Non-instructed advocacy – work in progress

Much advocacy work is predicated on the assumption that the people for whom we advocate are able over time to express their wishes, hopes and fears and can to a greater or lesser extent ‘instruct’ their advocates. But what happens if someone lacks the capacity to instruct or direct their advocate? This can affect many people including those with dementia, learning disabilities, mental health problems and stroke or head injuries victims.

For many years advocates working in Hampshire have found themselves advocating for people who may be affected this way but the matter has been brought into a sharper focus through a number of recent developments including the 2005 Mental Capacity Act. HARG members agree with one of its key principles – i.e. that we start from the premise that a person has capacity unless proved otherwise but it is also our experience that some people do find it very difficult to articulate their wishes for any number of reasons including age, disability or personal circumstances.

We strongly believe that the principles of advocacy apply to ‘non-instructed’ advocacy as much as they do to ‘instructed’ advocacy. Indeed, people who lack capacity may be even more disadvantaged – for example, they may not be able to engage in the development of their care plans, they may not be able to decide who will deliver their care or where and with whom they will live.

We understand that people may well be surrounded by very skilled and caring family members and professionals but their advocates have a special role – they are independent and quite separate from statutory bodies or any other interested parties. This means they will not be influenced by anyone else and will act only for the person they are supporting.

There are several approaches currently being used in the delivery of non-instructed advocacy. They are not mutually exclusive – it is more important to find ways to ensure that the person’s voice is heard and listened to:

1. All advocacy is person centred and we expect the advocate to spend time engaging directly with the person by visiting them on a regular basis and getting to know them. In this way, a trusting relationship can form.
2. The advocate needs to be observant of how the person relates to themselves, other people around them, objects and the environment in which they live. Forms of communication will vary according to the individual person. In some cases, the advocate will look for the ways in which the person uses sensory stimulation e.g. sound, smell, taste and touch to make meaningful contact with their world.
3. The advocate will also link with staff and other people who are important in someone’s life in order to gain a more holistic understanding of the person, the context and the appropriateness of present and future plans.
4. It is generally agreed that access to satisfactory care and civil rights, freedom of choice, independence, social inclusion and opportunities for progression can be described as ‘ordinary life principles’ which are the right of everyone. So advocates will ask –
   
   
   • Is the person being treated as an individual with unique needs and wishes?
   • Is the total well-being of the person being addressed including their physical, psychological, social and health needs within a safe and secure environment?
   • Are their life experiences, preferences, their friends, their part in the local community (and their sense of belonging to it) being taken into account?
   • Are they being treated with respect and dignity? Are they listened to?
   • Is the person being encouraged to be as independent as possible?
   • Is there a commitment to maintaining and developing their existing relationships and social networks?
   • Does the person have the opportunity to make choices, influence and control their lives? Are they allowed to take risks?


5. There may be occasions when an advocate is not able to develop a relationship with someone for a variety of reasons. In these circumstances, an advocate can still offer independent scrutiny of proposals and decisions affecting a person’s life. An advocate can ensure that all options are considered, that no particular agendas are followed and that the person’s civil rights, human rights and welfare rights are respected.

HARG members acknowledge the work of BILD, POhWER, ASIST, Di Barnes at Durham University and others in developing our understanding of non-instructed advocacy.

Richard Tickner – East Hampshire Advocacy Scheme
April 2006