The Ten Glib Compromises of Advocacy

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10 July


Following on from Is mental health advocacy better than nothing ?



Never mind The Advocacy Charter – The Ten Glib Compromises of Advocacy


1. Tokenistic proceedings and their prosecution or defence
Just as with letting the client have his or her day in court, the solicitors who – satisfied that he or she has consent – go through the motions, knowing that the nature of their client’s condition means that he or she is automatically at a disadvantage before the judiciary (and almost admit as much to the advocate).


2. Relations with health professionals (1)
The advocate has never met somebody just admitted for the first time, whereas he or she sees the ward staff all the time – can they not make the advocate seem on their side through the pleasantries and formalities of intercourse, subtly undermining the client–advocate axis ?


3. Don’t tell me… ! (1)
One advocacy mantra is maintaining client confidentiality unless the client reveals that he or she intends serious harm to him- or herself or to someone else, which the clients are supposedly told right at the start (when they actually want to jump straight in with their story most of the time). They should then be interrupted with, and because of, it as soon as they appear to be making a disclosure, unless they manage to blurt it out.

And the purpose of this principle ? If you intend to poison your consultant, don’t tell me, because I’ll have to tell him or her – whereas, if I can say that I didn’t know (even if on account of the fact that I stopped you telling me), that’s OK. Really ?


4. Relations with health professionals) (2)
Let alone when it comes to a complaint about a member of staff who supports or facilitates one’s visit to the unit… Does one really put one’s heart into the client’s concern, or, as one should, declare a conflict of interests between duties to one’s service and to the client ?


5. Don’t tell me… !) (2)
Some staff, however much they are reminded that one has to share everything with the client, drop little prejudicial comments or otherwise drip-feed negative messages.

If the client’s issue, say, with which his or her involvement is needed is to do with something off the unit, is there an incentive to say Z looked ‘in a funny way’ when I went to ask about that and mentioned it concerned you ? No possibility of thinking of getting other client work done, meeting targets, or just not wanting to foment avoidable upset ?



6. Giving options, not advising action (1)
Of course, because one has to give the options in some order and may not be able to eliminate emphasis by that and / or other means, does the client get an absolutely free and influenced choice ?


7. Relations with health professionals (3)
If the arrangement with the unit is to visit periodically to be available for a time and then come into the planning / community / ward meeting, does one, even by refusing to laugh with the staff when one or two of those present kick off with frustration or something unintentionally funny, appear to endorse this humiliatory aspect of long-stay ‘care’ ? The staff are not so much laughing with, as at, the rehab patient, and they seek to engage the advocate with their looks, their smiles, their laughs.


8. Giving options, not advising action (2)
Take an unfamiliar part of the benefits system (or challenging it). What makes the advocate competent to say what the options are ? For our service, I pressed for us to have Citizens’ Advice’s information system, which objectively gives those options, but despaired of ever persuading anyone else to use it - some would think it better to interrupt busy colleagues and ask their opinion, even if they were, in fact, on hold on a call that was liable to be resumed before the others could finish answering.


9. Invoking – or failing to invoke – legal principles
Advocacy services that make much of being independent from the NHS cannot very well take an office on hospital premises for a peppercorn rent, as if nothing compromises pursuing any issue for clients on that hospital’s units.

If advocates ever could correctly identify conflicts of interests, this is one – between serving the client and having been done a favour by the hospital. However, advocates usually find / invent such conflicts where none exist, or, with maintaining confidentiality, miss the fact that the person whose confidentiality is being protected can always seek to waive it.

For example, by going to the ward office with the client and getting him or her to say that she wants one to know XYZ.


10. Giving options, not advising action (3)
No one can have failed to read points 1 to 9, above, without noticing that I say that advocates are generally weak at analysing when the principles whose names they bandy about apply : what hope, then, of them knowing how to analyse, and of actually analysing, the problem(s) of which their client is narrating some of the facts, of knowing what facts are missing, and of being able to present the analysed medical, legal or other problem back to the client so that he or she can understand ?

If the client lacks capacity, he or she may feign understanding, just as he or she may claim to be tired or to have glasses to disguise being effectively illiterate. He or she is supposed to weigh up the options and make an informed choice of action for him / her and / or the advocate…


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