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A. Patients’ Rights Advocates

California has a state-mandated patients' rights advocacy system made up of three components: (1) County Patients’ Rights Advocates, (2) State Hospital Patients’ Rights Advocates, and (3) Office of Patients' Rights. The county Patients’ Rights Advocates are either appointed and/or contract employees of their respective counties. The Patients’ Rights Advocates of the state hospitals and the Patients Rights’ Specialists of the Office of Patients' Rights are contract employees of the California Department of Mental Health.

In addition to the patients' rights advocacy system, California has a federally-mandated program, Protection and Advocacy, Inc. (PAI), which provides legal protection and advocacy services to Californians who are identified as mentally ill and who are or have been residents of facilities providing treatment or care.

B. Expressed vs. Best Interest

Advocates represent client's interests as defined by the client, as long as those interests are within the bounds of the law and achievable within the Advocate's resources. Advocates do not determine what is most "appropriate" for the client or in the client's "best interest." Rather, the Advocate will counsel clients about their options and the implications of those options and assist the client to make an informed choice. This perspective is different from the traditional clinical "best interest" approach.

C. Kinds of Advocacy

Individual advocacy - Historically, Patients’ Rights Advocates' primary responsibility has been the investigation and resolution of individual problems. This can involve an explanation of legal rights and remedies, assistance in negotiating a solution to a problem, or representation of a client in a hearing or other dispute resolution process. Increasingly, Advocates have taken on the representation of clients in mental health administrative hearings. Advocates also may assist clients with problems in the community mental health system which are related to their hospitalization.

System Advocacy - Advocates also work to improve mental health facilities by: (1) regularly monitoring mental health facilities for compliance with patients' rights laws; (2) reviewing and commenting on policies and practices which affect recipients of mental health services; (3) providing consultation and generating policy questions for the Office of Patients' Rights; (4) coordinating with other Advocates for system reform; (5) analyzing state and federal legislation and regulatory developments; (6) educating and performing outreach to recipients of mental health services to increase clients' ability to Advocate for themselves; (7) representing clients' interests in public forums.

D. Value of Advocacy

For the Patient - In addition to solving problems that contribute to psychological distress, advocacy helps to give clients a measure of autonomy and dignity. By participating in the processes that affect their lives - making treatment decisions, negotiating with clinicians, setting house rules in their residence or controlling their finances - clients grow in their independence, self esteem and ability to work with others.

For the Mental Health Professional - Having an Advocate work with a client means "an extra pair of hands" to resolve a client's problems. Because he/she is external to the system, an Advocate can also help to improve communication, diffuse tensions and resolve conflicts when disagreements have arisen between a client and a service provider. Finally, a client whose self-respect and functioning is enhanced through resolving problems will need fewer traditional mental health resources.

For Mental Health Facilities - Because of their access and perspective, Advocates help to identify systemic problems that are hidden, even from those working in the system. By participating in the development of policies and practices, Advocates help prevent future abuse and neglect. By articulating their clients' concerns, Advocates contribute to making the mental health system more responsive and humane.

For the Community - Advocating for the rights and interests of their clients, helps increase public awareness and eliminates stigma. Advocates also can help generate public support for financial, medical and social progress in mental health treatment.

E. County Advocates

Each county mental health director must assign a Patients’ Rights Advocate and delegate to this person(s) the responsibility for ensuring the statutory and constitutional rights of persons identified as mental health clients (Cal. Welf. & Inst. Code § 5520). Department of Mental Health policy provides a formula for determining minimal staffing: one full-time Advocate for every 500,000 population. (DMH Information Notice 80-37).

The legally prescribed duties of the county and state hospital Patients’ Rights Advocates include:

· Assist staff in ensuring that the information about patients' rights is posted in all facilities providing mental health services, and that all incoming clients are informed of their rights including the right to contact the Advocate and the Office of Patients' Rights (Cal. Welf. & Inst. Code § 5520(d), 9 C.C.R. § 863.2).

Investigate and resolve complaints received from patients about violations or abuse of their rights (Cal. Welf. & Inst. Code § 5520(a), 9 C.C.R. § 863.2).

Monitor facilities for compliance with patients' rights laws, regulations and policies (Cal. Welf. & Inst. Code § 5520(b), 9 C.C.R. § 863.2).

Train staff in mental health facilities about patients' rights, laws, regulations, and policies (Cal. Welf. & Inst. Code § 5520(c), 9 C.C.R. § 863.2).

Advocate for patients and residents who are unable or afraid to register a complaint.

Act as liaison between the advocacy program and the Office of Patients' Rights.

Many county Patients’ Rights Advocates are also responsible for representing patients in certifica0tion review and/or capacity to give informed consent hearings.

F. State Hospital Advocates

There are four state hospitals in California that provide mental health treatment: Napa State Hospital in Napa County, Atascadero State Hospital in San Luis Obispo County, Metropolitan State Hospital in Los Angles County and Patton State Hospital in San Bernardino County. Each hospital has a Patients’ Rights Advocate that is employed by the Office of Patients’ Rights. Each state hospital Advocate provides the same advocacy services as County Advocates with the exception of certification review and/or capacity hearing representation. (the Advocate at Patton provides representation in Kehea hearings).

G. Office of Patients’ Rights

The major statutory duties of the Office of Patients' Rights are contained in Cal. Welf. & Inst. Code §§ 5510, 5512, 5513, Title 9 C.C.R. § 864, and Title 9 C.C.R. § 868:

· Ensure observance of mental health laws, regulations and policies on the patients' rights in state hospitals and in licensed health and community care facilities (Cal. Welf. & Inst. Code § 5510).

· Provide training, support and technical assistance to county and state hospital patient rights Advocates in a number of areas including patients' statutory and service rights; civil commitment statutes and procedures; other state and federal laws affecting persons identified as mentally ill; and, skills and knowledge in providing advocacy services (Cal. Welf. & Inst. Code § 5512).

· Serve as liaison between county and state hospital Patients’ Rights Advocates and the State Department of Mental Health (Cal. Welf. & Inst. Code § 5513).

· Respond to patients' rights complaints referred to the Office of Patient’s Rights by local mental health directors, as part of the complaint procedure required by regulation (9 C.C.R. § 550)·

Conduct annual reviews of local Patients' Rights advocacy programs, with the assistance of the county and state hospital Patients’ Rights Advocates (9 C.C.R. § 868).

· Obtain quarterly reports of seclusion and/or restraint and denial of patients' rights from mental health facilities, and analyze such reports for further review or investigation (Cal. Welf. & Inst. Code § 5326.1).

· Analyze and make recommendations regarding legislation on patients' rights.

· Maintain liaison with patient advocacy groups organized by former patients, their parents and families, and other concerned citizens through meetings, discussions, and regular exchange of materials and information.

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