Mental Health Nursing

84 Acute Mental Health Nursing
Advocacy, crisis cards, advance directives
The experiences reported above, especially if repeated over years of contact
with services, erode self-esteem and reduce the sense of individual power.
How, then, can some degree of power be reinstated?
One approach towards maximising user involvement at the individual level
is the use of advocacy. Advocacy – stated simply – is the opportunity to have
someone alongside you who will voice your concerns for you if you wish
them to. Many people (and I count myself among them) may be articulate for
most of the time, but in the face of a ward round consisting of a number of
professionals, can be reduced to the silence of stone. Peter Campbell (2001)
supports the value of independent advocacy: the ability to make a personal
choice of advocate, regardless of their training or qualifications, because it is
the personal alliance that matters. He questions whether advocacy ‘works’, in
the sense of securing better results, but believes that having someone on your
side throughout your experiences is worth fighting for.
Crisis cards, on the other hand, may have a practical use that will enable
their value to be appreciated by service providers and service users alike.
They were originally conceived of as advocacy tools, to enable people to contact
someone on behalf of the card carrier, who would offer support in a crisis.
In some places where crisis cards have been implemented, their use has
become somewhat more elaborate and often service-focused – with named
keyworker, sometimes services, and even information about medication.
These additions may not detract from their original intention (to ensure that
the person experiencing a mental health crisis receives the help they want) so
long as they are drawn up with the full consent and involvement of the card
carrier. Difficulties may emerge in situations where the card becomes more
complex and more negotiation with mental health workers is required.
Which brings us to advance directives. An advance directive (also
known as a ‘living will’) allows someone to make decisions before
they become ill, about their future treatment. These decisions cannot be
ignored unless:
• the advance directive does not apply to the particular situation which
arises;
• the advance directive is not clear;
• or if the Mental Health Act is used to override a person’s intentions
regarding treatment.
Advance directives are designed to establish – and, essentially, communicate
to others – a person’s preferences for treatment should they become
incompetent to express these in the future to treatment providers. The
principle behind an advance directive is to enhance an individual’s ability