IMHA (Independent Mental Health Advocacy) Rights

The Independent Mental Health Advocate (IMHA) is a statutory role established under the Mental Health Act (MHA) 1983 (as amended by the 2007 Act). The primary function of an IMHA is to provide an additional safeguard for patients who are subject to the restrictive powers of the Act. This service is not a matter of clinical discretion; “qualifying patients” have a legal right to access an IMHA, and hospital staff, including clinicians and managers, have a statutory duty to inform patients of this right and facilitate contact with the advocacy service.

Criteria for Qualifying Patients

The right to an IMHA is determined by a patient’s legal status under the Mental Health Act, rather than their medical diagnosis. Qualifying patients include those who are currently detained under the Act (with the exception of short-term holding powers such as Sections 4, 5, 135, or 136). The right also extends to individuals who are subject to guardianship or those living in the community under a Community Treatment Order (CTO).

Furthermore, “conditional discharge” patients and those being considered for specific high-risk treatments—such as neurosurgery for mental disorder or, for patients under 18, Electro-convulsive Therapy (ECT)—are legally entitled to IMHA support. This ensures that even when a patient is not residing in a hospital setting, they have access to independent expertise to help them navigate the legal complexities of their treatment and restrictions.

Statutory Rights of Access and Information

Under Section 130B of the Act, IMHAs are granted unique legal powers to ensure they can represent their clients effectively. An IMHA has the right to visit and interview a patient in private, regardless of the hospital’s standard visiting hours, provided it is at a reasonable time. This privacy is essential for maintaining the confidentiality and independence of the advocacy relationship.

In addition to physical access, IMHAs have the statutory authority to inspect any records relating to the patient’s detention or treatment, as well as social care records held by local authorities. If the patient has the capacity to consent, the IMHA may access these records upon request. In cases where the patient lacks the capacity to consent, the IMHA may still access records if the record-holder is satisfied that the inspection is necessary for the IMHA to carry out their legal functions. This access allows the advocate to scrutinize the clinical rationale behind treatment decisions and ensure that the patient’s rights are being upheld.

Support During Tribunals and Hospital Managers’ Hearings

A significant portion of an IMHA’s work involves supporting patients through the formal processes used to challenge detention. When a patient applies for a Mental Health Tribunal or a Hospital Managers’ Hearing, the IMHA assists them in understanding the legal criteria for discharge. The advocate helps the patient prepare their own statement, ensuring that their perspective on their health, risk, and future care is clearly articulated to the panel.

During these hearings, the IMHA ensures that the patient understands the evidence provided by the Responsible Clinician (RC) and the Social Worker. If the patient disagrees with the clinical evidence—for example, regarding the necessity of medication or the level of risk they pose to themselves or others—the IMHA supports them in presenting counter-arguments or requesting independent medical evidence. This role is vital in addressing the power imbalance inherent in psychiatric detention, ensuring the patient remains a central participant in the legal proceedings that determine their liberty.

Empowerment and Self-Advocacy

The overarching goal of the IMHA is to empower the patient to speak for themselves. By explaining the “consent to treatment” provisions under Part 4 of the Act, the advocate helps the patient understand which treatments can be given without their consent and which require a Second Opinion Appointed Doctor (SOAD). This knowledge enables patients to engage more effectively with their multi-disciplinary team, ask informed questions about their care plan, and participate in decisions that affect their long-term recovery and autonomy.