Authors: Stephen Rosenman, Ailsa Korten, Leigh Newman, ACT
Event: 2003 TheMHS Conference
Type of resource: Conference Presentations and Papers
Abstract: This is a report of a study of an experimental model of personal advocacy based on continuing advocacy of best interests and needs. Current advocacy and rights protections cluster around admission and the commitment process hearing. Once the patient is committed, coercion and derogations of rights are licensed and few protections are maintained. We believe that this sets the patient against the caring institution and compromises care and continuing cooperation with follow-up treatment. In the model studied, a specialist advocate represented involuntarily treated patients, accompanying the patient not only through the commitment but also in interactions with the hospital and its staff throughout the period of involuntary treatment.
Method: Fifty-three consecutive subjects who had been involuntarily hospitalised received experimental personal advocacy from soon after compelled hospitalisation through commitment to the time of discharge from involuntary care. They were compared with 52 consecutively involuntarily hospitalised control subjects who received routine rights advocacy from hospitalisation to commitment hearing.
Results: The experimental and control subjects were similar in demographics, diagnosis and severity of illness. Satisfaction with hospital care was similar in both experimental and control subjects at the outset of care but improved significantly in the experimental subjects while it declined in the controls. Attendance aftercare was significantly better in the experimental group. The experimental subjects’ risk of subsequent involuntary hospitalisation was less than half the risk of control subjects and community tenure was significantly increased. Clinical staff reported that the experimental advocacy improved their care of patients.
Conclusions: Compared with routine rights advocacy, the experimental advocacy based on needs and best interests, which accompanied patients throughout involuntary hospitalisation, significantly improved patients’ and staff experience of involuntary hospital care. The resulting better compliance with aftercare produced a statistically and economically significant reduction in rehospitalisation for involuntary treatment.