Mental health advocacy services delayed six months

Jim Symington, national lead for legislation at the National Institute for Mental Health in England, told HSJ that advocacy services were not expected until April 2009 - yet the treatment orders can be imposed from October next year.

The right to an independent advocate was a concession made by the government to help push the controversial Mental Health Bill through Parliament earlier this year. Ministers accepted demands to give patients the right to representation only at the last minute after an eight-year battle to get the bill passed.

All patients detained or given supervised community treatment orders should get access to an individual who can make sure their wishes are taken into account.

But Mr Symington said there was expected to be a shortage of advocacy services.

'Commissioners and advocacy organisations have asked for support in getting ready for the act,' he said.

'Commissioners have been receiving guidance on model specifications and providers are saying they want time to get into a position where they can be tendered.'

A 'big bang' introduction of community treatment orders is unlikely, and as yet no-one knows the extent to which they will be used, he said.

Steve Shrubb, director of the NHS Confederation's Mental Health Network, said the situation was 'disappointing'.

'Ideally you'd want advocacy brought in as soon as possible,' he said. 'Having someone who's informed but independent does bring a whole range of benefits. I hope that some of the trusts and PCTs will try to bring it in early.'

Groups such as the Mental Health Alliance fought for years against the introduction of community treatment orders, dubbed 'psychiatric asbos'.

Intended for so-called revolving-door patients who have been discharged from hospital, they can dictate where a person lives and what medication they must take. They can also impose a curfew or ban patients from attending certain places such as pubs.

The government conceded a raft of safeguards, including advocacy services, in order to get the measures passed.

Paul Jenkins, chief executive of charity Rethink, said: 'The right to advocacy is fundamental.

'There are some very important issues about providing a level of protection to very vulnerable people, before taking their liberties away.'

A code of practice is being drawn up to help trusts implement the act and to set out patients' rights. Best practice guidance on community treatment orders is expected to be available next summer.