Given the stated intention of the Royal College of Psychiatrists to review its position on patient advocacy in 2004 (Royal College of Psychiatrists, 1999; due for review 2007), it seems appropriate to highlight some findings of a recent qualitative study of 10 paid independent advocates on acute and continuing care wards in England. Although this collaborative venture aimed to explore the day-to-day experiences of advocates, participants felt that politically, advocacy was still bereft of real power within the National Health Service and advocacy projects were generally hampered by insecure funding.

Advocates saw their independence from staff as vital, both to them and service users, but constructive working relationships with psychiatrists and nurses were equally important for advocates in achieving desirable outcomes. Most participants did feel relationships with clinicians were generally good, although all had encountered some defensiveness or hostility from some, even allowing for the tension that should exist between advocate and clinician (Reference Graley, Mooney, Conlan, Conlan and DayGraley et al, 1996). In some cases participants suggested that previous advocates had created mistrust by behaving unacceptably. On the other hand, some older nurses and psychiatrists seemed unconvinced by any moves to support greater patient autonomy.

Confusion over the role of the advocate remained common, even among those supportive of advocacy, and participants felt that clinicians might be more reassured of the legitimacy of advocacy if advocates had access to recognised and standardised training themselves.

An account of this project may be found in the February and June 2003 editions of The Advocate, the newsletter of the UK Advocacy Network.