Psych · Professional practice — advocacy
Advocacy in mental health
Also known as Consumer advocacy · Carer advocacy · Peer workforce · Lived experience workforce · Self-advocacy · Systemic advocacy · Nothing about us without us · Co-production in mental health
Exam-exhaustive fellowship topic on advocacy in mental health — individual, group and systemic advocacy; the consumer and carer movements; the peer/lived-experience workforce and its evidence base; self-advocacy through psychiatric advance directives and joint crisis plans; co-production without tokenism; CRPD rights, will and preferences; the clinician as advocate and the conflicts that come with it. FRANZCP W01-primary, globally tagged.
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Red flags
- Speaking 'for' a patient who can speak for themselves — advocacy that removes voice is not advocacy
- Peer roles created without pay parity, supervision or role clarity — tokenism that harms the worker and the service
- Using advance statements as paperwork that no one reads at 3am — a plan not embedded in the record is not a plan
- Carer exclusion by reflex 'confidentiality' — you can always receive information and give general education
- Clinician advocacy with undisclosed conflicts of interest (industry, institutional, media)
- Presenting the CRPD position or its critique as settled law — state the debate, do not invent statutes
Meet the patient
Your patient — 34, schizophrenia, two involuntary admissions — arrives with a folder. Inside: a housing appeal, a Centrelink review, and a one-page document he wrote in remission that says "if I become unwell: call my sister, no depot in the first week, and never my father."[5][8]
He asks you two things. Write to housing. And promise the plan will be read next time.[4][7]
Most registrars can do the letter. The exam — and the patient — care far more about the second promise.[6][7]
References20ShowHide
- [1]Lloyd-Evans B, et al. A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness BMC Psychiatry, 2014.PMID 24528545
- [2]Cooper RE, et al. The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review BMC Med, 2024.PMID 38418998
- [3]Gillard S, et al. Implementing peer support into practice in mental health services: a qualitative comparative case study BMC Health Serv Res, 2024.PMID 39261915
- [4]Tinland A, et al. Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness: A Randomized Clinical Trial JAMA Psychiatry, 2022.PMID 35662314
- [5]Swanson JW, et al. Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness Am J Psychiatry, 2006.PMID 17074946
- [6]Thornicroft G, et al. Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial Lancet, 2013.PMID 23537606
- [7]Henderson C, et al. Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates BMC Psychiatry, 2017.PMID 29178895
- [8]Farrelly S, et al. What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans Soc Psychiatry Psychiatr Epidemiol, 2014.PMID 24691492
- [9]Szmukler G, et al. The UN Convention on the Rights of Persons with Disabilities: 'Rights, will and preferences' in relation to mental health disabilities Int J Law Psychiatry, 2017.PMID 28647294
- [10]Hoffman SJ, et al. Is the UN Convention on the Rights of Persons with Disabilities Impacting Mental Health Laws and Policies in High-Income Countries? A Case Study of Implementation in Canada BMC Int Health Hum Rights, 2016.PMID 27836014
- [11]Craigie J, et al. Legal capacity, mental capacity and supported decision-making: Report from a panel event Int J Law Psychiatry, 2019.PMID 30389184
- [12]Galderisi S, et al. Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs World Psychiatry, 2024.PMID 39279422
- [13]Rodolico A, et al. Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis Lancet Psychiatry, 2022.PMID 35093198
- [14]Bøgh Jacobsen N, et al. Caregiver burden among relatives of individuals with severe mental illness: a qualitative systematic review Nord J Psychiatry, 2026.PMID 42312619
- [15]Sreeram A, et al. Anti-stigma initiatives for mental health professionals-A systematic literature review J Psychiatr Ment Health Nurs, 2022.PMID 35500153
- [16]Hopkins I, et al. What Do We Know About Sharing Power in Co-Production in Mental Health Research? A Systematic Review and Thematic Synthesis Health Expect, 2024.PMID 39235102
- [17]Åkerblom KB, et al. Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review Adm Policy Ment Health, 2023.PMID 36396756
- [18]Sashidharan SP, et al. Reducing coercion in mental healthcare Epidemiol Psychiatr Sci, 2019.PMID 31284895
- [19]Giacco D, et al. Interventions for involuntary psychiatric inpatients: A systematic review Eur Psychiatry, 2018.PMID 30118918
- [20]Stacey D, et al. Decision aids for people facing health treatment or screening decisions Cochrane Database Syst Rev, 2024.PMID 38284415