Mental Health Advocacy Outcomes from Service User Perspectives

Purpose: This paper addresses a knowledge gap on advocacy outcomes from mental health service users’ perspective, and the implications for evaluating advocacy impact.

Methods: Three qualitative studies of independent advocacy involved: (1) focus groups and interviews with 30 African and Caribbean men who were mental health service users; (2) 90 ‘qualifying patients’ in a study of Independent Mental Health Advocate (IMHA) services; and, (3) nine young women in Children and Adolescent Mental Health Services (CAMHS). Secondary meta- analysis identified four common dimensions: how mental health advocacy is conceptualised and understood; how service users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacy outcomes.

Findings: Advocacy outcomes were conceptualised as a) increasing involvement; b) changing care and treatment; c) supporting personal development. There was evidence of advocacy acting to empower mental health service users, and of broader impacts on service regimes and policies. However, there was limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen as important. These studies highlight challenges for measuring the outcomes of advocacy, but underline the importance of doing so, and of involving service users alongside other stakeholders in co-designing evaluation systems.

Originality: Few studies have focused on the perspectives of people using independent mental health advocacy, or on the experience of ‘advocacy as empowerment’, and none has done so across diverse groups. These studies add insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems.