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Durham University

Department of Sociology

Completed Projects

A Review of the Patient's Advocacy Service at Ashworth Hospital

A research project of the Department of Sociology.


hen the patient's advocacy service was set up at Ashworth Hospital in 1993, it was the first mental health advocacy service to be established in a high security hospital in Britain. Therefore the service undertook ground-breaking work pioneering the provision of advocacy in a secure setting, and not only has it survived for 5 years in often difficult circumstances, but has offered a valued service to patients.


It is in part to celebrate this success that the review was undertaken, but other reasons the review was commissioned were:

  • to quantify and describe the work done by the advocacy service
  • to examine the impact of advocacy for patients, individual members of staff and the hospital in general
  • to identify the achievements and understand the experience of using and delivering advocacy
  • to use the findings to explore the most appropriate models of advocacy for secure environments and to learn lessons from Ashworth which can be applied elsewhere.


The review included 4 stages:

  • Developing an understanding of advocacy
  • Developing an understanding of the advocacy service and the high security hospital
  • Reviewing the work done by the advocacy service
  • Examining the process and outcomes of advocacy as perceived by key stakeholders.

A stakeholder approach was adopted with the key stakeholders identified as: patients; hospital staff and managers; patients' relatives; and advocacy staff. Semi structured interviews were carried out with a sample of each stakeholder and 5 focus groups were held with patients, trade unions and the advocates. Patients and ward staff were accessed.


Advocacy activity: the advocate's daily record sheets of the work they have undertaken have been analysed to provide an audit of the type and quantity of work undertaken. This was particularly helpful in verifying wards with high and low uptake of the service as there is a widely held perception that patients with a personality disorder receive a disproportionately high level of service.

Opinions of the advocacy service: stakeholders were asked to comment on the nature of the advocacy provided, the quality of the service and the impact it has had. Findings show a great deal of commonality between stakeholders, but a wide divergence of views within each group. Patients and staff tend to feel strongly for or against advocacy but there was overwhelming support for advocacy services in high security hospitals.


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