‘Although some people need to be here I believe they have a right to a good standard of life. As advocates we are here to support patients wherever possible to take control over their lives and to ensure they have a say in the care and treatment they receive,’ explains Ruth Ingamells, Area Manager for advocacy services.

The aim is to give patients access to the information and support they need to make informed choices about their day-to-day living. Ruth explains: ‘Our job is to make patients aware of the choices they can make and to support them in that choice. As an advocate it is not our role to pass on our opinions, rather it is to be aware of and to accept patients’ views, opinions, needs and experiences and support them to express these.’

Rampton Hospital
Rampton is a high-security hospital, which was opened in 1912. For most people admittance is through the courts or prison system; they are detained under the Mental Health Act 1983 or equivalent legislation, and usually require Home Office clearance before they can leave. Normally people are admitted either because they need very intensive nursing care and/or they are considered dangerous. The hospital is split into four directorates:

• women – where all the women live regardless of diagnosis
• mental health
• personality disorder
• learning disabilities.

The patients
Men are allocated to a directorate according to what is considered to be their underlying diagnosis. Many patients at Rampton will have more than one diagnosis and over 90 per cent have a drug- and/or alcohol-related issue. Each patient has a treatment plan, which provides information about the range of programmes they are required to complete before they can move on. This includes psychology, psychotherapy, therapies related to the offence they committed, such as arson treatment programmes or sex offenders treatment programmes and substance misuse courses. The average length of stay is six to eight years.

Ruth explains: ‘When we first started providing an advocacy service at Rampton it was very much about mediation as the patients’ complaints were largely about staff and the treatment they were receiving. That type of support is needed less now, because patients tend to be more proactive and identify problems before they become serious.’

How the service supports patients
The service Together’s advocates provide includes:

• individual consultations where patients are supported with their concerns. This can involve:
  - providing support to find solutions to day-to-day problems occurring within the hospital, such as staff shortages or the cancellation of day services
  - dealing with more complex issues such as detention and legal liaison
  - ensuring that a patient’s opinion is heard and included in decisions concerning them, this may require attending meetings on their behalf if they are not well enough to attend
• running ward advocacy clinics. Advocates specify a regular date and time when they will attend the ward so that patients can raise any issues
• attending community meetings. These are initiated by the hospital and their frequency varies from directorate to directorate. They are an opportunity for patients to raise any issues they have about their ward - for example, if one person keeps watching a particular TV programme while a lot of the other patients want to watch a different one. The advocates encourage the patients to chair and minute these meetings
• facilitating the patients' council, which is a voice for patients at the hospital. For example, advocates supported the patients’ council to negotiate a fairer reward scheme for all patients with senior management . The advocacy service also helps arrange dates and times for council meetings, organises guests and takes minutes. Members set the agenda and the aim is for the council to take its own minutes and to become generally more self-sufficient in the future
• meeting all new patients within ten days of arriving at Rampton and providing them with information about how the advocacy service can help them
• acting as an ‘appropriate adult’, which means ensuring any patients who are interviewed by the police or hospital inspectors understand what is happening. This is a legal requirement under the Police and Criminal Evidence regulations for anyone who is classed as a ‘vulnerable adult’.

Dedicated staff teams
The team consists of seven staff including the Project Manager and an Administrative Assistant, with one advocate allocated to each hospital directorate. Staff come from a wide range of backgrounds including hospital services, learning disabilities and mental health. This is important as directorates vary in the way they work and the knowledge base they need an advocate to have. For example, patients in the Learning Disabilities Service often need an informal approach. They look for support around day-to-day issues within the hospital that can usually be dealt with directly with ward staff. Patients in the Personality Disorder Service on the other hand, tend to require a more formal approach. Their issues tend to be more complex, and often require legal liaison. They might look for support to write letters or to organise an appointment with someone they wish to speak to.

A ‘typical’ request for support
Peter* was ready to move to a medium-secure unit but his local authority refused to fund his move there, so he contacted one of the service’s advocates. The advocate supported him to apply pressure by getting a solicitor involved, and helped him write to the Mental Health Commission too. After some discussion, the funding was agreed and Peter was able to move from Rampton to a medium-secure unit.
* name has been changed

Developing the service
Ruth explains: ‘We are good at telling people they do have rights, that they have the right to dignity, respect and a good quality of life. Our main aim is to support people to self-advocate and to “do ourselves out of a job”. It’s not about doing it for people, rather it is about enabling people to do it for themselves.

‘The service Together provides is recognised as a model of a good advocacy service; in fact it is seen as leading the field. I receive phone calls from all round the country looking for advice and we have been asked to speak at conferences as far apart as New York and Preston.’

More information
To find out more about the Rampton service, contact them direct.