Through the gaps: Advocacy in the face of systemic silence

This reflective article examines the advocacy role of clinical psychologists when patients face significant barriers to participating in decisions about their care. Drawing on a composite neurorehabilitation case, it explores how aphasia, language barriers, fluctuating capacity, and social vulnerability interacted to limit meaningful engagement within clinical systems. The paper considers ethical challenges related to supported consent, capacity assessment under the Mental Capacity Act, and risks of neglect by omission when communication needs are insufficiently addressed. It argues that advocacy is a core component of psychological practice and calls for systems-aware, equity-focused care in complex clinical contexts. Note: All identifying details have been altered to protect confidentiality. The clinical scenario represents a composite of experiences drawn from neurorehabilitation practice.