Independent Mental Health Advocate

The IMHA must be available to all 'qualifying patients' — those detained under section 2, 3, 4 (after 72 hours), 5(2), 5(4), CTO patients, guardianship patients, and detained patients due for serious medical treatment under section 58. The IMHA can: visit the patient, attend meetings, see medical records, take instructions from the patient, advocate for the patient's wishes to the clinical team, and help with Tribunal applications. Patients can request an IMHA at any time. Funded by the Integrated Care Board (formerly CCG). Different from an IMCA (Mental Capacity Act).

In practice, an IMHA is the person on the ward whose only job is to represent what you want, rather than what the team thinks is best for you. That distinction matters. Your responsible clinician, your nurse and even your family are all forming views about your interests; the advocate takes instructions from you. They can attend ward rounds and care programme approach meetings with you, help you put questions to the team, and speak on your behalf if you would rather not.

Worked example: Ben is detained under section 3 and unhappy about the side effects of his medication. He asks a nurse to arrange an IMHA. The advocate meets him privately, helps him write down what he wants to say, attends the next ward round, and asks the clinician to explain the alternatives and to record Ben's objection in his notes. The advocate also explains the section 58 second opinion process, helps Ben apply to the Tribunal within the correct window, and requests the leave policy so Ben understands what section 17 leave he could ask for. None of that requires Ben to have capacity to instruct — an IMHA can also work non-instructed, representing a patient's rights where the patient cannot direct them.

The pitfalls come down to knowing the service exists. Hospitals must take reasonable steps to tell qualifying patients about IMHA services and to arrange a meeting if the patient asks, but in busy wards this often does not happen, so ask directly and ask again. An IMHA is free and independent of the hospital even though it is commissioned locally. They are not solicitors and cannot represent you at the Tribunal — that is a separate, free, non-means-tested legal aid entitlement, and you should have both. And informal patients are not qualifying patients, though many services will still offer general advocacy.

The IMHA role comes from the Mental Health Act 1983, supports applications to the Mental Health Tribunal and discussions about section 117 aftercare, and differs from the IMCA role under the Mental Capacity Act. Read our guides to independent mental health advocacy and the Mental Health Act.