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Consumer: An individual who is receiving (patient) or has received mental health services.

Advocate: A person who pleads the cause of another.

Mental health patient "consumer" advocacy was mandated by the federal government in 1986 by Public Law Chap. 114, 42 U.S.C. 1061 sections 10801-10851, 1986 amended 1989. Better known as the "Protection and Advocacy for Mentally Ill Individuals Act," the law was patterned after the protection and advocate act for those with developmental disabilities. This act ensures a basic framework of design for an advocacy system. However, it is up to the states as to how vocal and effective advocates and advocate groups become. Although many advocates are attorneys, often it is grassroots organizations, run by consumers themselves, that are the most effective.

By law and nature, advocates have several functions. They legally represent the individual patient, attempt to change policy, and educate. Representing the individual may be as simple as letting the client's wish regarding medication be known to the doctor, or as complex as filing a writ in federal court to have the client released form the hospital. Education can be as informal as discussing a client's rights with a mental health aide or the client himself/herself, or as formal as offering regular in-service training sessions on rights of the mentally ill. Policy changing is accomplished through discussions with facility directors, and/or lobbying legislatures for new laws and policies.

Advocacy is based on the premise that all persons have inherent rights-that the bill of rights applies to all individuals, including those who are mentally ill. According to federal law, each state is required to have a formal advocacy program designed to ensure that the mentally ill's rights, taken from federal and state statutory law and the constitution, are advocated for and protected. Advocates investigate abuse and neglect.

Case law-such as Donaldson v. O'Conner which says that states cannot confine persons who are not dangerous to themselves or others and who are capable of surviving on their own-has enumerated that most of the rights embedded in our constitution are to be applied to the mentally ill. Dixon v. Weinnberger gave mental health patients the right to treatment in the least restrictive environment. Another case, Okin v. Rogers, gave the mentally ill the right to refuse treatment. Baxton v. Harold recognized that the mentally ill have a right to treatment. One of the most far reaching cases was Ward v. Kort , wherein states seem to have an affirmative duty to find and offer legal representation (advocates) to clients confined in state mental hospitals whose fundamental and constitutional rights have or may be violated.

Past problems with mere case law to support patient rights stem from the tremendous number of consumers who were without the funds and the knowledge to invoke and utilize the law. Furthermore, many of the laws were only protecting those in state mental hospitals. Even today, with the Protection and Advocacy Act and a more "user friendly" system, many consumers are without advocacy protection, not even aware that advocates exist, or how to contact one. Furthermore, many facilities are privatized and therefore out of the government's reach.

There are basically two types of advocates—a system advocate and an ex-patient consumer advocate. Both are effective. A systems advocate, usually housed at the mental health hospital, is generally employed by the state or a subcontracted agency. Sometimes the advocate is responsible to other agency's as well for example, the Department of Mental Health. This advocate attempts to work separately and apart from the facility, yet remain an important member of the patient's treatment team. The main problem with a systems advocate is often they appear to be in conflict between the needs and goals of the facility and the patient. Many times they can't advocate and protect clients in private facilities (those that receive no funding or certification from the state). However, on the positive side, this advocate is generally easily accessible.

Consumer advocates are consumers themselves. Many times these are volunteers who are in non-profit and/or self-help groups (sometimes funded by federal and/or state grants). The consumer advocate is normally separate from the facility in which he/she advocates and often works within the private facilities not available to the systems advocate. Consumer groups are vocal, highly effective, and a growing business in a mental health system which for the most part has not been held accountable for how clients are treated. These groups are also effective lobbyists because they have a very real understanding of the realities of the mental health system and what the client endures.

What does one look for in an advocate? Generally, the advocate should never appear to be in a conflict of interest with the patient. The advocate should appear separate from the facility (not paid by the facility or responsible for other jobs at the facility). The advocate's foremost concern should be the patient and his/her rights. This is not to say that advocates can not be cooperative with the facility. Frequently the best advocate is non adversarial in conduct. This type of advocate is a team player and, like the facility, has the clients best chances for recovery as the goal.

Finding an advocate can be difficult. If one is sick and without the support of family or friends, the chances of invoking the help of an advocate diminish. A good advocate system should have active advocates monitoring the facilities, educating patients about their rights, and doing random visits and checks to help ensure some clients don't fall through the cracks. Most states have a department of mental health which has an ombudsman, grievance coordinator, or patient rights person. Some states have placed the mental health division in the Department of Human Services or Health rather than a department of mental health.

There are national clearinghouses and national organizations that are good resources for those trying to access an advocate. One of the largest organizations is the National Directory of Consumers and Ex-patient Organizations and Resources at 1-800-832-8032. Another large national organization with state chapters is National Alliance of the Mentally Ill (NAMI) at 1-800-950-6264.

Other helpful organizations include Children's Mental Health Services at 1-800-789-2647.