About Advocacy:
Advocacy is taking action to assist people to say what they want, secure their rights, represent their interests and
obtain services they need. Advocates and advocacy schemes work in partnership with the people they assist and
take their side. Advocacy promotes social inclusion, equality and social justice.
Advocacy is not:
Advocacy will help to:
X Counselling, befriending, or support work
X legal advice or legal support
X A long term intervention
X Guarantee the outcome
 Get your voice heard
 Access Services
 Understand your right
 Make informed choices
When we receive a referral, the information will be entered onto a secure password protected system to ensure
confidentiality and data protection. The information you provide will be shared amongst the Total Voice Suffolk
partners and the referral will be responded to by the referrals coordinator within 5 working days.
Total Voice Suffolk provides formal advocacy for people over 18 who live in Suffolk. We support people with
learning disabilities and their family carers, people with dementia, older people and adults with serious Mental
Health conditions.
If you would like to speak to the referrals coordinator about a possible referral or if your referral is urgent i.e.
safeguarding please call the referral line on 01473 857631
Total Voice Suffolk also provides NHS Complaints Advocacy.
To make a referral call 0300 330 5454
People wishing to make an IMCA referral should also read the ‘Joint guidance on the instruction of Independent
Mental Capacity Advocates’ before deciding whether to make a referral for an IMCA.
Please complete the referral form and appendix 2 or for more information call 01473 857631For people under
Section who need an IMHA or people in the community with mental health issues please complete referral for
and appendix 1 or call 01473 857631
PLEASE NOTE: Please complete all relevant sections of the referral form as incomplete referral forms will be
returned to be completed
Total Voice Suffolk is a collaboration of partnership organisations led by VoiceAbility. This brings together a range
of established and experienced advocacy providers in Suffolk. Organisations in the partnership are: ACE Anglia
Ltd, IMPACT, The Alzheimer’s Society, Suffolk
Family Carers, and
Age UK.
PERSONAL DETAILS
Full name of person being referred for advocacy:
Date of birth
/
/
Gender:
Current Address (Inc. postcode):
Type of Accommodation:
Home address (Inc. postcode):
Telephone number:
Primary support needs:
Email:
Ethnicity:
Religious
beliefs:
Sexuality:
Preferred method of communication:
KNOWN RISKS
Any known risks to the person being referred or to the advocate? (I.e. health, behavioral issues, vulnerability):
If known risks are there any triggers and how can we minimize the risk?
How does the person being referred communicate? I.e. language, facial expressions, gestures, Makaton
Please outline why you or the person you are referring requires an advocate?
MEETING CLIENTS
Is there any particular time of day which is best to meet?
Does the person being referred have any family members whom they do not wish to be
included in the process?
YES
NO
DETAILS OF PERSON MAKING THE REFERRAL
Name of person making referral (if this is not a self-referral):
Relationship to the person being referred:
Contact address
(Inc. postcode):
Telephone number:
Email:
Other parties involved (e.g. doctors, advocates, friends, etc.):
Has the person requested an advocate?
Is the person aware of the referral?
Mobile
YES
YES
NO
NO
I confirm that for the above issue I am making this referral on behalf of:
Insert NHS body or Local Authority:
THIS DOCUMENT CAN BE EMAILED TO US AT [email protected]
SIGNED:
DATE:
Any other comments:
PLEASE RETURN TO: TOTAL VOICE SUFFOLK, Westbury House, 630 Woodbridge Road, Ipswich, IP4 4PG
*Please note that this referral form was produced in partnership with VoiceAbility and Ace Anglia Ltd*
IMHA APPENDIX 1:
SECTION:
Date Sectioned?
ADMISSION DATE:
INFORMED OF MHA:
COMMUNITY TREATMENT
ORDER:
INFORMED OF MHA:
IMCA APPENDIX 2:
WHAT IS THE BEST INTERESTS DECISION?
Serious Medical
Treatment
Long Term
Accommodation
Adult Protection
Care Review
Please describe the decision:
E
Date decision need to be made by:
Meeting dates (please specify)
F
CAPACITY ASSESSMENT
Name and position of the profession who had decided the referred person lacks mental capacity to make a
decision on the referral issue:
Has a 2 stage functional assessment of capacity been
carried out?
G
Yes
No
FAMILY AND FRIENDS
Does the referred person
have a family or friends?
Yes
No
Are the person’s family/friends appropriate to be involved in the best
interest decision?
If no, what is
the reason the
family/friends
are not
involved?
Yes
No
KEY PEOPLE
J
Professional making the best interest
decision:
Referrer (if different from decision maker)
Print Name
Position
Organisation
Tel No
Mobile No
Fax No
Email
Pager
K
Involved professionals
(not listed above) and
contact details
L
Is the referred person aware of the advocacy referral?
M
Signature (Referrer)
N
Signature (Decision Maker)
O
PLEASE RETURN THE
COMPLETED FORM TO:
Yes
No
Date:
VoiceAbility, Mount Pleasant House, Huntingdon Road, Cambridge, CB3 0RN
IMCA FAX: 08444 432 459
Email: [email protected]