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Introduction
Advocacy is commonly framed as supporting people to “have a voice” and is conceived of as a way to achieve social justice (Action for Advocacy, 2002). In a mental health context, advocacy has its foundations in mental health activism and the critique of psychiatry, which led in 2007 to establishing a right to independent advocacy under English mental health law. Its significance in safeguarding human rights and promoting the empowerment of people experiencing mental ill health has been recognised internationally by the World Health Organisation (WHO, 2003).
Research suggests advocacy can be “life changing” and its outcomes wide ranging for both children and adults supported by health and social care services (Thomas et al., 2016). However, reviews of the literature highlight gaps in the evidence base demonstrating its impact (Newbigging et al., 2007; Macadam et al., 2013; Perry, 2013). Despite widely held belief in the transformational power of advocacy, and reporting of positive individual stories (NDTi, 2016a, b), there is a failure to demonstrate its impact systematically. There is also little understanding of impact from the perspective of people using services, with studies mainly considering outcomes from advocates’, professionals’ and family carers’ perspectives (Perry, 2013; Bocioaga, 2014; Lonbay and Brandon, 2017).
Background
Increasing participation, choice and control, and the self-determination of people who use health and social care services are at the heart of social policy reform intended to radically transform service delivery and support in the twenty-first century (Leadbeater, 2004; NHS England, 2015). At the centre of mental health policy including Future in Mind (DH & NHS England 2015) is an emphasis on changing the professional: user dynamic to one that acknowledges people as “experts by experience”. This underlines the importance of co-production and shared decision making between service users and professionals based on trust, respect and a willingness to share different forms of knowledge (Ramon et al., 2017). Concurrently, England has seen the parallel introduction of the statutory right to independent advocacy in mental health and wider: in 2002, the English Adoption and Children Act supported children in care and care leavers with making complaints under the Children Act 1989; the right to an Independent Mental Capacity Advocate for individuals deemed to be lacking capacity was introduced under the...