DIPLOMA CHCMHS008

 Make sure questions do not include assumptions.  Allow others to express their feelings without offering solutions.  Shift your own ideas to take into account new information.  Empower the individual or group entering into self-advocacy. To further your understanding and find practical suggestions of how to use strategic questioning effectively, you can learn more from Fran Peavey’s Strategic questioning manual (Links to an external site.) . Types of strategic questions In Fran Peavey’s assessment of approaches to change, Peavey identified strategic questions that should be asked when working with individuals or groups who want to self-advocate. The types of strategic questions are described here.  Focus questions  Observation questions  Feelings questions  Visioning questions  Change questions  Alternative questions  Personal inventory and support questions  Personal action questions Focus questions identify the situation and gather the key facts necessary to understand the issue. These are context questions, rather than strategic, required to establish a general understanding of the issue to be discussed. Example: ‘What are you most concerned about in the area of mental health services?’ Clarify advocacy issues Asking strategic questions of an individual or group will allow you to clarify their advocacy issues. Sometimes there may be a number of issues faced by a person. If this is the case, ask questions that get to the root cause of the problem so that you can get a clear idea of what the person’s main advocacy issue is and work to help them solve their own problems, one at a time. Write down the answers an individual or group gives you so you can refer back to the information in the future, and record how you assisted them to prepare for self-advocacy. Strategic questioning will allow you and the self-advocates to:

possible so occasional problems do not develop into something more serious. Depression Depression is the most common mental health problem and, according to the World Health Organization (WHO), one of the leading contributors to the global burden of disease and disability. Depression affects people of all ages, genders and backgrounds, and WHO predicts the impact of depression will continue to grow worldwide. This WHO factsheet (Links to an external site.) provides clear information and statistics. Treatment for the milder forms of depression involves a combination of medication and psychological treatments, such as cognitive behaviour therapy (CBT) and interpersonal psychotherapy. A person with depression may have symptoms such as:  a prolonged and unusually sad mood  loss of interest in activities they previously enjoyed  tiredness and lack of energy  loss of confidence and low self-esteem  difficulty sleeping  difficulty concentrating and making decisions. Beyond Blue is an Australian charity that provides and information and resources to support people with mental illness and to promote good mental health. Their resources on depression (Links to an external site.) include videos, factsheets, checklists, publications and personal stories. This TED-Ed video helps to illustrate the difference between clinical depression and simply feeling depressed, and suggests common ways to provide support: Source: TED-Ed (Links to an external site.) Anxiety disorders As with depression, most people experience anxiety from time to time, but this does not mean they have an anxiety disorder. Normal anxiety is not as severe as an anxiety disorder; it does not last as long and does not disrupt a person’s work or social relationships to the same extent. There are many different types of anxiety disorders, including generalised anxiety disorder, panic disorder, phobic disorders, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). The following includes an outline of the symptoms of anxiety disorders.

Advocates support people receiving mental health support to meet the outcomes they desire. Advocacy can be on behalf of an individual, a group of individuals, a community, or for a specific cause. In some situations, a person is legally entitled to an advocate. The role of an advocate in the mental health sector is further described here.  What an advocate will do  What an advocate will not do An advocate will:  listen to the person’s views and concerns  help the person to explore their rights and options  provide information to the person to help them make informed choices  assist the person to contact relevant people or contact them on the person’s behalf  accompany and support the person in meetings or appointments, if requested. Self-advocates Self-advocates are individuals or groups who stand up for their own rights and ensure their opinions and wishes are heard in matters affecting their lives. Self-advocates should understand their rights and responsibilities, speak up for those rights, and make choices and decisions that affecting their care and recovery. The purpose of self-advocacy is for the individual or group to decide what they want, and then develop and carry out a plan to help them achieve their goal. Self-advocates may still require help and assistance, but they make their own decisions and are responsible for the choices they make. Questions about self-advocacy are further explored here.  Why is self-advocacy important?  When is self-advocacy useful?  Where can self-advocacy occur?  What do self-advocates do? Using self-advocacy skills allows individuals and groups to decide what is important to their mental health. Self-advocacy skills enable a person to have more control and make decisions that are in their best interests. Self- advocacy empowers individuals and groups to stand up for issues important to them, and make decisions about their own lives.

The range of information that you may need to provide people to self- advocate will vary widely depending on their needs and individual circumstances. However, they should always start with education about their rights. Section 2 of the National Mental Health Policy 2008 (Cth) (Links to an external site.) sets out these rights. The Australian Human Rights Commission (Links to an external site.) is a tremendous resource for information about people’s rights, including people with a disability or mental illness. Also keep in mind that state/territory legislation may vary depending on your location. Example: Review and provide relevant information on self-advocacy to assist individuals and groups Sonia, a mental health worker, is approached by a group who wants to advocate for the better treatment of people with mental health issues who are involuntarily hospitalised. The group firmly believes that individuals who are ordered to undergo an initial mental health assessment in hospital are not provided with adequate opportunities to negotiate their rehabilitation plan. Sonia meets with the group and asks them a series of strategic questions to clarify their advocacy issues. The group indicates that they would like to know where they can seek legal advice to assist individuals affected. Sonia conducts some research and discovers a mental health advocacy service that provides free independent advice about all areas of mental health law. She passes on service contact details to the group and encourages them to make contact without her assistance. 1.3 Assist clients to clarify their own needs and rights Self-advocates must understand their needs and rights, and identify situations in which their rights are being infringed upon or needs are not being met. Promoting and facilitating self-advocacy with an individual or group with mental health needs means that all of your actions and the way you work should reflect the person’s right to direct their own care and recovery. To effectively assist individuals or groups to undertake self- advocacy activities, you should first gain an understanding of:  the rights of individuals and groups accessing mental health services

Australia's anti-discrimination laws (relevant to the mental health industry) are contained in the following legislation:  Australian Human Rights Commission Act 1986 (Links to an external site.)  Age Discrimination Act 2004 (Links to an external site.)  Disability Discrimination Act 1992 (Links to an external site.)  Racial Discrimination Act 1975 (Links to an external site.)  Sex Discrimination Act 1984 (Links to an external site.) The Australian Human Rights Commission is the primary source for information about anti-discrimination legislation and requirements in Australia. They offer a range of factsheets and other valuable resources, including on age discrimination (Links to an external site.) , racial discrimination (Links to an external site.) , sex discrimination (Links to an external site.) and disability discrimination (Links to an external site.) . You can also find important information from the Australian Human Rights Commission, including information on gender equality legislation (Links to an external site.) and requirements. Keep in mind that discrimination can occur against any marginalised group, including refugees, Aboriginal and Torres Strait Islander people and LGBTQI people. In your work as a mental health support worker, you are likely to encounter people who may suffer from discrimination as a member of multiple groups. To learn more about these different types of discrimination, visit the Australian Human Rights Commission website (Links to an external site.) . This video highlights the links between racial discrimination and mental health issues (allow 25 minutes to watch in full): Source: Canadian Mental Health Association (Links to an external site.) Duty of care Duty of care is part of the body of common law. There is no specific Act outlining duty of care — it is part of the broader legal concept of negligence. Another word for negligence is carelessness. Duty of care means that in any situation where one person’s actions may affect another person, there is a legal duty to act in ways that are not careless and do not cause harm to the other person. Duty of care principles have been established by the law of torts. ‘Torts’ is a legal term that can be broadly translated as wrongs. When working with consumers who receive mental health support, you have a duty of care to offer a safe environment and to provide the best support you can in every situation. As a support worker, it is vital that you fully understand duty of care and the extent of your responsibilities. Your workplace policies and procedures will have information and directions to follow, but you can also educate

Promotion and prevention The MHS works in partnership with its community to promote mental health and address p Individuals Individuals have the right to comprehensive and integrated mental health care that meets th terms of their recovery. Carers The MHS recognises, respects, values and supports the importance of carers to the wellbei Governance, leadership and management The MHS is governed, led and managed effectively and efficiently to facilitate the delivery Integration The MHS collaborates with and develops partnerships within its own organisation and exte integrated services for individuals and carers. Delivery of care The MHS incorporates recovery principles into service delivery, culture and practice provi that will support sustainable recovery. Key principles informing the Standards Here are some of the key principles that inform the National Standards for Mental Health Services 2010.  Promote an optimal quality of life  Decision-making  Nominated carer  Collaboration  Person-centred approach  Rights and choices

Share information When supporting a person, it may be necessary to work with a range of other agencies. A person (or their representative) must give consent before any information is shared with or accessed from another agency. Most community organisations gather this consent using a specific form. Consent is given for access to particular information for a particular purpose. You must not pass on information without the person’s consent. People receiving services have a right to know what you record about them and to see their own records. A person’s record is highly confidential and you may be required to sign a confidentiality agreement when you are employed, saying you will not, without consent, divulge any information that you have acquired during or after your involvement with people to whom you provide services, unless legally required to do so. Between them, agencies may share:  information to enable referrals  incident reports  support plans and goals  information about individual needs. These information-sharing guidelines (Links to an external site.) developed by the Queensland Government will give you a good idea of when information can be shared. Keep in mind though, they are based on Queensland legislation and the state or territory where you live may have its own set of guidelines to follow. Always check with your supervisor and/or workplace policies and procedures if you are unsure about whether you can share information. If in doubt, do not share any information until you have clarified with your supervisor. Disclosure of confidential information There are some instances in which you are permitted to disclose information as part of your duties. For example, if the person is being referred on for medical treatment regarding mental health issues, the hospital, specialist or doctor needs to know the person’s history, allergies and personal details. You must always obtain the person’s informed consent before you disclose confidential information to a third party. There are some situations where you may be required to disclose confidential information. Disclosure of confidential information may be required when:  compelled by law; for example, if the person has a reportable disease or the information is requested by a court of law

 a person’s interests require disclosure and there is a serious risk that justifies breaching confidentiality; for example, risk of suicide, self- harm or harm to others  there is a duty to the public; for example, there is public threat or concern  the person has consented to the disclosure. These circumstances will clearly be laid out in your workplace policies and procedures and there will be specific forms to complete to document your actions. Policy frameworks The National framework for recovery-oriented mental health services (Links to an external site.) provides a new policy direction to improve and enhance mental health service delivery in Australia. It combines a range of recovery-oriented approaches developed in each Australian state and territory, and draws on national and international research to provide a national understanding and approach to recovery- oriented mental health practice and service delivery. The purpose of the framework is to improve outcomes and quality of life for people with mental health issues, illnesses and disorders. The framework was developed through an extensive consultation process involving individuals and organisations across Australia. The lived experience and insights of people with mental health issues and their families are central to the framework. It is designed to help mental health professionals in a range of settings to align their practice with recovery principles. Mental health settings include hospitals, community mental health services and other public, private and non-government health and human service settings. The framework applies to all people employed in the mental health service system, regardless of role, profession, discipline, seniority or degree of contact with people accessing services. It is also designed for people working in administration, policy development, research, program management and service planning. Resources for practitioners, services, carers and mental health consumers to help in the implementation of the framework are available at the Department of Health (Links to an external site.) . Rights and responsibilities In every organisation, whether it is public or private, small or large, everyone has rights and responsibilities. For example, an employer has a right to expect certain levels and standards of performance from employees, and employees have a right to expect certain conditions from employers. The employer is responsible for the successful operation of the

organisation; employees must complete their work tasks to ensure the operation runs efficiently. Your primary responsibility when supporting people with mental health issues is to ensure the person’s safety.  Employee rights  Employee responsibilities  A safe workplace  A workplace free from harassment and discrimination  Access to grievance (complaint) process  Wages in accordance with the award rates  Clear direction of duties  Being punctual, courteous and respect cultural diversity The Fair Work Ombudsman (Links to an external site.) and SafeWork Australia (Links to an external site.) have additional information about workers’ and employers’ rights and responsibilities. These have been expanded to address the COVID-19 pandemic (Links to an external site.) . You and your workplace have specific rights and responsibilities to ensure that you, other workers, visitors and clients all remain safe. You will receive specific training in the workplace and must comply with your workplace health and safety guidelines at all times. Individual’s rights and responsibilities Most community services organisations will have policies and procedures that express and protect the rights and responsibilities of the people receiving services. These policies may be based on legislation and legislated standards, as in the disability services sector; or on individual organisational values. Information about the rights and responsibilities of the people receiving services from a particular organisation or within a particular industry sector can be found in service standards, professional practice standards and organisational policies. Here are some examples of an individual’s rights and responsibilities.  Rights  Responsibilities Individuals have the right to:  be treated with respect and dignity  be consulted

 be involved in the decision-making process  have their privacy and confidentiality respected  a complaints process. These rights and responsibilities must be communicated effectively to people with whom you are working, and/or displayed on your organisation’s website. They may also be different rights and responsibilities according to location, type of service and in the case of compulsory mental health orders. To see one example, watch these videos from NorthWestern Mental Health (Links to an external site.) , a MHS in Melbourne: Source: NorthWestern Mental Health (Links to an external site.) Employer’s rights and responsibilities Here are some rights and responsibilities of an employer. Rights and responsibilities of an employer include the following:  Providing a safe workplace.  Ensuring that you have all the skills, knowledge, training and qualifications required to carry out your role competently.  The right to expect certain levels and standards of performance from employees. Work role boundaries Working within the legal responsibilities and limitations of your role is essential. If you step outside these boundaries, you may cause harm to people who receive services and you may also risk legal action for damages against you and your employer. Understanding legal responsibilities and limitations protects the people you provide support services to, yourself, your employer and your colleagues. The key source of information setting out the responsibilities and the limitations of your work role is a duty statement. When a duty statement is developed, the employing organisation will check relevant legislation and service standards, as well as organisational policies, to make sure the duty statement meets these requirements. Organisational policies and procedures are also sources of information. Maintaining clear work role boundaries can be complex at times: it is important to raise concerns with your supervisor if you are unsure. Some of these issues and good work practices for support workers are discussed by Mabel Technologies (Links to an external site.) , Relationships Australia (Links to an external site.) and this factsheet by Queensland Health (Links to an external site.) .

Work health and safety On 1 January 2012, the Work Health and Safety Act 2011 (Links to an external site.) (Cth) came into effect, replacing the Occupational Health and Safety Act 1991 (Cth). This model legislation was developed by the Commonwealth government to harmonise workplace health and safety laws across Australia. The object of the harmonisation of work health and safety laws, according to the Explanatory Memorandum – Model Work Health and Safety Bill (Links to an external site.) (Safe Work Australia, 2010), is to:  protect the health and safety of workers  improve safety outcomes in workplaces  reduce compliance costs for business  improve efficiency for regulatory agencies. For the Act to be legally binding, it must be passed by the Parliament in each state and territory. WHS laws are based on duty of care principles applied specifically to places of work. This means that everyone in a workplace has a duty and responsibility to contribute to safety. Employers have a duty to provide a safe workplace; workers have a duty to follow WHS policies and procedures and to identify and report safety issues. Workplace WHS policies and procedures must be followed at all times, and may change over time, such as with the current COVID-19 crisis. Compliance with WHS requirements is an essential job requirement for all support workers. Speak to your supervisor and/or WHS Officer in your organisation, and explore the resources at your state/territory Safe Work organisation (Links to an external site.) . Exercise rights By exercising their rights, a person with mental health needs can play a role in changing attitudes and reduce the negative stigma attached to mental health. By changing stereotypes and the perceptions held by the community and portrayed in the media, the public can be made more aware of the facts about mental illness. This means that people with mental illness are more likely to be included by their community and feel less isolated. An individual might exercise their rights through self-advocacy. This means the person can influence the way their service is provided. A person might also exercise their rights at a government level, in which case the person can have input into policy and government plans for current and future mental health services.

Watch this video from Equip for Equality and about what self-advocacy for people for mental illness can involve: Source: Equip for Equality (Links to an external site.) Keep in mind that this video was created by a US organisation: specific recommendations may vary for people in your location. Determine when rights are being infringed or unmet Mental health consumers have a right to self-determination under mental health legislation and standards, but there are instances where these rights are infringed or are not being met by mental health service organisations, professionals, or treatment facilities. This is especially so in the absence of consent. As a mental health worker, you must assist individuals and groups to determine if their rights are being infringed or not being met. To access examples of human rights violations of mental health consumers and the strategies recommended by the World Health Organisation (WHO) to eliminate or minimise the risk of these violations occurring, visit the WHO website. (Links to an external site.) Social justice principles Social justice contains the notion of equality and equal opportunity in society. It may also be viewed as ‘justice as fairness.’ Social justice principles target the marginalised and disadvantaged groups in society. People with mental health issues often fall into the category of the marginalised and disadvantaged. Social justice principles may include human rights, self-determination, access and equity, participation and empowerment. As we discussed above, social justice principles for mental health align with many other social justice campaigns for change. As an example, watch this RUOK video that discusses the intersection between racial social justice and mental health: Source: Project UROK (Links to an external site.) Human rights Human rights recognise the value of every person, regardless of background, where we live, what we look like, what we think or what we believe. Human rights are based on principles of equality and respect, shared across cultures, religions and philosophies. They are about being treated fairly, treating others fairly and having the ability to make genuine choices in our daily lives. Respect for human rights underpins the values

and principles of the mental health sector and should be applied by all workers when supporting consumers with mental health issues. It allows all people to contribute to society and feel included. Watch this TED-Ed video that explains how the concept of human rights has developed and been legally recognised: Source: Ted-Ed (Links to an external site.) Treat all people in your care with respect. Ensure the person has access to a safe environment, and use principles of cultural safety when supporting them. These are not only ethical values to uphold but are codified into law, making them legally mandated. Self-determination Self-advocacy is built of the principles of self-determination. As a mental health worker, it is critical that you do not control or make decisions for the mental health consumer, but instead, advise and oversee the person, and encourage them to make the right decision that meets their individual needs. The mental health consumer should be the person responsible for deciding how their recovery program is developed and administered. Not only does this involvement give them the opportunity to choose services and strategies that meet their needs, but it also reinforces the person’s self-determination and respect. Your goal as a mental health worker is to work in partnership with the person to develop their sense of self-empowerment and build independence, participation in the community, and the skills and confidence to determine and implement their own decisions. The four principles of self-determination are outlined in the following tabs.  Freedom  Authority  Support  Responsibility The ability of individuals and groups with freely-chosen representatives to plan and make decisions about their lives with the necessary support, rather than to adopt a pre-planned program developed by the mental health system. In practice, self-determination principles involve treating each person with dignity and respect and recognising each person is an individual, with their own ability to makes choices and decisions for themselves.

This video demonstrates the importance of self-determination in supporting people with mental illness: Source: Centre for Inclusion and Citizenship ~ Rights-Based Social Policy (Links to an external site.) Access and equity Recognising and respecting diversity means encouraging access and equity for everyone. The law makes sure that people in the community and within organisations offering mental health services do not discriminate or act with prejudice. Knowledge of the cultural and religious factors that impact a person allows mental health workers to develop relationships based on respect and where communication reflects and recognises the importance of these values to the person. Mental health workers need to reflect on how a person’s culture may affect that person’s behaviour and thoughts. Attitudes towards mental health have changed dramatically over the years. Approaches to working with people with mental health needs have also changed to reflect these shifts in attitude. Such changes have also influenced political, government and economic decisions. In some cases, social attitudes have changed as a result of policies and decisions made by governments. Part of ensuring access and equity is understanding and respecting different cultures and their understanding and different experiences with mental illnesses. For example, many Aboriginal and Torres Strait Islander people are dealing with grief, trauma and social disadvantages. Developing your cultural competency will help you work effectively with people from different cultures and uphold their rights. This NSW Health video is the first in a series about working with Aboriginal and Torres Strait Islander people in mental health care: Source: NSW Health (Links to an external site.) Empowerment Empowerment is a major principle of the mental health sector and drives the way mental health workers support people with mental health needs. Empowerment is about power dynamics and encourages the idea that people with mental illness are the experts in their own lives. Empowerment supports these people and their families to make informed decisions and choices about their goals, needs and delivery of services. A disempowered person will find it difficult to make choices and decisions, and may see themselves only as a patient.

Empowerment in mental health services is more complex than is often expressed in popular culture and social media. To gain a more nuanced version of what empowerment is within mental health care, watch this video: Source: Dr Todd Grande (Links to an external site.) The following offers a comparison between an empowered and a disempowered person.  Qualities of an empowered person  Qualities of a disempowered person  Decision-making power  Access to information and resources  Assertiveness  Understanding that people have rights  Uses the opportunity to contribute to the development and management of mental health services  A positive self-image and overcomes stigma 1.4 Work with others to evaluate and negotiate advocacy options As a mental health worker, you should work with individuals and groups to evaluate and negotiate their advocacy options. Self-advocacy is just one form of the advocacy available to mental health consumers and may not be the most appropriate choice for every individual, or at a specific time. There may be other advocacy options that are more appropriate for people to use in addressing their mental health issues. Each situation needs to be addressed individually. A person with mental health needs may require the assistance of an advocate to represent their interests, needs, rights and preferences in situations where the person:  is not mentally strong enough to represent themselves  does not have the requisite skills and knowledge  does not have access to appropriate resources  is not confident in self-advocacy  does not have the mental or physical capacity to make decisions about their care and treatment without assistance.

Whenever you work with mental health consumers, you must ensure that you work within your work role boundaries, responsibilities and limitations. Advocacy functions Advocacy is the process of standing alongside an individual or group who is disadvantaged, and speaking out on their behalf in a way that represents their interests, needs, rights and preferences. The purpose of advocacy is to bring about beneficial outcomes in a way that enables each mental health consumer to retain as much control and independence as possible over how services are delivered. Advocates provide information and advice to people with mental health needs in order to assist the person to take action to resolve their own concerns, or may take an active role in representing the individual or group’s rights to another person or organisation. Advocacy incorporates a number of discrete functions, including:  promoting the interests of mental health consumers to ensure government, agency, and service provider accountability  monitoring compliance with international and national obligations  scrutiny of legislation, programs and initiatives  conducting or coordinating research to promote best practice in relation to mental health  resolving complaints and conducting inquiries into individual concerns  supporting and assisting mental health consumers to access services or obtain redress for complaints or issues  encouraging the development of structures to enable people with mental health needs to be active participants in the decision-making processes affecting their lives. Advocacy approaches and options Self-advocacy approaches are underpinned by the principles of the Mental Health Act 2014 (Vic.) and by relevant legislation in your state or territory. In every situation, there are various advocacy options available. Evaluate the situation of the person you support and help them to select an advocacy option that suits their needs and interests, and that will achieve the best possible outcome. The primary focus should be on the person with mental health needs, and you should present them with all available options to ensure they receive the most comprehensive service available. Take action to link consumers with existing community-based services with the goal of making these services more approachable and useful to the consumer. Some of the advocacy options available are shown here.

 Self-advocacy  Individual advocacy  Group advocacy  System advocacy  Peer advocacy  Legal advocacy  Parent advocacy  Crisis advocacy  Professional advocacy Self-advocacy means standing up for yourself. Anyone can act as their own advocate. It involves a person making an informed decision about an issue important to them and then taking responsibility for bringing about the change necessary to make their choice a reality. This information from SCIE (Links to an external site.) discusses types of advocacy as relating to people with a disability. It is important to educate yourself about the types of advocacy that may be relevant for different people at different times, so that you can provide them with individualised support. In this short interview with disability advocate Sue Salthouse, identify how many areas and types of advocacy she discusses and calls for: Source: ABC Australia (Links to an external site.) Evaluate options Evaluating advocacy options for an individual or group will depend on their situation, their advocacy issue, and their individual needs and preferences. Generally, you can evaluate advocacy options by:  holding discussions with people of identified choice for the purpose of addressing a specific concern or issue  holding discussions with individuals or services of choice based on acquisition of accurate information to achieve self-advocacy  holding discussions about the differences between advocacy and self- advocacy and related services. Always apply a person-centred approach and provide people with relevant advocacy options to them, and support their choices. The role of the advocate As an advocate, your role is to assist and provide support to an individual or group of mental health consumers, in order to have their voice heard. It is not up to you to negotiate an outcome that meets the needs of both parties, as is the way in mediation or conciliation. You must position

yourself on the side of the individual or group you represent, and be biased in meeting the person’s needs, rights or interests. Negotiation is a bargaining process between two or more parties, seeking to reach an agreement to settle a matter of mutual concern or resolve a conflict. Negotiations are conducted by a negotiator who confers with others in order to come to terms or reach an agreement. The differences between key roles in the negotiation process are described here.  Facilitation  Mediation  Conciliation  Arbitration Facilitation refers to the intervention of a third party to promote the resolution of conflict. A facilitator helps a group of people to understand their common goals and assist them to plan how they can achieve these goals. The facilitator must remain neutral and not take a particular position during the discussion. Relationships Australia goes into detail about mediation (Links to an external site.) , as well as describing other forms of conflict resolution. Depending on the person’s needs, various forms and roles in the negotiation and conflict resolution process might be required. Types of support When providing support or advocacy services for people with mental health needs, it is useful to consider and review the types of support that can be offered. These are outlined here. Emotional support Living with mental illness can be emotionally demanding and stressful. Offering emotio Practical support Practical support includes housing, transport, managing finances and completing forms Financial support Many people experience financial hardship because their earning capacity is impacted. Spiritual support

Many people find comfort in their spiritual beliefs and need these nurtured. Acknowledg Physical support Some people with mental health needs can become aggressive, risking the physical sa Clearly, each individual will have specific needs and priorities that will need to be supported. Your role is to help them identify and access the types of support they need, using appropriate forms of advocacy. Example: Work with others to evaluate and negotiate advocacy options Jenny was diagnosed with a serious mental illness when she was 17. For the first few years she didn’t consider working because she was struggling to cope with her life. She often speaks to her mental health worker, Suzi, and others at the service she attends, that she is unhappy with changes recently made to her treatment plan by her psychiatrist. She has raised the issue with her psychiatrist, but he insists that inclusion of stronger medication will be more effective for her recovery long-term. Jenny asks Suzi if she would assist her to have a more decisive role in her treatment and recovery. Jenny says that is not confident enough to challenge her psychiatrist and would like the assistance of a third party to help her express her needs. Jenny and Suzi sit down and carefully discuss Jenny’s concerns. Suzi explains to Jenny the different type of advocacy options available to her. Suzi assists Jenny to contact a mental health advocacy service in her local area that can support Suzi to:  gain skills, knowledge and education on how to advocate for herself  have more control over her psychiatric treatment plan, including making decision on the medication prescribed to her. 1.5 Document advocacy options It may be necessary for you to document the different advocacy options selected by the individual or group you support so that they can take information with them and evaluate their options before making a decision. Follow your organisational policy and procedures, and offer appropriate documentation, which could include brochures, pamphlets,

printed information from a website, contact details, or other informational handouts. Documenting advocacy options, interactions and service details about a person with mental health and/or advocacy needs is an important job that should always be done in a professional manner outlined by your organisation’s policies and procedures. There are several legal requirements for the reporting, secure storage and access of these reports. The person with the mental illness should have their privacy and confidentiality rights respected and the records management system of an organisation should be such that these legal and ethical values are incorporated into their operations. You can see what is typically included in a policy related to advocacy in this template from the Mental Health Care Coordinating Council (MHCC) Download template from the Mental Health Care Coordinating Council (MHCC) . Document an advocacy action plan If the individual or group you support decides to pursue self-advocacy or another advocacy option, you should develop a document that outlines a structure for taking action. Here is some more information on the steps to documenting an advocacy action plan. Clarify the advocacy issue Clearly label the issue by writing a concise and descriptive title. Identify the relevant stakeholders Make a list of the decision-makers and other relevant stakeholders that have the power and things relating to the issue. When collecting contact information, include the names, roles a Plan actions Make a list of the actions or steps that need to be taken for the advocacy process to take pla person responsible for ensuring it occurs. Take action

Record the action that has been taken and the results that were achieved. Evaluate the effec action that needs to occur. Make recommendations for how the process could be improved Community Tool Box offers a range of resources (Links to an external site.) useful for groups wanting to undertake advocacy actions, including checklists and templates, as well as how-to guides. The kind of plan needed for an individual may differ. Check with your organisational policies and procedures: they may have a template that you can use or adapt. Documentation Mental health workers have a responsibility to document information about the services being delivered to people, and this documentation must be completed in the manner that reflects the policies and procedures of the organisation. Supervisors provide the necessary guidance for policies and procedures when a person first starts work with an organisation. Failure to meet the employing organisation’s standards for record keeping can put people’s care at risk and can damage the reputation of the organisation. While there are many similarities between how organisations manage information and their standards for note-keeping, each service will have its own protocols that must be followed. Records must be documented so:  workers and others can remember what action was taken from one appointment to the next  supervisors and other senior staff can monitor a person’s progress  people are made accountable for their actions  files that are presented in court meet professional standards and endure legal scrutiny  colleagues can read the reports and notes to provide continuity of care for the person  auditing requirements by government regulatory agencies are met  you can reflect on what strategies and actions worked and what did not. Verbal reports There may be instances where you also have to make verbal reports, particularly if you are giving someone instructions or reporting a situation

that requires urgent attention. You can do this by telephone, online conferencing or face-to-face, as required. A verbal report should never be a substitute for a written report, and important information should always be followed up or confirmed in writing. There may be instances where you are unsure of what to do or where you need to relay information verbally to your supervisor. You must always take care not to compromise the person’s confidentiality, and you must always document your verbal communications. Security and access The person’s privacy and confidentiality must always be a high priority in all of your work activities. Do not leave records loose in the file; they should be attached together so nothing can fall out and be lost. Most case files are numbered or coded and are stored and retrieved using this code rather than the person’s name. The reasons and methods used for collecting information are governed by legislation and organisational policies concerning confidentiality and privacy. Each state and territory has laws and regulations regarding the collection, content, storage and availability of a person’s records, including medical records and personal files. Ensuring confidentiality is also part of your duty of care. These policies are designed to help organisations meet their requirements under different legislation, regulations or industry standards, including privacy laws, freedom of information legislation, regulations and codes of practice service standards and principles. Your current or future workplace will have policies that dictate:  who receives information about a person’s progress  how the records are stored  who may access the records  how information is gathered. As an example, read this privacy policy by Mental Health Australia (Links to an external site.) . File documents according to organisational procedures Information must be kept in safe and secure areas. It is common to store hardcopy files in a lockable cabinet with files stored alphabetically by surname. Personal information should not be kept in an area accessible to members of the general public. You must always follow organisational procedures for filing information to ensure that information is not lost and can be readily retrieved by authorised personnel.

Electronic filing systems are common. In most cases, software will allow information to be retrieved by using one or many fields, such as a person’s last name or file number. Electronic filing systems use a password instead of a lock and key to protect the information. You should avoid logging on for another staff member and always log off when leaving the computer. In any organisation there will be policies, guidelines and procedures about where reports and documents are to be filed. Records must be stored in the correct place so that they can be easily located and referred to when required, particularly if information has to be located quickly in an emergency. Example: Document advocacy options Marcelle wants to introduce an electronic recordkeeping system in the mental health organisation for which he works. He thinks that moving from a manual system to an electronic system will provide a more secure way of collecting and storing personal information about mental health consumers. Marcelle’s manager, Clive, asks Marcelle to write a list identifying the benefits of introducing an electronic filing system. The new system will cost a considerable amount and Clive must request permission from the senior management team first. Marcelle creates the following list of benefits of introducing a new system:  It will help to record business transactions, including income and expenses, payments to workers and asset details  It is a more efficient way to keep personnel and consumer records and requires less storage space  It will be easier to generate reports  It will automatically tally amounts and provide reporting functions  It allows the organisation to back up records and keep them in a safe place in case of fire or theft. 2.0 Introduction Mental health workers are responsible for enabling individuals to gain self- advocacy skills so that they have the knowledge needed to succeed, and are given the opportunity to participate in decisions that affect their lives. Mental health workers actively contribute to the facilitation of self- determination and empowerment by collaborating with individuals to develop their self-advocacy strategy and arguments, and helping them to overcome any potential barriers that could prevent the person from accessing mental health supports and services.

Building self-advocacy skills in an individual is best achieved by practice. Using the numerous resources available, mental health workers should provide opportunities for individuals to role-play self-advocacy experiences that equip them to successfully make decisions about their care and recovery in the future. In this module you will learn how to:  build a shared understanding about advocacy issues and choices available  identify potential barriers and relevant strategies to overcome them  collaboratively develop an individual’s self-advocacy strategy and arguments  provide opportunities for practising self-advocacy  identify and utilise self-advocacy resources  support individuals to document the circumstances and events relevant to the advocacy situation. 2.1 Build a shared understanding of advocacy issues and choices available Building a shared understanding about the advocacy issues and choices available allows mental health workers to collaborate with the people they support to make decisions about advocacy strategies and actions, and develop self-advocacy skills in the person so that they can effectively achieve their advocacy goals. When assisting an individual or group to develop an advocacy strategy and build advocacy skills, it will be necessary for everyone involved to have a common understanding about the advocacy issues central to the situation. The best way to do this is to ask questions and use the person’s answers to guide your planning and determine the information that you need to provide. Ask questions To identify, clarify and build a shared understanding of an individual or group’s advocacy issues, a series of questions will need to be answered. Questions may include the following:

 What is the issue?  Is this a new issue?  What is the scale and impact of the issue?  Who is at the cause of the problem?  What rights are being infringed upon?  Has anyone else tried to change this issue?  Who is responsible for making the changes?  What is it that you are unhappy with?  Is the issue a complex one?  What is the root cause of the problem?  What rights are not being met?  What needs to change?  Do the changes need to occur immediately?  Can the issue be addressed slowly or over a specified period of time? The series of questions that need to be asked will depend upon the individual circumstances and should result in clarifying the person’s or group’s advocacy issues. Make sure to use active listening, support people’s communication and access needs and document the answers. Gather information You should encourage and motivate the person with mental health needs to conduct independent research on the advocacy issues relevant to their situation. This will ensure they make an informed decision about the advocacy goals they set, and the advocacy options they choose. Encourage the person with mental health needs to discuss their issues with as many people as possible (if appropriate) to gain an understanding about the scale and impact of the issue, whether it impacts anyone else in the community, and whether it is something that can be changed at all. Information contained in brochures, academic publications, newspaper or magazine articles, handouts, meeting minutes, reports, or other print or digital materials will be useful resources for building a shared understanding of the issue. The person with mental health needs could also attend support group meetings, discussions on the issue, or meet with people directly impacted by the same problem to brainstorm ways that advocacy could be used to achieve the desired outcome. Make sure to support people to access different types of materials that are relevant to them, and to meet any access or communication needs that they may have, such as needing materials in different languages. It can be helpful to have your own portfolio about information that is commonly needed in supporting self-advocacy, such as information/contacts with advocacy groups, information about financial support options etc. Always make sure that the information that you provide is accurate, up-to-date and relevant for the person’s needs. For example, this list of advocacy services and organisations in Victoria (Links

to an external site.) will be useful for those in that state; look for similar lists in your location. Also consider how you can support people to research and locate their own information, where relevant. In some cases, helping people learn how to find relevant information for themselves will be an important support for their self-advocacy. Consider possible solutions Assist the individual or group to consider all possible solutions of the advocacy process. This should include:  the solution they hope to receive  the actions required of them to reach their desired solution  whether they are prepared to do what it takes to achieve their goals. By having a comprehensive understanding of the best-case scenario, the individual or group will be more motivated to work to achieve their ideal solution. It is just as important that you assist the individual or group to consider other possible solutions that may be acceptable, but not ideal. They may need to consider:  what they are willing to sacrifice  what issues they are willing to compromise on  other issues that they consider non-negotiable. To build a shared understanding, consult with the person about the information that they have gathered and the other opinions that they have sought. Where appropriate, work through this with them to consider alternative solutions and options. Some people with mental illnesses can have difficulty making decisions and/or processing information, while others may feel that too many questions are intrusive or undermining their confidence. Use your good communication skills to listen to and work with each person individually. Example: Build a shared understanding of advocacy issues and choices available Rochelle works for a mental health advocacy service in NSW. Rochelle is responsible for providing free and independent legal information, advice and assistance about mental health law to individuals who are appearing before the Guardianship division of the NSW Civil and Administrative Tribunal (NCAT). Warren is referred to Rochelle by his mental health support worker.

Five years ago, Warren was diagnosed as having schizophrenia. He seeks to appeal a financial management order that has appointed Warren’s sister as the manager of his financial affairs. The order states that Warren is incapable of making his own decisions about his finances. Warren ran a successful landscaping business for over thirty years and has built up a considerable portfolio of shares and property during this time. He is worried that his sister will take advantage of her financial guardianship and that he will lose ownership of his assets in the process. Rochelle meets with Warren to discuss how she can act as his legal advocate to deal with this issue. She asks Warren a series of questions to get to the bottom of his issue, including his concerns, his goals, and the solution he hopes to achieve. While Warren seeks to regain the financial management of his wealth, he understands that his mental illness sometimes inhibits his ability to make rational decisions relating to his finances. He tells Rochelle that he would consider his ex-business partner and trusted friend, Simon, to collaboratively manage Warren’s finances with him instead. 2.2 Identify potential barriers and relevant strategies to overcome them To effectively assist individuals and groups to participate in self-advocacy, you must identify any potential barriers to self-advocacy and relevant strategies to overcome them. Developing a respectful relationship with a person with mental health needs allows you to have an understanding of the common, key issues that many people face. Potential barriers People with mental illness face a range of barriers that can impact their treatment and recovery. Such barriers might stem from misconceptions based on a lack of knowledge and community understanding, and can result in discrimination and prejudice. The attitudes of others might cause a person with mental illness to set up internal barriers that inhibit their recovery and can lead to low self-esteem and a lack of belief in themselves. Developing a positive relationship based on respect and understanding of these barriers means that the person is more likely to exercise their rights, direct their own recovery, and facilitate self-advocacy.

The following outlines some of the potential barriers to self-advocacy, which will be explored in more detail. Potential barriers include:  organisation or service-system culture  discrimination, prejudice and judgmental attitudes  insufficient and inaccurate provision of information and withholding of critical information that would promote and support the achievement of self-advocacy  language, literacy and numeracy issues  cultural context and situational interpretations of empowerment and protocols  geographic, economic and social barriers. Social barriers People with mental health issues and illnesses face a range of social barriers that impact their ability to recover and access opportunities for self-advocacy. Most of these barriers stem from negative beliefs, lack of knowledge about mental illness in the wider community and lack of appropriate resources and services. Often the person themselves internalises negative beliefs, which makes it more difficult for them to respond to barriers. Misconceptions and lack of understanding about mental illness result in stigma or negative attitudes about people with mental health needs. This serves to perpetuate stereotypes and misinformation. Many people may be sympathetic to someone with physical disability, but they are often uncomfortable with someone with mental health needs. Stigma about mental illness can be internalised as shame, both by the person with mental illness themselves, or their family members. Watch this TEDx Talk that explores the burden of stigma and shame surrounding mental illness: Source: TEDx Talks (Links to an external site.) Some of the common reactions to mental illness within the community are outlined here. The following reactions explore how the unwillingness to learn about mental illness results in the spread of misinformation.  Reduced contact  Embarrassment  Spread of misinformation When people reduce contact with or fail to understand someone with mental illness, they further isolate and stigmatise the person. When people are unwilling to try to understand what it might be like to have mental health needs, they are

demonstrating that they don’t want to learn or think about mental illness. Understanding comes from empathy. HealthDirect provides useful information about mental health and stigma (Links to an external site.) , and SANE Australia has a program called StigmaWatch (Links to an external site.) , where you can report media items that promote stigma against people with a mental illness. Watch this SANE Australia video where people with a mental illness and their families talk about the effect of stigma on their lives: Source: SANE Australia (Links to an external site.) Internal barriers Stigma may create internal barriers for people with mental illness, such as loss of self-esteem and lack of belief in themselves. Those who encounter discrimination and prejudiced behaviours often start internalising the beliefs of others, often without realising it. They learn that the wider community generally does not understand or trust a person with a mental illness. This can lead to a negative cycle that actively makes recovery more difficult. People with mental health issues or illness may:  feel like they don’t have the same rights as others  blame themselves for their condition  be afraid to raise the issue with family, friends, or health professionals  give up on believing they can be well  give up trying to get a job or somewhere decent to live  lack the literacy skills to read or write information about mental health services  be resistant to change  feel different and ashamed  be less likely to seek the treatment they need  feel too embarrassed to acknowledge their need for assistance  expect to be rejected and treated disrespectfully  become less confident of their ability to control and direct their lives  experience feelings of intimidation when advocating  fear a negative outcome. Each person is different, and these internal barriers may change over time: for example, a person in the middle of a depressive episode may feel particularly burdened with internal barriers that may not be present at other times. Your empathy, respect and support are vital for people with mental illness to normalise their experiences and remove the stigma. By treating them as valuable members of the community with rights, you support them to break down internal barriers and be effective self-advocates.

Beyond Blue’s Mental health and workforce participation submission (Links to an external site.) outlines how stigma and internalised barriers significantly contribute to people’s participation in the workforce and, as a result, in financial security. These kinds of barriers are not simply affecting people’s quality of life in terms of their emotions, but affect their ongoing ability to recover and to be contributing, included members of the community. Systemic barriers The practice of managing mental illness is becoming more widely accepted. Overall, society is generally committed to supporting people who have mental health needs; however, people with mental illness still face long-term issues including a lack of services and lack of appropriate training and responses from many in the health sector. Government funding for support programs changes over time and we are a long way from fully supporting the needs of people with mental illnesses. Here are some of the systemic issues and barriers faced by people with mental health needs.  Lack of access to accommodation and work  Lack of appropriate government policies  Other systemic issues that impact people with mental illnesses People with mental illness may live a life of extreme hardship because of a lack of opportunities and services to help them obtain work and suitable accommodation. Many live on disability pensions, and struggle to survive and can only afford basic accommodation. Lack of access to jobs or other opportunities for earning entrenches poverty and causes stress that may worsen mental illness. Watch this TEDx Talk about how to become an advocate, particularly regarding systemic issues: Source: TEDx Talks (Links to an external site.) Attitudes and stigma Misconceptions about mental illness and lack of understanding result in stigma, prejudice, discrimination or negative attitudes about people with mental health needs. A lack of knowledge in the community can serve to perpetuate negative stereotypes and misinformation. Stigma, fear and lack of understanding by other people may make it harder for people with

mental illness to get jobs, maintain friendships and participate in social activities. People may be sympathetic to someone suffering a physical disability but they are often uncomfortable around someone with a mental illness. Stigma is stronger against some forms of mental disorder than others. For example, psychotic disorders such as schizophrenia and schizoaffective disorder have greater stigma than anxiety disorders. Many people believe that people with serious mental illness cannot hold a job, be a responsible parent or contribute to society in any way. People are inclined to ridicule or be fearful of those with serious mental illness because it is outside their experience and they do not understand it. Here are some common misconceptions and stigmas attached to serious mental illnesses (SMI).  Judgments  Characteristics  Generalisations  Behaviour  People with mental illness have intellectual disabilities.  They should be segregated from the community because they cannot look after themselves. Overcome barriers to self-advocacy Your ability to effectively assist individuals and groups to overcome potential barriers to self-advocacy can be using a strength-based approach to practice. This type of approach acknowledges that all people have skills and capacities, and encourages individuals and families to build on these strengths, encouraging self-direction and self-advocacy. Self-direction encourages a person and their family or carers to make their own choices. Strategies may include ensuring:  policies and procedures support the promotion and facilitation of self- advocacy  professional development includes self-advocacy promotion  the provision of accurate and timely information about individual and group rights relevant to each situation and context  the use of cultural consultants in relevant situations  information is presented in a way to promote access and equity while addressing individual literacy, language and numeracy skills. This article on Positive Psychology (Links to an external site.) goes into detail about the strengths-based model, and includes strategies and

exercises. Watch this Social Care for Institute for Excellence video explaining the strengths-based approach when working with individuals: Source: Social Care for Institute for Excellence (Links to an external site.) Communication Mental illness can affect anyone. As a result, mental health workers may encounter people from many different backgrounds. Mental health workers must show respect and understanding of cultural and linguistic differences when communicating with people of all cultural backgrounds to encourage the person’s self-advocacy and self-determination. Some people with mental health needs may have had negative experiences of the mental health sector and its systems and structures. This may be based on an experience where they have not been listened to and their opinions have not been acknowledged. It is important to ensure that during the communication process to participation is encouraged and the person’s opinions are acknowledged. It is vital to use all of your good listening and communication skills when supporting people with a mental illness and seek to meet any communication, language or access needs. For example, access translation services (if required), for people from an ESL background, and learn specific recommendations for communicating with people in distress. Also be aware that some mental illnesses affect how people can communicate, and can result in extra challenges in effective communication. NSW Health has a range of resources available regarding effective communication with people with a mental illness (Links to an external site.) that are worth exploring in depth. Example: Identify potential barriers and relevant strategies to overcome them Ethan is 21 years old and has recently been diagnosed with bipolar disorder II. His father, Donald, is feeling overwhelmed. He is afraid for his son’s future and he is angry with his wife because he feels she is unable to cope, leaving him to manage the situation. Donald generalises about the treatments he has heard are given to people with bipolar disorder, although he readily acknowledges he knows nothing about the disorder or its treatment. He speaks with a mental health support worker who acknowledges Donald’s feelings and empathises by demonstrating a willingness to understand the situation from Donald’s point of view. Together, they identify Donald’s need for information about the illness and its treatment

and how to access that information. They talk about the emotional support the family needs now and how this may change over time. 2.3 Collaboratively develop an individual’s self-advocacy strategy and arguments As a mental health worker, you are responsible for working with an individual to collaboratively develop their self-advocacy strategy and arguments. Collaboration is one of the key principles that inform the national mental health standards. Participation by individuals and carers is integral to the development, planning, delivery and evaluation of mental health services. You should adopt a team approach to facilitating self-advocacy in collaboration with the individual. Communication and teamwork skills are required to ensure that the person is making the decisions and is guided and supported by the mental health team. Collaborative practices form part of the National Framework for recovery- oriented mental health services (Links to an external site.) and should underpin all of your work actions. Self-advocacy argument and strategy An argument refers to the reason or set of reasons given in support of an idea, action or theory. In the context of self-advocacy, an argument is the reason why mental health providers and professionals should do what an individual or group wants them to do. The argument supports that person’s position and justifies why their mental health needs, interests and opinions must be met. A self-advocacy strategy is developed to raise a person’s mental health issue and deliver their argument. The strategy works as an action plan that identifies what will be done, how it will be done, who is responsible, and in what timeframe it will be completed. Tips for developing effective self-advocacy arguments and strategies are listed here.  Self-advocacy arguments

 Self-advocacy strategy Arguments should:  be factual and measurable where possible  be supported by verifiable evidence demonstrating the significance of the issue  validate the position taken by the individual or group  influence perceptions, policy and systems  be communicated in a language and tone that is not aggressive  be reasonable and proportionate. Self-advocate strategies should:  focus on the main goal  be detailed and specific  clearly describe the issue  provide an argument as to why action or change is required  indicate the action that should be taken to resolve the issue  clearly identify an opportunity for the other party to rectify the issue  use polite and assertive communication  record important information and interactions that have taken place. Group advocacy strategies are typically highly formalised and documented, such as the Wellworks Advocacy frameworks and strategy (Links to an external site.) . Individuals’ advocacy strategies are likely to be simpler, but should also be documented. Prepare the self-advocacy strategy Prior to a self-advocacy strategy being developed and implemented, a number of steps must be completed. These are listed here. Define the advocacy goal Once you have agreed on your priority issue or advocacy goal, you should set out how the The individual must decide what they would like to occur, and when. Setting an advocacy achieve, and will assist you in your planning and design of other objectives along the way. The self-advocacy goal should result in positive changes to the individual’s life. Assist the self-advocacy process. Identify the target audience Once the individual has agreed on what they want to achieve from the self-advocacy proce

you need to influence to make sure the goal is achieved. Conduct research and analysis to build your understanding of the relevant decision-makers audience. Once the audience has been identified, you can determine the best way to influen Consider past cases or decisions Mental health workers should consider how similar issues have been resolved in the past. S others have been successful in the past. They should also consider cases that were not succ Consider legal and ethical responsibilities You should provide the individual with information pertaining to their rights as laid out in individual has a legal right to have their specific needs met, or whether there is recourse w argument enables the support worker/advocate to enter into the advocacy process from a st Identify people who can help Identify the appropriate people, service providers, organisations or agencies to approach w This should include people who have an interest in the result of the self-advocacy process. threats to the success of the proposal can be reduced or planned for. Contact people for assistance in writing, by the phone, online, or during a face-to-face mee policies and procedures when making a complaint, or filing a request for a meeting. Develop the message A strong overarching message will hold the entire self-advocacy strategy together. In order developing the key message early in the self-advocacy planning. The message should grab impact. There are two types of messages in self-advocacy:  Primary message: This is the most universally compelling message for the target audie o include a statement about the issue o include evidence to support the argument o include an example o highlight what the individual wants to achieve o describe the action desired to resolve the issue.  Secondary message: This explains how the goals of the primary message will be met. specific audiences.

Select a messenger The self-advocacy message will have a different impact depending on who is delivering it. the influence they have over the target audience. In self-advocacy, the individual will be th individual to ensure they maximise on their opportunity to express themselves and have a s Identify opportunities and activities to deliver the message Decide on the best way to get the individual’s message heard by the target audience. The b hear, receive, and clarify the individual’s request. The message should be carefully formatted so that it can be communicated via a variety of delivered in a variety of ways that reinforce and complement each other. Identify gaps and areas in need of improvement Before developing the self-advocacy strategy, you should consider the individual’s self-adv alliances, support groups, or information available to you that will influence the outcome o It may be useful to conduct a SWOT analysis that identifies the strengths, weaknesses, opp plan on using. You should identify the financial resources available to facilitate self-advoca process. Manage risks Conduct research during your self-advocacy planning to identify any potential risks to the the likelihood of the risk(s) occurring and the impact it may have on the self-advocacy stra strategies that minimise the chance of risks occurring. Consider the alternatives Encourage the individual you support to consider what they would do if the self-advocacy for the individual to revert to if necessary. Brainstorm the external conditions that may cha individual to be flexible in their self-advocacy preparations to prepare for a range of possib Information about how to do a SWOT Analysis can be found at Community Door (Links to an external site.) . This is a very useful tool for all kinds of planning activities. Develop the message A strong overarching message will hold the entire self-advocacy strategy together. In order to influence decision-makers, you should invest time in developing the key message early in the

self-advocacy planning. The message should grab the attention of the target audience and have a real memorable impact. There are two types of messages in self-advocacy:  Primary message: This is the most universally compelling message for the target audience. It should: o include a statement about the issue o include evidence to support the argument o include an example o highlight what the individual wants to achieve o describe the action desired to resolve the issue. Secondary message: This explains how the goals of the primary message will be met. There can be several secondary messages that are designed for more specific audiences. Develop and implement the self-advocacy strategy You should always keep the individual’s advocacy goal at the centre of your mind when developing the self-advocacy strategy to ensure that you correctly identify and determine what needs to be done to achieve that goal. Identify the strategies that will most likely influence the party you are targeting. Make sure the strategy is effective so that the argument has a significant impact. Once you and the individual have developed and selected the most appropriate strategy, you should develop an action plan that outlines what needs to be done, when it should be done, who is responsible, and the timeframe in which the action must be taken. The action plan should clearly identify the steps that must be taken to achieve the individual’s advocacy goals and resolve their issues. Implementation of the self-advocacy strategy and action plan should involve all those required to ensure the self-advocacy process is successful. You can find a great set of templates, including action planning, in the Advocacy for Inclusion Self-advocacy kit (Links to an external site.) . Consider how you could adapt this to meet different individuals’ advocacy needs. Collaborative approach Collaboration is a vital component of a person-centred approach. It empowers the person by encouraging them to develop an understanding of what they want and need, and supports them to make decisions and choices to control all aspects of their lives. It also reflects a commitment to the values related to human rights such as dignity and empowerment, respecting the person’s right to ask what they want. A collaborative approach means that the person you support has a say in the strategies developed to meet their goals, and it encourages a commitment by all parties to implement the agreed strategies.

Successful collaboration requires:  unconditional positive regard; you may not like all the people you support but you must accept and support them  receptivity; all parties must be open and responsive to different outlooks, approaches and suggestions  active involvement; collaboration can only work if all parties are focused on the same outcomes and working together  active listening between all parties; this fosters an open, honest and respectful relationship. Skills You Need has a series of resources for understanding and developing excellent communication (Links to an external site.) and collaboration skills (Links to an external site.) , including active listening (Links to an external site.) . Developing and maintaining these skills should be an ongoing feature of your professional development. Difficulties in meeting goals It is not unusual for a person to face difficulties in meeting the goals of their self-advocacy strategies. Plans to address these difficulties or barriers can be developed in collaboration with the person and others, such as a supervisor, by using problem-solving skills. When new strategies are developed, they must be incorporated into the person’s self-advocacy strategy. Here are some suggested strategies that can be used by mental health workers to address common barriers experienced when there are difficulties in meeting strategic goals.  Barrier  Strategy  Affected motivation to start or engage in activities  Medication side-effects that make it hard to engage in activities  Limited local resources  Restrictions to service delivery or limited access to emergency relief  Long waiting periods for appointments due to high demand for services  Strategy  Consulting with psychiatrist to discuss side effects  Working with other service providers to fund and establish new services  Placing the person’s name on as many relevant service lists as possible  Calling to see if extra appointments are available and seek interim assistance

Learning about different types of problem-solving skills and developing them yourself is an important professional development activity. Skills You Need has a wide range of resources on problem-solving skills (Links to an external site.) that you and the people with whom you work can use. Write self-advocacy messages To support your learning, read the following tips on developing clear and effective self-advocacy messages. Tips for writing self-advocacy message 1. Summarise the change you want to bring about or the issue you wish to resolve. 2. Make messages simple, short and concise. 3. Ensure messages are jargon-free. 4. Tailor the message to your target audience. 5. Include a deadline for when you want to achieve your goal. 6. Include reasons why the change or issue is important to you. 7. Write the message using language that has a memorable impact. 8. Repeat the message until it gains influence. 9. Be consistent. 10. Combine your emotional and rational arguments. Adapted from Water Aid (2007), The Advocacy Sourcebook. Available on the WaterAid website. Select a messenger The self-advocacy message will have a different impact depending on who is delivering it. Messengers should be chosen strategically and selected based on the influence they have over the target audience. In self-advocacy, the individual will be the messenger. You should build self- advocacy skills in the individual to ensure they maximise on their opportunity to express themselves and have a significant impact on the target audience. 2.4 Provide opportunities for practising self-advocacy As a mental health worker, you should provide the people you support with time and opportunities to build and practise their self-advocacy skills. Individuals and groups may have a comprehensive knowledge of the issue they are self-advocating for, but do not have the tools and techniques to promote and present their issue in a way that will bring about change.

The manner in which a person communicates their issue has a significant impact on the results of self-advocacy. Mental health workers can provide opportunities for people with mental health needs to practise self- advocacy through role-play activities, the delivery of verbal presentations or practising written communication. Self-advocacy skills Self-advocacy skills enable a person with mental health needs to decide what they want from the mental health system, and what they should expect. When a person has good self-advocacy skills, they have more control over their care and recovery and make the life decisions that are in their best interests. Self-advocacy skills help empower individuals and groups to speak up for themselves, and make decisions that positively affect their lives. Self-advocacy skills may include, but are not limited to:  understanding of and use of basic choices  awareness and understanding of own rights  assertiveness skills  knowledge of people and services that can offer assistance  decision-making skills  sense of responsibility and control over life decisions and actions  ability to influence agency processes and policies  ability to express needs and preferences  self-confidence  ability to speak up in appropriate ways  awareness and understanding of own responsibilities  the ability to make complex choices  understanding and knowledge of meetings and procedures  capacity to work effectively as part of a group. More about self-advocacy skills and how to develop them can be found from the extensive self-advocacy toolkit that you can download from BrainLine Links to an external site. . This toolkit would be an excellent resource to offer people with mental illness that you support, and/or groups starting out on self-advocacy issues. Benefits of self-advocacy skills People who lack self-advocacy skills are more likely to be insecure, isolated, vulnerable, and exploited. The development of self-advocacy skills promotes:  the ability of the individual to identify mental health issues  the development of self-confidence and self-esteem  independence and control over one’s mental health care and recovery

 dignity and self-determination  strengths and knowledge, which guard against exploitation and abuse  power as an individual with rights  the development of skills in speaking up for own needs and rights. Watch this TEDx Talk about the increased confidence that self-advocacy creates in people: Source: TEDx Talks Links to an external site. Practise self-advocacy skills As a mental health worker, you should begin building self-advocacy skills in the people you support as early as possible to ensure they understand the basic concepts involved, such as choice and decision-making. Look for opportunities to build self-advocacy skills in a non-pressuring manner. Encourage individuals to participate in formal training on self-advocacy or assertiveness where appropriate. The following techniques can be used to practise self-advocacy skills.  Role-play  Oral presentations  Written communications Provide participants with different types of situations and have them role-play what they would do. Encourage participants to face the person they are talking to, make eye contact, be aware of non-verbal cues, and speak clearly and at a reasonable pace. Role-plays are useful for demonstrating to an individual how to go about asking for what they want and need. Practise a range of different situations and outcomes to help the individual feel prepared to respond to potential challenges in self-advocacy. Example: An individual might role-play requesting that a service provider allow them access to mental health services. This set of resources about being an effective self-advocate Links to an external site. includes tips for written and verbal communications. You might like to have a set of templates, scripts and activities on-hand that you can adapt to each person’s specific needs. Allowing people to practice and develop the skills they need to self-advocate in a safe environment is a crucial step to improving self-esteem and becoming effective self- advocates. Example: Provide opportunities for practising self- advocacy Ben is 44 years old and has been living with schizophrenia for nearly 25 years. He lives near a community garden, which he has been visiting

regularly for three years. He enjoys the social aspects of the garden and likes meeting people from a diverse range of backgrounds and from the local community. He is also actively involved in a peer-support program targeting people with mental illnesses. When he is well, he assists the teacher. Ben wants to request financial support from the local government to expand the community garden. He also wants to use the funds to recruit a paid support worker who could run a weekly peer-support program in the community garden for people with mental health needs. Ben’s support worker, Aaron, helps Ben to develop his self-advocacy skills by asking him to draft a letter to the local council outlining his request for financial support. Once Ben has finished writing his first draft, Aaron sits down with him and provides him with information on language and formatting techniques that could be used to make the correspondence even more compelling. Aaron encourages Ben in his written communication skills and tells him that he produced a great first draft. 2.5 Identify and utilise self- advocacy resources To facilitate and promote self-advocacy it will be necessary for mental health workers to access a variety of resources. Mental health workers can also assist individuals to identify, source, request, access and utilise resources that will provide them with more information about self- advocacy. Self-advocacy resources The types of resources necessary to facilitate and promote self-advocacy vary depending on the needs and goals of the individual or group. Examples of self-advocacy resources can be found the tabs below.  Physical resources  Financial resources  Human resources  Professional expertise  Information Physical resources include the following:  Computer or other electronic equipment  Software programs  Internet access  Paper, printer, print cartridges

 Other stationery items  Communication equipment, such as a smart phone  Office equipment and furniture  Manual or electronic filing system  Financial resources  Human resources  Professional expertise  Information Financial resources include the following:  Money to purchase physical resources  Money to spend on printing and photocopying promotional material  Resources to pay for bills for internet or phone usage  Human resources  Professional expertise  Information Human resources who can help and support the self-advocate to achieve their goals may include the following:  Key people who can help self-advocates to access their target audience.  Mental health workers or other support workers who can assist individuals or groups to prepare for self-advocacy  Local, state or federal government agencies  Private organisations  Community services organisations  Mental health service provider  Family or friends of the self-advocate  Professional expertise  Information Certain experts or health professionals may be required to provide advice, evidence, or specialist expertise on an individual’s self-advocacy issue, such as the following:  Community and/or business leaders  Employers  Pastors or spiritual advisers  Legal and financial advisers  Media and media services  Political representatives  Ombudsmen  Information Useful information may include the following sources:  Academic research papers and results  Newspaper and magazine articles  Television programs or documentaries  Australian Bureau of Statistics data  Social media campaigns  Government agencies

 Libraries  Government departments and advisory bodies  Support groups  The internet  Peak industry bodies  Other people with similar issues. Resource and referral options There will be times when you are unable to provide all the assistance that a person and their family, carers and friends may require, and you may not have the expertise or competence to provide the assistance required. You must be able to recognise these situations and source referral options to other people or services. Service providers that may be identified as resources options may include government, private or community-based agencies that specialise in particular needs. Your organisation may have a resource file that contains resource options with agency details and accessibility criteria. To utilise new resource options, such as an agency that has not been used before, you may need to negotiate with them to define roles and responsibilities of the agencies and expectations of all people involved in the new resource option. Referral options to support additional advocacy support will be determined by the:  urgency of the situation  wishes of the person  ability of the current service to provide advocacy support. Remember that there are privacy and confidentiality restrictions and procedures to follow before sharing client information with other agencies or organisations. Follow your workplace’s documented referral procedures and/or ask your supervisor for help. Your workplace is likely to have established contacts and connections with other agencies and organisations, which can facilitate quicker responses: make sure to take advantage of these established relationships (where relevant) to help people get the services they need quickly and efficiently. Example: Identify and utilise self-advocacy resources Lorna is a welfare worker who is working with Jacinta and her son, Charlie. Charlie is 20 years old and is experiencing confusion and delusions. Lorna’s nephew displays similar behaviours and he has just been diagnosed with schizophrenia. Lorna considers disclosing her situation to Jacinta but realises that her own personal experiences could be clouding her judgment. In addition, she is aware that she is not qualified to make a diagnosis of schizophrenia.

She says to Jacinta, ‘There are many possible reasons for your son’s behaviour. how would you feel if I referred you to a mental health specialist?’ Jacinta says that she would be pleased to receive specialist advice. Lorna arranges a referral letter immediately. 2.6 Support individuals to document the circumstances and events relevant to the advocacy situation Self-advocates need to document the circumstances and events relevant to their advocacy situation. Documentation will help the individual to be aware of what self-advocacy strategies and action plans they have implemented to date, and record the progress and success of their self- advocacy efforts. All conversations about the advocacy situation, either face-to-face or by telephone, should be recorded in writing. The self-advocate should make note of the date, time, the full name of the person they have dealt with, the person’s role and organisation they work for, the person’s phone number or location of the meeting, and details of what was discussed. Effective note-taking will assist self-advocates to clarify the outcomes of conversations and remind the self-advocate of any follow-up actions to be carried out by either party. You may need to demonstrate how to take these notes or provide the person with a set of templates they can easily use, according to their communication and access needs. Make sure to explain that documentation helps to keep the people they encounter accountable, as well as allowing themselves to develop their self-advocacy skills by assessing what works well. Also ensure to set up good communication protocols between the person and yourself, so that both parties are informed about the progress of the self-advocacy activities and important information, such as appointments, dates, requirements etc. Notes and records Here are some guidelines for taking notes about conversation, circumstances and events relevant to the advocacy situation.

Be objective Only report the facts and don’t include opinions or assumptions. Be precise Be concise and only report relevant information that is essential to service de Be clear Use plain English that can be easily understood by all people. Be timely Write your notes as soon as possible so you do not forget relevant informatio Ensure notes are complete Notes must contain all relevant information. By omitting relevant information Handwriting Write as neatly as possible so other people can understand what you have wri No personal abbreviations Use only approved abbreviations or acronyms in all documentation. Spelling Use a dictionary if necessary. Date Date each entry in a person’s file and specify whether the information has be Correspondence Notes should be made on the file each time you speak to the person or an ext Don’t incriminate Do not record incriminating information about the person. These records may Don’t judge Do not record disrespectful or judgmental comments about the person. Other Objective and factual reporting Professional standards require that reports and documents use objective language based on fact and observation. Objective language describes what has been observed or heard, while subjective language may be based on feelings, emotions or opinions. Objectivity is important for accuracy and accountability, ensuring that individuals are described in ways that are not affected by judgments, stereotypes, assumptions or opinion. Here are examples of subjective and objective language.  Subjective language  Objective or factual language  Mrs Smith seemed depressed.

 Alex acted aggressively.  Tamara looked nervous when I mentioned her parents.  Mark is a drug addict.  Mr Thompson is unable to care for himself at home. Know what information to document Although different organisations require workers to document different types of information, here are some examples of information that is usually required when documenting self-advocacy activity. Information required  Basic details such as name and contact details for person and other relevant parties  Case history such as background information, description of presenting problem and diagnosis, previous experience with service delivery and the mental health system  The person’s progress against their self-advocacy strategy, such as details the actions taken to date, the strategies and goals  Difficulties the person is having in meeting their self-advocacy goals and actions taken to address these difficulties  The person’s concerns or difficulties they have in meeting their self- advocacy goals  Interactions with other services, internal and external  Copies of correspondence (in and out, including relevant emails) kept on the file  Important dates such as court dates, appeal limitation periods, health or training appointments  The person’s permission forms such as giving permission for the worker to speak with another agency about the person’s situation or to advocate on their behalf Organisational policy and procedures Self-advocacy information must be recorded according to your organisation’s procedures. Procedures for adapting self-advocacy strategies will be outlined by the particular service organisation’s policy frameworks. The expected outcomes and responsibilities must be clearly documented and communicated to all people responsible for implementing and monitoring the self-advocacy strategy. If this is done then the latest information is recorded and the person will be better supported if everyone in the care network knows what changes have occurred and why they were needed.

Example: Support individuals to document the circumstances and events relevant to the advocacy situation Examples of basic file notes are provided here. 29/10/2020 Ming attended an appointment at the office. Her mother drove her. She stated she was feeling miserable because she is not receiving person- centred care from her assigned mental health worker. Her demeanour was very flat and her speech slow. We discussed the individual and parental advocacy options available to her. Ming left with a brochure explaining both services. 5/11/2020 Discussed with Ming my conversation with TAFE about art courses available next term. Ming was interested in the drawing course but we agreed we should discuss this again at our next meeting, as Ming was struggling to concentrate. Ming has an appointment with Dr Flynn tomorrow. Meeting cut short as Ming wanted to return home to sleep. Follow up: phone Ming in three days to touch base and at next appointment discuss drawing classes. 2.0 Summary 1. Mental health workers are responsible for enabling individuals to gain self-advocacy skills so they have the knowledge needed to succeed, and are given the opportunity to participate in decisions that affect their lives. 2. Mental health workers should encourage and motivate the person with mental health needs to conduct independent research on the advocacy issues relevant to their situation. 3. People with mental illness face a range of barriers that can affect their treatment and recovery, which might stem from misconceptions based on a lack of knowledge and community understanding. 4. Participation by individuals and carers is integral to the development, planning, delivery and evaluation of mental health services. 5. A self-advocacy strategy is developed to raise a person’s issues relating to their mental health and deliver their argument. 6. Individuals and groups may have a comprehensive knowledge of the issue they are self-advocating for, but may not have the tools and techniques to promote and present their issue.

7. Self-advocates will need to document the circumstances and events relevant to the advocacy situation. 3.0 Introduction What you do after advocacy or self-advocacy action has taken place is just as important as the action itself. Mental health workers should have a follow-up plan in place to confirm the individual or group’s understanding of the self-advocacy process and agreed-upon actions. Reporting self-advocacy action is important for monitoring and evaluating the process and measuring the achievement of self-advocacy goals. In this module you will learn how to:  follow up and reflect with the individual on the self-advocacy process and outcomes, and identify further strategies and next steps according to the individual’s needs  provide additional advocacy support to individuals to further enhance their self-advocacy efforts. 3.1 Follow up on the self- advocacy process and outcomes Self-advocacy can be carried out by individuals or members of a group. For people to be empowered in self-advocacy, developing skills in planning

and preparation is required. Reflection is a strategy to promote the development of self-advocacy skills. As a mental health worker together with the person, you should follow up and reflect on their self-advocacy process and outcomes. This will assist you to identify whether further strategies are required and what steps are to be taken. Follow up with the individual When you follow up after an advocacy or self-advocacy process that has produced an agreement, or actioned a change, you are creating a forum for individuals to report back on how their issue has been resolved, and to explain both the successes and challenges since the action was taken. Follow-up is a vital part of any self-advocacy process, especially in situations where the self-advocate has requested changes to their mental health care, treatment or recovery plan. Follow-up strategies are described here.  Reflection  Measure success  Revisit goals  Consider feelings Reflection enables the individual to identify things that were done well, as well as things that could have been done differently to achieve a better outcome. Assisting individuals to reflect allows them to improve their future self-advocacy efforts. Ask the individual questions that prompt reflection, such as the following:  Are you satisfied with the outcome you have achieved?  Are you on track with your self-advocacy plan?  Does the advocacy approach need to be improved?  Do you have any new goals?  Measure success  Revisit goals  Consider feelings One of the easiest ways to measure the success of self-advocacy is to ascertain whether the individual’s self-advocacy goals were achieved, and to what extent. For example, if the individual’s goal was to include a medication on the Pharmaceutical Benefits Scheme (PBS), success will be measured on whether the inclusion of that medication on the PBS was achieved.  Revisit goals  Consider feelings

You should revisit the individual’s self-advocacy goals to determine whether the individual was able to meet those goals, or is actively working towards achieving them. To do this, you should assess whether the strategies used by the individual to deliver their self-advocacy argument were effective in generating a resolution or agreement.  Consider feelings Look back through your case management notes and consider how the individual felt before and after self-advocacy took place. If the individual is feeling defeated or overwhelmed by the process, it is unlikely that the self-advocacy strategy was the best option in helping them to overcome their issue. Alternatively, if the individual is more confident and positive about their situation after self-advocacy, it is likely that the strategies and actions used were successful and beneficial. Encourage progress You may discover in your follow-up that the individual is still working towards achieving their self-advocacy goals. It is important that you encourage and support the individual to continue the self-advocacy process so that they do not lose motivation or feel as though they have failed to have their needs met. Celebrate small successes and congratulate the individual on the progress made so far. If no progress has been made, it might be necessary for you to re-evaluate the self-advocacy strategy and design new activities that will be more effective in delivering the self-advocate’s message. If progress is ongoing, conduct regular follow-up activities and ask questions that determine the individual’s achievements, progress and motivation levels. Ask the individual to describe any strategies they have used to further their cause, and discuss how any new or potential barriers to self-advocacy can be overcome. Further strategies and next steps If the individual’s issue has not been resolved, or their self-advocacy goals has not been achieved, it may be necessary for you to develop further strategies and take steps that will achieve the individual’s desired outcome. Potential next steps:  Organising a meeting with the self-advocate’s target audience  Providing self-advocacy skills training for the individual  Informing a local member of parliament about the issue  If reasonable, bringing more attention to the issue by involving the media  Producing promotional material on the issue and distributing it to those impacted  Progressing the issue on to a higher authority for action

 Re-defining the individual’s self-advocacy goals and identify areas they are willing to compromise on  If applicable, providing opportunities for people to rectify their mistakes; for example, responding to a self-advocate in a way that is considered illegal or unethical  Engaging the services of a professional advocate if the individual is no longer comfortable self-advocating  Encouraging the individual to join an advocacy group if the issue is widespread or has a broader impact Example: Follow up and reflect on the self-advocacy process and outcomes Mirella works for an organisation supporting young people with depression, anxiety and other mental health issues. The organisation provides free support and assistance for people aged 12–25 who are experiencing mental health issues and want to find an education or employment program that suits their needs. Mirella also provides group activities and programs throughout the year such as mindfulness, art, personal development, sporting activities, and recreational activities. Mirella is approached by a group of 16-year-old girls who are unhappy about the lack of access they have to mental health services and programs at their high school. Their idea is to create a link between Mirella’s organisation and the school, so all students have unlimited access to mental health services and programs when they need it. The group need Mirella’s assistance to turn their idea into a workable strategy but would like to advocate their issue to the school on their own. A self-advocacy strategy is implemented and it is a success. Mirella develops a follow-up plan to monitor and evaluate the effectiveness of the new services agreement on a regular basis. Mirella involves the original group of girls in the evaluation process to ensure they continue to have ownership over the strategy, and self-advocate for any changes or improvements that could be made to the program over time. 3.2 Provide additional advocacy support to further enhance self-advocacy efforts As a mental health worker, you should provide additional advocacy support to individuals as required to further enhance their self-advocacy efforts and support them to achieve their self-advocacy goals. Individuals

who do not have the skills and knowledge necessary to continue self- advocacy activities may find it difficult to progress their issue any further. If this is the case, you may need to refer the individual to a professional and experienced advocate who can support the individual to develop their self-advocacy skills, or develop a new advocacy strategy. Providing additional advocacy support to individuals empowers and motivates them to resolve their advocacy issues. Provide support It may be the case that you have the requisite skills, knowledge and experience to advocate on behalf of the individual you support. To become an advocate, you must be confident in the skills of public speaking, conflict resolution, problem-solving and persuasive communication. You can use these skills to help an individual improve their own self-advocacy skills, access appropriate support services, identify new issues and concerns or develop new strategies to overcome barriers to self-advocacy. If you are not qualified to advocate on the individual’s behalf, you should refer the individual to an advocacy organisation or other professional. The advocate should have experience dealing with issues similar to that of the person you support. If an advocate does not have the skills, knowledge or confidence to represent the individual’s rights and interests, they are less likely to achieve a reasonable outcome and may actually delay or hinder the advocacy process. Peer Connect Links to an external site. has a wide range of resources for developing advocacy skills, as well as links to advocacy groups and services. Explore these and bookmark those most relevant to your work and location. Understand the need for referral Referral to other services and supports is necessary when:  the assessment process and discussions with the individual reveal the person’s needs are best met by another service  only some of the person’s needs can be met by your service and others must be met by external services  the person has met their goals within your agency and is ready to move on to meet other goals at other services  your service is only funded to provide time-limited services  the service provided by your organisation has not worked; for example, the person has not met any of their goals so alternative arrangements must be considered  your service is currently unable to meet the needs of the person because of resource limitations or a lack of vacancies in the program.

Consider referral services Be sure to always provide considered and appropriate referrals for the people you support. It is important you involve the person in choosing services and ensure they have given their consent to the referral. You should provide the person with information about a range of advocacy service options and discuss their needs with them in order to help the person choose the option that suits them best. Considerations may include:  how well the service matches the person’s needs  the person’s wishes  how far the person has to travel and whether suitable transport is available  any costs involved  eligibility requirements  waiting periods  agency willingness to review service provision to meet the person’s needs  whether the service has adequate feedback and complaints procedures in place. Evaluate the benefit of referral You should always consider the benefits of an external referral to the individual before making the decision to refer. Accepted procedures to evaluate the benefit to the individual of referral include the following.  Discuss options with the person, carers and family  Check availability of services within the organisation  Check availability and accessibility of other services It is important that the person is willing to be referred to another agency and that, where appropriate, the person’s family and/or carer also understand and agree with the need for a referral. You should discuss the range of options available with the person and their significant others to ensure everyone understands what is involved and the person can make an informed choice. Keep in mind that the goal is to ensure continued, unbroken and effective services to the person. Make sure to only refer them to reputable services that have the resources and expertise to help them in a timely manner.  Check availability of services within the organisation  Check availability and accessibility of other services In many cases, it may be more convenient for a person to receive services within one organisation rather than having to go elsewhere. Workers should check the

availability of services in their own organisation before referring the person elsewhere.  Check availability and accessibility of other services Before referring a person to an external agency, you should check the availability and eligibility requirements of the program or service the individual requires. If a person is not eligible or has to wait several months to receive a particular service, other options should be considered. Make the referral Each organisation will have its own procedures for making referrals, and you should make sure that you follow these. The steps outlined here are an example of general processes. Process for making referrals:  Evaluate the individual’s needs and discuss the referral with the person.  Provide information about referral sources and explore options with the person.  Help the person to make a decision about the service that best meets their needs.  Make contact with the chosen organisation to check eligibility and vacancies requirements and vacancies.  Document information according to your organisation’s policies and procedures.  Provide the individual with the contact and address details of the organisation.  Follow up with the individual and the referral agency to check that all is going well for both parties. Make effective referrals to advocacy service providers Consider the following tips that provide important advice and considerations for making effective referrals to advocacy service providers. Tips for making referrals:  Keep an up-to-date list or database of services and advocacy professionals that you may be able to use for referrals.  Know the hours, eligibility criteria and basic services provided by the services you use on a regular basis.  Develop a relationship with people from services you use on a regular basis.  Make sure you are always courteous to agency personnel.  Follow up all the referrals you make and check with the individual that the referral is meeting their needs.  When making a referral, take into account how easily it will for the individual to get to the agency.

 Be prepared to offer another referral if the first one does not work out.  Never criticise other workers or the services they represent.  Keep accurate records about all the referrals and follow-up calls you make.  Seek permission from the individual before making a referral and disclosing any information about them. 3.0 Summary 1. Mental health workers should have a follow-up plan in place to confirm the individual or group’s understanding of the self- advocacy process and agreed-upon actions. 2. When following up after an advocacy or self-advocacy process that has produced an agreement or actioned a change, you are creating a forum for individuals to report back on how their issue has been resolved, and to explain both the successes and challenges since the action was taken. 3. If the individual’s issue has not been resolved, or their self- advocacy goals have not been achieved, it may be necessary for you to develop further strategies and take steps that will achieve the individual’s desired outcome. 4. Providing additional advocacy support to individual empowers and motivates them to resolve their advocacy issues. 5. If you are not qualified to advocate on the individual’s behalf, you should refer the individual to an advocacy organisation or other professional. 6. It is important that you involve the individual in choosing services and ensure they have given their consent to the referral. 4.0 Introduction Mental health workers can promote self-advocacy by using assertive communication skills, promoting the rights of individuals to stand up for their needs and interests, encouraging a culture of self-determination and dignity of risk, raising awareness about barriers to self-advocacy, and producing promotional material. Promoting self-advocacy empowers individuals and groups to speak up for themselves on issues that affect their lives, and make decisions about their mental health care, treatment and recovery. In this module you will learn how to:  model aspects of self-advocacy through assertive communication skills  identify and use opportunities to promote the right of individuals to self-advocate and develop promotional material  encourage a culture of self-advocacy and dignity of risk

 raise awareness about barriers to self-advocacy. 4.1 Model aspects of self- advocacy through assertive communication skills Assertive communication is clear in its intent – it involves standing up for your own rights and feelings while respecting the rights and feelings of others at the same time. When you communicate assertively, you are demonstrating honest but appropriate communication given the context of the situation. Assertive communication is direct communication that relies on honesty and transparency, and on expressing one’s needs clearly without impinging on the needs and rights of others. As a mental health worker, you should model aspects of self-advocacy through assertive communication skills. If communicating in groups, all opinions should be valued and assertive communication should be modelled and encouraged. Assertiveness Links to an external site. is an important skill for both you and the people with whom you work to develop, and should not be confused with aggression or over-confidence. Assertive communication Assertive communication skills can assist both to protect and uphold the rights of people of all ages and abilities. People will listen to an advocate when they communicate with an assertive attitude of awareness, calmness, confidence and respect. Often it is not what we communicate, but how we communicate that makes a difference in the results we are likely to achieve. An advocate can say all the right things, but their message will not be received unless they communicate their boundaries and wishes with an assertive attitude. The difference between being passive, aggressive and assertive should be learned and understood. Here are examples of the three types of communicating.  Passive communication  Aggressive communication  Assertive communication Behaviours of passive communication may include the following:

 Using a soft, unsure voice  Maintaining a hopeless expression  Displaying limp postures and gestures  Not making eye contact  Using an apologetic tone of voice  Closed body language  Standing too far away while speaking  Sighing or shrugging  Using hesitant, unclear language  Aggressive communication  Assertive communication Behaviours of aggressive communication may include the following:  Angry facial expresssion  Tense, rigid posture  Using a loud voice  Displaying jerky body language and gestures  Strutting or pacing  Using insulting language  Disrespecting the person space of others  Interrupting others impatiently  Not listening  Acting annoyed or frustrated  Assertive communication Behaviours of assertive communication may include the following:  Using body language that is confident, calm and respectful of others  Making eye contact with the people you are talking to  Having facial expression consistent with your message  Using polite and respectful language  Using a clear voice that can be easily heard  Sounding firm if you seek change  Sounding appreciative if you seek help  Sounding happy if you want someone to do something for you  Respecting the personal space of others  Speaking passionately about the issue There are resources, tips and strategies available for developing assertive communication skills from Healthy WA Links to an external site. , Project Bliss Links to an external site. and NSWNMA Links to an external site. . Watch this TED Talk and consider how you could apply this information to supporting people with mental health needs to self-advocate: Source: TED Links to an external site.

Example: Model aspects of self-advocacy through assertive communication skills To model aspects of self-advocacy through assertive communication skills, mental health workers could use the SOLER communication theory Links to an external site. to remember and use effective non-verbal behaviours during advocacy or self-advocacy processes. 4.2 Identify and use opportunities to promote the right of individuals to self- advocate People with mental health needs and/or mental illness often experience human rights violation, stigma and discrimination. To address this problem, mental health organisations and workers should identify and use opportunities to advocate for their needs and rights of people with mental health needs. Developing promotional materials will provide essential information about self-advocacy to people with mental health needs, as well as spelling out their individual rights and responsibilities. These materials also provide key contact information and links to other resources and services that will assist individuals and groups to pursue their rights and interests via self- advocacy processes. Identify opportunities There are many ways to promote the rights of individuals to self-advocate. Your organisation should adopt appropriate mental health policies and procedures that:  promote the rights of people with mental health issues and illnesses  empower people to make decisions about their lives  provide people with legal protections in the workplace  ensure the individual’s full integration and participation into the community  involve mental health consumers and their families and carers in self- advocacy processes.

Additionally, there may be opportunities to promote self-advocacy by facilitating community engagement, by facilitating connections with larger advocacy groups or by creating new advocacy groups. Policies and procedures promoting self-advocacy Policies and procedures should address specific issues and challenges that people accessing mental health or community-based services may face. For example, they should address:  the role of advocates and self-advocates  the function of advocacy or self-advocacy supports and services  the methods by which advocacy and self-advocacy should take place  legislative compliance requirements, including anti-discrimination provisions  the ethical principles underpinning self-advocacy, such as integrity, avoiding conflict of interest, collaboration, transparency and person- centred care  the use of interpreters, cultural consultants, or others who can assist people with diverse needs to participate in self-advocacy  facilitated communication methods  ‘best interests’ advocacy guidelines that direct the advocate to make direct representations that are in the best interests of the person affected. Your workplace will have communication policies and procedures that guide your activities for promoting self-advocacy, such as guidelines for social media posts, for blog posts and for emails. These must be followed at all times to ensure that all communications comply with required ethical and legal standards. Additionally, they should represent the organisation positively and express the organisation’s vision and mission statements. Plan promotional material In some cases, you may need to plan promotional material to support individual or group self-advocacy. Planning a successful promotion involves the following steps. Determine objectives Promotional materials could seek to provide information to people with m advocate and explain what is involved in the self-advocacy process. Alte gain other people to join a group or to facilitate community awareness.

Determine target audience Determine who the promotional message is aimed at and select commu reaching and impacting that audience. Select communication channels Select communication channels that will be the most successful in reach Develop the message Carefully write a promotional message that focuses on the argument, co promotional materials in a way that best presents the information in a cl Determine the budget Determine the budget allocated towards your promotional activities and promotional materials can be developed. Develop promotional materials Develop promotional materials develop and produce the promotional materials by way of:  print products  websites  bulk mail  email campaigns  social media. Distribute promotional materials Distribute the materials in the most appropriate way of reaching target audience. This may  direct mail  email  social media  web page  networking  advertisements etc.

Evaluate promotional activities Monitor the success of promotional materials by response or inquiries made. Promotional materials can form part of wider organisational activities designed to promote people’s rights and to access care, as well as forming educational opportunities for the wider community. This Integrated health promotion resource kit from Health Victoria Links to an external site. discusses how social media can be used within other health promotion activities. It is always helpful to explore what has worked well in the past. Watch the videos and read through the assessment of these 7 mental health campaigns that made a difference Links to an external site. . Example: Identify and use opportunities to promote the right of individuals to self-advocate Zara is the manager of a national youth mental health foundation providing early intervention mental health services to 12–25-year-olds. The organisation Zara works for makes it as easy as possible for a young person and their family to get the assistance they need for problems affecting their wellbeing. Services can be accessed through the organisation’s centres and online counselling services. Zara wants to promote the rights of young people to self-advocate for their mental health needs. She also wants to empower young people to make decisions affecting their own lives, especially in their school and work environments. Zara is savvy with social media and often uses the organisation’s Twitter account to send tweets informing followers of the organisation’s supports, services, programs and announcements. Zara spends some time developing a short, clear and concise statement about the rights of young people to self-advocate and includes a link to an article on empowerment through self-advocacy. The tweet is received by over 20,000 followers and is retweeted (shared again) by over 4,000 of them. Zara decides to post one tweet a day for a week promoting self-advocacy and includes the number of an information line that young people can call to find out more information. At the end of the week, Zara will evaluate the effectiveness of her promotional campaign by measuring the number of calls received and inquiries made as a result of reading the tweets.

4.3 Encourage a culture of self-advocacy and dignity of risk Dignity of risk in the self-advocacy context refers to self-determination or taking responsibility for one’s self-management and autonomy in one’s life choices, and the willingness to take informed and planned risks in order to grow. When discussing and preparing plans to meet the needs of a person with mental health needs, it is important to find a balance between the duty of care you have for the person and encouraging them to take risks and experience life. Dignity of risk needs to be discussed and considered carefully, and the person should understand and agree to the risks they are undertaking. As a mental health worker, you should encourage a culture of self- advocacy and dignity of risk in the provision of supports and services to people with mental health needs. Encourage a culture of self-determination For mental health providers to encourage a culture of self-determination that supports self-advocacy and dignity of risk, there is the challenge to reinvent their approaches to risk-management that determine whether the risks are worthy of the extra effort, tension and uncertainty. This is the balance that people with mental health needs seek and the kind of support that will have a significant effect on their lives. There is increasing recognition of the rights of people with mental health needs, illnesses and disorders: that they must have the dignity of control over their own lives and of their right to take the normal risks in life that the rest of the community takes for granted. However, access to these rights can sometimes be hindered by concerns about risk-management within mental health organisations, resulting in the needs and goals of mental health consumers being marginalised. This article explains the importance of the concept of dignity of risk for people Links to an external site. with mental health needs and how it promotes self-determination.

Self-advocacy Self-advocacy refers to the ability to speak on one’s own behalf. To encourage a culture of self-advocacy means to promote and uphold the principles of self-advocacy in your workplace. Encouraging a culture of self-advocacy may involve promoting awareness through training in self- advocacy skills, such as communication, assertiveness and leadership. In the mental health sector, it is important that a service’s culture assists the person receiving support to develop self-advocacy skills through a culture of support and encouragement. As a mental health worker, it is important that encouragement of self-advocacy is demonstrated by providing the person with the necessary resources and facilitation to nurture this skill. Dignity of risk The rights of people to dignity and choice, upheld in legislation and service standards, also requires that duty of care or safety is not used as a reason to limit a person’s freedom or personal choice. A support worker’s adherence to duty of care and safety must be coupled with the concept of dignity of risk, which means that a person has the right to make their own choices and to take risks. Dignity of risk acknowledges that life experiences come with risk, and that we must support people in experiencing success and failure throughout their lives. However, it can be a challenge to support decisions that we feel are too risky, or with which we do not agree, without considering safety and viewing decisions through our safety-oriented health care culture. You need to consider dignity of in terms of capacity and decision-making. It is necessary to find a balance between the need for duty of care and a person’s right and capacity to decide the level of risk with which they are comfortable. This blog post from Interchange WA Links to an external site. discusses how dignity of risk and duty of care are not opposed, and discusses how services are changing their practices towards more person-centred approaches. Level of risk With many activities, it is not possible to eliminate the element of risk altogether. Risk is a part of our daily lives; it is through risk and trying new things and making mistakes that we learn. The idea that a person has the right to make their own choices and to take risks is referred to as dignity of risk. A support worker’s adherence to duty of care and safety must be coupled with the concept of dignity of risk.

The key issue when considering the legal and ethical aspects of dignity of risk is determining an acceptable level of risk for the benefit that the activity offers. These questions should be discussed with the person and appropriate others offering support. Always remember that the person is the expert in their own lives and has the right to make their own choices and decisions. You can support them to make informed choices, by applying basic risk management processes, such as asking the questions below. Three questions to ask about risk:  What are the potential risks?  What are the potential benefits?  How can the risks be reduced without reducing the benefits? Example: Encourage a culture of self-advocacy and dignity of risk Caroline is 22 years old, and has a mild intellectual disability. She enjoys socialising with her friends and going on day trips with her housemates. Caroline needs support in the home, particularly in preparing meals and using the stove. Caroline tells her support worker, Phillip, she plans to go camping with her friends to the coast and stay in a caravan park for two nights. Phillip is concerned about Caroline’s safety in using the stove and preparing her own meals unsupervised. Phillip and his supervisor discuss possible strategies and suggest to Caroline that she practise at home preparing the meals she will eat while away using the camping stove. Caroline agrees – she is excited and can’t wait to go away with her friends. 4.4 Raise awareness about barriers to self-advocacy The stigma, prejudice, discrimination and misconceptions surrounding mental health issues, illnesses and disorders act as barriers to treatment. People with mental health issues, their families and carers, often fail to seek the care and support that they need for fear of being stigmatised. Barriers to self-advocacy also results in discrimination and human rights violations. Many people with mental health needs face discrimination in the areas of employment, education, housing and health. Sometimes people with severe mental health disorders are denied their basic human rights, such as the right to vote, marry and have children.

As a mental health worker, you can prevent much of the stigma surrounding mental health issues by changing attitudes and making the public aware that mental health illnesses and disorders are treatable. Government departments, agencies, community service organisations, family groups, health professionals, NGOs, academic institutions, professional organisations and other stakeholders all have important roles to play and should combine their efforts to educate and change public attitudes towards mental health disorders, advocating for the human rights of people with mental health needs. Combating stigma, prejudice and discrimination is not the sole responsibility of the government and requires a multi-sectoral approach, involving welfare, labour, education and justice sectors to contribute. Raise awareness There are numerous ways you can raise awareness about an issue such as barriers to self-advocacy. To raise awareness:  Increase your own knowledge so you have current and reliable information ready to share with others when asked.  Host educational events that people can attend to learn about barriers to self-advocacy.  Organise a service project that allows community groups to volunteer together in some way that is related to self-advocacy.  Attach the issue to existing news stories by providing media outlets and reporters with information they can use to update existing articles.  Distribute promotional materials about barriers to self-advocacy.  Publish research, case studies, or trends data that positions you as a trusted expert on the issue.  Bring attention to and share your gratitude for people in the community who are working to overcome barriers to self-advocacy.  Empower and connect people who have a common interest in overcoming barriers to self-advocacy and gaiun their sharing and networking so they know they are not alone.  Share information on various social media platforms. 4.0 Summary 1. Assertive communication is direct communication that relies on honesty and transparency, and on expressing one’s needs clearly without impinging on the needs and rights of others. 2. Assertive advocacy communication skills can assist both to protect and uphold the rights of people of all ages and abilities, and prepare them to develop better relationships.

3. People with mental health needs and mental illness often experience human rights violation, stigma and discrimination. To address this problem, mental health organisations and workers should identify and use opportunities to promote the rights of individuals with mental health issues to advocate for their needs and rights. 4. Developing promotional materials will provide essential information about self-advocacy to people with mental health needs, as well as spell out their individual rights and responsibilities. 5. Dignity of risk in the self-advocacy context means self- determination or taking responsibility for one’s self-management and autonomy in one’s life choices and the willingness to take informed and planned risks to grow. 6. For mental health providers to encourage a culture of self- advocacy and dignity of risk, there is the challenge to reinvent their approaches to risk management by taking up the challenge to operate closer to where their consumers want to live.