Research shows that tensions between family carers and professionals become acute where the issue of compulsory admission to hospital is at stake. In England and Wales, a specific family member is appointed to safeguard the interests of a person assessed under the Mental Health Act 1983. This currently occurs through the Nearest Relative (NR) role. The Government is proposing to replace this with a Nominated Person role, chosen by the service user. Drawing on the concept of carer burden, this study reports on the views of nineteen NRs in England to discover their experiences of being involved in a Mental Health Act assessment. Participants identified that they undertook the role due to a sense of duty. Their experiences were mixed with participants highlighting both feelings of distress during the assessment and feelings of relief once their relative had been detained. Participants reported feeling conflicted when their relative was detained and feelings of frustration towards mental health services. The findings have implications for proposals to reform the Mental Health Act 1983. They show that education and support programmes should be created for NRs/Nominated Persons and that research is needed to assess whether such support is effective at reducing carer burden.

In this article, we review current advocacy services for people with dementia in England and Wales (provided, respectively, under the Mental Capacity Act 2005 , the Mental Health Act 1983 /2007 and the Care Act 2014) through the lens of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We examine what a human rights' approach to advocacy support would entail, and whether current frameworks in England and Wales are adequate for this approach and provide a sufficient safeguard. First, we consider how the human rights of persons with dementia have become increasingly important and the extent to which the CRPD provides an opportunity to bolster safeguards and protection. Second, we discuss cause and case advocacy, and how these advocacy models could be shaped by the CRPD to promote the rights of persons with dementia at each stage of the disease. Third, we highlight current dilemmas and challenges in the provision of advocacy support in England and Wales by focusing on case law, commissioning of services and current practice. In particular, we analyse how the different legislative schemes have given rise to some confusion about the various advocacy provisions, as well as potential for overlap and discrepancies between different regimes. We also highlight the need for further research to address important gaps in knowledge, including the scale of need, patterns of referral and attitudes to advocacy services. The article concludes by highlighting how advocacy support could be recalibrated as a universal right to promote the aims and aspirations of the CRPD, and how education is needed to address the stigma of dementia and promote the benefits of advocacy in protecting the rights of those with dementia.

Article 16 of the United Nations Convention on the Rights of Persons with Disabilities includes the right to be free from all forms of violence, exploitation and abuse. In pursuance of this aim, Article 16 (3) imposes an obligation on States Parties to 'ensure that all facilities and programmes designed to serve persons with disabilities are effectively monitored by independent authorities'. Effective independent monitoring is viewed as a key mechanism to help safeguard people from violence, exploitation and abuse. This is highly pertinent in the wake of the highly publicized abuse of patients in care homes and hospitals in England in the last few years. This article examines the monitoring requirements of Article 16 and, by drawing on the author's research into the Care Quality Commission (the national health and social care regulator and mental health monitor) in England, assesses the extent to which independent inspection of hospitals and care homes can play a part in realizing Article 16(3) to prevent violence, abuse and exploitation of persons with mental disabilities. The potential scope and reach of Article 16 is extremely wide: this brings with it great potential but, at the same time, significant challenges for achieving effecting monitoring. Some of these challenges are explored and the paper concludes with some consideration of how monitors/inspectors, such as the Care Quality Commission in England, can strengthen their protection for people with mental disabilities, in line with the ethos and aspirations of the CRPD.

Dementia may make adults more susceptible to abuse and neglect and such mistreatment is recognised as a human rights violation. This article focusses on how the rights of people living with dementia might be protected through the use of supported decision-making within safeguarding work. The article begins by reviewing the aims and scope of adult safeguarding services. It then describes how the concept of ‘legal capacity’ is set out in the UN Convention on the Rights of Persons with Disabilities (CRPD) and how this differs from the concept of ‘mental capacity’ in the Mental Capacity Act 2005. Focussing on practice in England, it is argued that tensions between the CRPD and domestic law exist, but these can be brought into closer alignment by finding ways to maximise supported decision-making within existing legal and policy frameworks. The article concludes with suggested practice strategies which involve: (i) providing clear and accessible information about safeguarding; (ii) thinking about the location of safeguarding meetings; (iii) building relationships with people living with dementia; (iv) using flexible timescales; (v) tailoring information to meet the needs of people living with dementia and (v) respecting the person’s will and preferences in emergency situations.

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