly” is open to interpretation, to ensure a high-quality service as standard, specific timescales must be given.

Consultation on advocacy standards in social security

The Scottish Government have posted a consultation on the proposed standards that advocacy services will have to work to to provide advocacy in the new Social Security Scotland system. You can have your say here. https://consult.gov.scot/social-security/social-security-advocacy-service-standards/

AdvoCard will be holding focus groups to provide a response to this. If you would like to be involved please get in touch with Arlene on [email protected] / 01315545307