About us Stories Interview with POhWER Advocate Emmett Holden-Carter Emmett works as an Independent Mental Health Advocate with POhWER. Read all about his journey to how he became interested in Advocacy to now supporting clients as an IMHA. How has providing the IMHA service been going since the pandemic? It depends on the hospital, really. The main difference is I’m unable to meet with clients and staff face to face as there are restrictions on the wards, and this makes it more difficult to get questions answered. It also means there are fewer referrals as I’m not a physical presence on the wards. I’m sending out a lot more emails than I normally would, but won’t necessarily get a response. I think some staff on the wards think ‘out of sight, out of mind.’ However, I am persistent with arranging speaker phone and Zoom calls to attend ward rounds and that can work really well. Some patients on the wards are not allowed mobile phones as you are not allowed to take photos, but there are designated phones that the clients can speak to the advocate on and these are used in attending ward rounds too. Remote ward rounds can be a bit tiring, as everyone who wants to attend the ward round remotely is on different speaker phones, so you have to listen intensely to work out who is speaking! It’s easier on Zoom or WebEx meetings. I always ask how the client wants to be contacted, some have mobiles and email addresses, with others it’s via the wards phones. How did you become interested in advocacy? That’s a bit of a long story. I was and still am an active patient. I was diagnosed when I was seventeen, I had a massive breakdown and was suicidal. This was back in the ‘70s and there was no such thing as advocacy. I had another breakdown in the 80s and spent 3 months as an informal patient on a ward, and there still wasn’t such a thing as advocacy, not in the way there is now. What would happen is I would go to my ward rounds and sit there, they would all talk about me, then say “what do you want to say?” I would not be given enough time to speak and they would say “That’s great, see you next week,” and that was it. I decided during that period that I wanted to help other people who were experiencing this. It was a very lonely time. I wasn’t happy that I didn’t have a voice and I wanted to make sure that everyone else I knew on that ward had a voice, too. It became a bit of a crusade, really. One of my friends was made to have Electroconvulsive Therapy (ECT) and they were a mess from that, they never had anyone to speak up for them. It wasn’t right, and I wanted to correct that. Years later, I found out about advocacy when I met some volunteers from the National Schizophrenia Society who were signing people up to do it voluntarily. I was a volunteer advocate with them and then later a paid forensic advocate with Mind, and in 2008 I got a job with North East London Advocacy (NELA) which became part of POhWER. It’s nice to be paid for it rather than being voluntary but I enjoyed the voluntary years too and learnt a lot. I’ve actually been on the same contract since then, which is quite an achievement! I will say there were a lot more activities on the wards than there seems to be now. We had carpentry, gardening, meditation, relaxation, walking groups and art classes. After I left hospital it all started to change and these things disappeared. I suppose it depends on the hospital. What is the biggest challenge in the role? Getting professionals to take you seriously as an advocate is a challenge. Some are very helpful, but some still see the advocate as an interfering busybody that comes on to the ward. They would like the client to sit there and do as they’re told, no questions asked. Some don’t respect that we are qualified, that we know the Mental Health Act and the Code of Practice and we’re there to support the client’s rights, and that it’s a statutory right for us to be there. We are there to support the client as much as possible and work towardsthe outcome they want in their care and treatment. Sometimes it’s a case of taking a deep breath and speaking up! Describe a typical day as an IMHA On a typical day now I look through emails, plan ward rounds by speaker phone or Zoom and make sure nothing overlaps. This can be difficult as hospital time management can be hectic. I then call clients and send emails on the client’s behalf to consultants and carecoordinators and update case notes. I go through clients’ notes for the next day and attend any training sessions. Sometimes I mentor other advocates. it’s rewarding to share experience with them. I am involved in the EmpowerRace sounding board as a Vice Chair and I’m a Vice Chair of the LGBTQI+ group as well. A typical day when I was on the ward was going to ward rounds, talking to clients individually about their rights and what they would like from their care, and communicating that to consultants. It was easier to get referrals when on the wards as well but you never knew what was going to happen. You could plan your ward round and suddenly a patient would kick off and you couldn’t attend. What is most rewarding about the role? The most rewarding thing about the role is when a client is on a section and they leave, and you’ve helped them achieve that, and if they’re homeless when you support them in getting a home. If a client has dementia, ensuring that they have a correct care package in place. Encouraging the clients to speak up for themselves is rewarding as well. Sometimes I find that clients end up advocating for themselves after I’ve spoken to them, and even advocating for others on the ward. That is the essence of advocacy. Empowerment from self advocacy and peer advocacy. Any particular cases that come to mind? I’m working on a complex case at the moment with a man who has autism. It’s a non-instructed case mainly, but he is sort of verbal and can communicate in many other ways. We have a strange sort of banter together. I’m there supporting him in his meetings, making sure that things go better than they did last time when he was discharged in to supported care. Professionals share information about his care with me and include me in all his ward rounds and other meetings. That’s one of the best cases I’ve got because we’re on the cusp of him being moved in to new supported housing, hopefully for the rest of his life. It’s been an interesting case and I have supported him over a number of years now. What do you like to do outside of advocacy? I like gardening, going to the gym, walking, dance and shopping. I enjoy reading, my favourite writers are Stephen King, James Herbert and HP Lovecraft. I’m currently enjoying watching the crime dramas Vera and Shetland on TV. Outside of POhWER I’m a trustee director of a charity called Survivors of Bereavement by Suicide and I provide email support for their helpline. I am also a bereavement counsellor and Trans Ambassador for Opening Doors London which is a LGBTQI+ charity for people over fifty. Do you have any advice for potential IMHAs? Always keep learning. Listen very intensely to what is going on around you and to the client. I take hundreds of notes in bullet points when I’m listening. I can then use them later to ask questions in the ward round or by email after I’ve spoken to my client. Also, network as much as possible with hospital staff and other professionals. I think I have every single consultant’s email address in the hospitals I work in. I also get the emails for admins, managers, matrons and mental health officers as well. With good networking you’ll find getting information from staff and consultants on the wards much easier. Another thing is to be persistent but friendly when working with consultants and other professionals on the ward. Remember that things are different and often difficult for everyone. Know when to speak in ward rounds to best get your point across. You’ll get a lot more achieved if you’re friendly, but stay independent too. Make sure to be patient with clients and listen respectfully to everything they say, even what they’re saying doesn’t make sense to you. It does to them at the time! Don’t be afraid to ask other advocates for support and advice and information. Maybe most importantly, enjoy being an advocate. It can be a challenging job but it’s often very rewarding when things go well.