Faith in independent advocacy and spiritual care in England: the voices of advocates, service users and chaplains* Geoff Morgan Department of Education and Professional Studies, King’s College London, UK Keywords: independent advocacy; theology; spirituality; spiritual care; well-being; professional studies; training

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Faith in independent advocacy and spiritual care in England: the voices of advocates, service users and chaplains* The Mental Capacity Act (2005) and the amendments to the Mental Health Act (1983) in which came into effect in 2007 and 2009 respectively in England and Wales- made it a statutory duty for the NHS and local authorities to refer to advocacy services. This is part of a growth in advocacy which coincides with an increase in literature on mental health and spirituality, of which a refreshed faith-based social conscience will want to be aware. Independent advocates and spiritual care coordinators (or chaplains) provide expressions of advocacy. For Independent Mental Capacity Advocates (IMCAs), social, cultural and spiritual factors are influential. Research involved a literature review on the history of advocacy, some comparisons with its forms in other European contexts, and interviews with 40 advocates, chaplains and service users and subsequent grounded theory analysis. The attested ‘rediscovery of the spiritual dimension in health and social care’ highlighted both shortcomings in the professionalisation of advocacy in relation to culture and spirituality and advantages in conversation between faith and advocacy practitioners.

Definitions of advocacy voices to raise voices to raise rights to know rights to know choices to face choices to face ‘everyone, sooner or later, needs help in making their voice heard – … people who can provide the time and support.’ (Atkinson 1999) ‘everyone, sooner or later, needs help in making their voice heard – … people who can provide the time and support.’ (Atkinson 1999)

Advocacy: a spiritual history (1) ‘It is a very indecent, inhuman thing to make... a show... by exposing them, and naked too perhaps of either sexes, to … idle curiosity… so the holy and tremendous name of God is dishonoured, whilst the wicked people, who think it is a diversion, instead of trembling as indeed they ought, being themselves really guilty of all these blasphemies… fall a laughing and a hooting...’ ‘It is a very indecent, inhuman thing to make... a show... by exposing them, and naked too perhaps of either sexes, to … idle curiosity… so the holy and tremendous name of God is dishonoured, whilst the wicked people, who think it is a diversion, instead of trembling as indeed they ought, being themselves really guilty of all these blasphemies… fall a laughing and a hooting...’ (Tryon 1689)

Advocacy: a spiritual history (2) Say to your selves ‘I am going to honour in my patients the incarnate wisdom of God, who willed that He himself should embrace this state in order to sanctify it like all others.’ Say to your selves ‘I am going to honour in my patients the incarnate wisdom of God, who willed that He himself should embrace this state in order to sanctify it like all others.’ St. Vincent de Paul 17C ‘I open my mouth for the dumb… I entreat you to place yourself in the place of those whose suffering I describe…Feel for them; try to defend them’ ‘I open my mouth for the dumb… I entreat you to place yourself in the place of those whose suffering I describe…Feel for them; try to defend them’ Perceval 19C

Advocacy: from the 1960s self-advocacy groups were established by former residents of large state institutions – often helped by staff, parents and other allies… related to the fight to close institutions and demands for the right to live in the community. At the time people with learning difficulties were not seen as capable of articulating, or indeed understanding, their own needs and wishes. Others were seen as being better suited to speak and make decisions on their behalf. self-advocacy groups were established by former residents of large state institutions – often helped by staff, parents and other allies… related to the fight to close institutions and demands for the right to live in the community. At the time people with learning difficulties were not seen as capable of articulating, or indeed understanding, their own needs and wishes. Others were seen as being better suited to speak and make decisions on their behalf. (Traustadóttir, 2006)

Comparing the practices of advocates and chaplains: 1. The voice of the advocate ‘In many cases communication may be a problem if (a client) comes from a different cultural background- an advocate who has more understanding of the language may talk on behalf of the person’ (Zablon 2008)

‘… a mouthpiece’ ‘to smooth the … communication process between service users and professionals … they feel they are just not listened to… I’m the ‘mouthpiece’, … it’s their experience, not mine… and (they say), “Ah, you will know how to put it better,” and (I say) “No, it’s not about me, it’s about you…” (Janine 2007)

Action based on Equality (ABE): ‘like an equaliser’ ‘You are a partner, an equal relationship…’ (Nebi 2007) ‘I suppose the overall idea of an advocate is to be like an equaliser… with the people you are working with,… that they have an equal say, … and have access to their rights as though they didn’t have a disability…’ (Sam 2008)

Comparing the practices of advocates and chaplains: [Action based on Equality (ABE)]: 2. The voice of the chaplain ‘I don’t know how secular advocates would define their role but I would define it as one of solidarity, one of empowerment, one of levelling out the imbalances of power…’ (Norman and Colin 2008)

Reconstructed Empowerment (RE) 3. Voices of the client: ‘it’s so good, I’m powerful… I’m taking over your job’ ‘have a good experience, make a good idea so people with learning disability can say things, people need friends, people need colleagues, people like us, it’s so good, I’m powerful… I’m taking over your job’ (laughter) (Louise, Michael et al. 2007)

Advocates meeting ‘cultural needs’; ‘social needs’; and ‘spiritual needs.’ ‘people in the parish… have supported her incredibly well, and that’s made a great deal of difference to her.’ (Bernard 2008) ‘people got better... It was because they were being told that it was not them who were going mad, they got better, it was amazing, they made speeches saying, “We are better…”’ (Fauzia 2007).

Finally…and thank you for listening! Work in progress: Addressing the theoretical deficit in advocacy practice in the UK using theological and philosophical resources © Geoff Morgan 2010 *This paper is related to the article, Morgan, G. (2010), Independent Advocacy and the ‘rise of spirituality’: views from advocates, service users and chaplains, Mental Health Religion & Culture, 13 (forthcoming)

Faith in independent advocacy and spiritual care in England: the voices of advocates, service users and chaplains* The Mental Capacity Act (2005) and the amendments to the Mental Health Act (1983) in which came into effect in 2007 and 2009 respectively in England and Wales- made it a statutory duty for the NHS and local authorities to refer to advocacy services. This is part of a growth in advocacy which coincides with an increase in literature on mental health and spirituality, of which a refreshed faith-based social conscience will want to be aware. Independent advocates and spiritual care coordinators (or chaplains) provide expressions of advocacy. For Independent Mental Capacity Advocates (IMCAs), social, cultural and spiritual factors are influential. Research involved a literature review on the history of advocacy, some comparisons with its forms in other European contexts, and interviews with 40 advocates, chaplains and service users and subsequent grounded theory analysis. The attested ‘rediscovery of the spiritual dimension in health and social care’ highlighted both shortcomings in the professionalisation of advocacy in relation to culture and spirituality and advantages in conversation between faith and advocacy practitioners. The Mental Capacity Act (2005) and the amendments to the Mental Health Act (1983) in which came into effect in 2007 and 2009 respectively in England and Wales- made it a statutory duty for the NHS and local authorities to refer to advocacy services. This is part of a growth in advocacy which coincides with an increase in literature on mental health and spirituality, of which a refreshed faith-based social conscience will want to be aware. Independent advocates and spiritual care coordinators (or chaplains) provide expressions of advocacy. For Independent Mental Capacity Advocates (IMCAs), social, cultural and spiritual factors are influential. Research involved a literature review on the history of advocacy, some comparisons with its forms in other European contexts, and interviews with 40 advocates, chaplains and service users and subsequent grounded theory analysis. The attested ‘rediscovery of the spiritual dimension in health and social care’ highlighted both shortcomings in the professionalisation of advocacy in relation to culture and spirituality and advantages in conversation between faith and advocacy practitioners.