Opinion piece by Aoife Price, DARE research fellow and Katie Hussey
From mid-2012, a private psychiatric facility in Ireland worked to establish a youth advocacy service for young people under the age of 18 who were engaging with their inpatient mental health services. Both authors, Aoife and Katie, were heavily involved in the initial advisory panel that was established in the creation of the service and then subsequently in the pilot programme that was rolled out in the facility.
The program involved a panel of former service users working as advisors in tandem with an independent advocate employed by the facility, holding weekly discussion groups with inpatients in the unit. It was designed to be a space where young people could raise any questions they had regarding their rights and entitlements during their time in hospital. The advocate would then relay these questions back to the advisory panel for their take on any matters discussed.
The ultimate objective being for the advisory panel to provide peer support to those being treated in the facility on an inpatient basis. The panel was run on a voluntary basis, with those involved receiving a stipend for their contribution. Despite being lauded as a pioneering step in terms of advocacy in the area of youth mental health, the program ceased to exist after failing to overcome a number of challenges. The authors are currently using their past experience of being involved with the pilot to assist in planning for the establishment of an analogous independent advocacy service for young people using mental health services in Ireland.
The vision is to build on the foundations previously created in order to work towards ensuring that children and young people are fully aware of their rights and entitlements when accessing mental health services, and that they feel confident and comfortable discussing their treatment throughout.
Peer advocacy empowers young people to fully understand their rights as service users as well as giving them the opportunity to express their concerns through partnerships with other young people who have shared similar experiences. The overall aim of peer advocacy is to encourage young people to develop the self-confidence and skills required to make informed decisions regarding their own mental health and wellbeing into the future.
On the other side, those acting as peer advocates, themselves now involved in meaningful participation, have the chance to unlock new skills and to derive positive benefit from their participation. It is important for children and young people to feel informed and comfortable enough to ask questions regarding their treatment.
There is a plan to engage with parents and guardians and to provide them with the tools required to support their children throughout their time in treatment. At present, the service aims to include young people under the age of eighteen in inpatient settings. The end goal would be to expand the programme to include people up to age twenty-five.
It is imperative that service users feel completely comfortable in being vulnerable whilst making their voices heard. It would be incredibly difficult to express worries or concerns if there was any lack of or confidence in the proposed advocacy model. This is why it is envisaged that peer advocates involved in such a program will need to be of a similar age to those receiving treatment in mental health facilities.
This is necessary to create a space where service users will be comfortable discussing their opinions and concerns with advocates who they consider to have a substantial number of shared traits and life experiences with themselves. Something which many young people may not feel comfortable doing with treating clinicians or staff members of the facilities where they are receiving their treatment.
It is hoped that utilising past experience in combination with the insights gained from clinicians and other experts in the field of mental health during interviews undertaken as part of further research will assist in taking the first steps in creating a new version of the service. The authors have received funding which will give them an opportunity to explore the issue further. The allocated funding will be used to undertake a feasibility study, which will focus on talking directly to young people who are currently using child and adolescent mental health services. It will take on board their opinions and thoughts on the idea of having a peer support service available to them and the potential benefits or pitfalls such a service could provide.
Those who have lived experience of availing of mental health services are in the best place to advise on how these services can be improved to ensure that they continue to be fit for purpose. A peer advocacy service would allow for a greater understanding of young people and their experiences as well as how services can best support them in their recovery. This will allow them to leave services with an understanding of their rights and entitlements and how to best use their voice in a way that works for them. As noted above, there are potential benefits for both those availing of services and those acting as peer advocates.