Book Review: “Independent Advocacy and Spiritual Care”

Independent Advocacy and Spiritual Care: Insights from Service Users, Advocates, Health Care Professionals and Chaplains (Geoff Morgan, Palgrave Macmillan, 2017, hardback and ebook, c£66.00)

This fascinating book, based (it would appear) upon the author’s PhD thesis, both sheds important light upon the practice of advocacy and suggests fruitful paths for its development.  Written by a current hospital chaplain and former IMCA, the book looks at the history of advocacy in England and Wales, and in particular its growth as a professionalised occupation in the early years of the 21st century, and is particularly interesting in tracing out some of the (often unspoken or even unconsidered) religious roots of advocacy, and also how advocacy can draw on theology as a message of reaching a deeper and more effective purpose.

The book benefits immeasurably from the fact that the author has worked both as an advocate and as a hospital chaplain, and in a particularly self-aware fashion is able to reflect upon the ways in which the two approaches are similar and different.  It also draws upon a relatively small but qualitatively rich body of interviews with advocates, NHS chaplains, and clients/self-advocates, and the author makes very good use of extracts from these interviews to develop his thesis.  Although expressly drawing from the Christian tradition, the author makes a persuasive case that a recognition of the potential importance of spirituality is the important hidden dimension in the lives of many on behalf of whom advocates seek to act.  More broadly, he seeks to draw upon theological insights (especially those of Practical Theology) to outline two models for the practice of independent advocacy – Reconstructed Empowerment and Action Based on Equality, as well as a set of very practical recommendations for advocates and those who manage them.

Along the way, the author explores the number of fascinating issues, not least of which is the ambiguous nature of advocacy itself, and in particular the complex place that it occupies in a world in which statutory frameworks increasingly provide the advocates to act as the voice of the individual.  With the growth of advocacy, especially following the Care Act, comes demands for increasing professionalisation. But as the author notes, legitimate questions can be asked as to what we might be losing by professionalising a service which is as much a ‘calling’ as anything else.  And, further, what place is left in the statutory framework for self-advocacy?

If I have one regret about the book (other than the sometimes slightly frustrating use of academic paraphernalia which on occasion detracts from the clarity of the insights) it is as to its timing.  As the author makes clear, much of the ground work for the book was done from 2005 to 2011, and the balance of the work seems to have it done in the period leading up to 2015.  It would have been fascinating to have had the author’s perspectives on the relationship between the models of advocacy he seeks to promote and the demands of the CRPD, which has only really started to gain major significance and profile in England, after the intellectual heavy lifting appears to have been done on this work.  I would hope that he would be able to address this in any second edition of this work, as the models of advocacy he outlines are, on their face, profoundly aligned to the ethos underpinning the Convention, but come from very different starting places.

This is only a minor regret, however, and I put this book down both with a renewed respect for the work of statutory independent advocates and a set of questions for myself as to the place and purpose of advocacy in supporting the exercise of legal capacity.  As we seek to develop advocacy going forward I for one will regularly be returning to this work for inspiration.

 [Full disclosure: I am grateful to the publishers for providing me with a copy of this book. I am always happy to review works in or related to the field of mental capacity (broadly defined)]


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