The obvious answer is a person who uses services.  This is an acceptable answer in an ideal world where funds are unlimited and anyone can access advocacy; where advocacy is a public service.  The unfortunate reality is that funds do not allow such an interpretation and we have to restrict access to our service.  In some instances this is conveniently defined within the contract.  For example the St Edwards resettlement project goes as far as to name the entitled service users!  Other projects are not so “lucky”.  Additionally, this is a problem that tends to occur with self-referrals as referrers are usually professional and that usually makes the referee a service user by definition!

The greatest area of confusion is with the generic projects as we really don’t mean generic at all. 

When we mean generic we mean generic for service users – a bit of a circular argument. What do we mean by service user?  Does it mean the person who uses services?  Well, we all have a doctor and have physiotherapists and the like and have all at one time been in a hospital as an in patient etc.  When do you become a service user? 

Traditionally we use the concept of disability.  As we all know this is problematic as many people would not consider themselves a disabled person despite major psychiatric needs.  At the other end of the “scale”, many people have enduring mental health needs (25 years on anti depressants) and have never seen anyone other than their doctor – so they have no psychiatrist – are they a service user?  Additionally, is a person in a general hospital ward who has a life threatening condition a service user?? – at that moment in time they may be as disempowered as any service users in the traditional sense.

  As “Deep Thought” famously commented - “tricky”.

The issue is that no matter how we define a generic service user it will be inconsistent, contain internal contradictions and be unfair to a number of “groups”.  So lets at least define who is definitely a service user.

1:  A person with a disability. 
Using the social model its all very woolly (though in other terms revealing) and does not get us far.  We are not about to make the analysis of disability that is different for each person and their relation to society as a whole and their disadvantage within society.  We thus need to rely on someone else doing the donkey work.  And that someone else is the range of statutory agencies that label the person “disabled” – whether the person accepts it or not.  Thus a person in a wheelchair may not call themselves disabled but social services does and thus they are eligible.  Conversely a person may consider themselves disabled but nobody else does and are thus not (is this hard!).  The really big problem will arise (or has already) as a whole number of hitherto chronic conditions are now being considered as disabilities as they talk in terms of normality etc.  Thus epilepsy, diabetics, and other conditions will become disabilities at least in employment terms!

  In essence then the guideline that Asist has to adopt if it is not to spend large resources on eligibility criteria is to consider disability to be defined by statutory agencies.  If they go for it then so do we.  We let them do the defining (when does back ache become a disability – when SS says so).

2:  A person with a mental health need.
This has been touched on earlier.  Mental health is a wide spectrum of conditions and disablement.  Many people with a GP diagnosed conditions (depression etc) are more “disempowered” than many service users who have a psychiatrist’s diagnosis for schizophrenia, but is well balanced and living in the community.  Again in pragmatic terms we are left with little alternative but to rely on others to do the defining – however we also need to be a bit flexible in order not to deny a legitimate claim for our services.  In general, an eligible user is one that obtains mainstream psychiatric/psychological services – typically accessing a doctor would not alone qualify someone as a legitimate user – if we allow this then we will be servicing the “worried well”. 

Of course a self-referral is different from a third party one.  If a person who has been on drugs for ten years wants to come off and their GP is uncooperative then perhaps they are eligible.  The person may well be unable to “fight” in these circumstances all alone and powerless against the might of the GP.

  It’s a bit of a fudge but one that is necessary.

3:  A person who wants to be a service user who is being denied a service.
We cannot think of any good reason why this person cannot be offered advocacy.  They are rare anyway.  There is a whole area of denial of services and we have all come across them.  We just have to go with the flow and support a person attempting to get an assessment from Social services or the health services.

In summary:
Third party referrals:  this is reasonably easy as usually the third party is a care agency.  They would not be involved unless the person is a user of their service at least.  In the main you accept a referral if it comes this way.  We have to recognise that there are levels of eligibility to referrer – a psychiatrist versus a physiotherapist with a person with poorly back!

Self-referrals:  In general this is positive.  However there is confusion amongst people that we are an alternative CAB.  We have to be careful about the questions we ask self-referrals.  In essence, our current methodology has solved the problem.