Friday, 12 June 2009

My First Mental Health Act Assessment (Part I)

It was 1976. I had my first job as an unqualified social worker (most social workers were unqualified in those days) in an area office with a mixed rural and semi urban catchment area. I had been working there for 2 months when Gordon, the area officer, called me into his room.

“Would you like to come out with me on a Mental Health Act assessment?” he asked.

Gordon was in his late 50’s. Before the major reorganisation of national social services a few years previously (arising from the Seebohm report, for those who may be interested), he had been what was known as a Mental Welfare Officer. Mental Welfare Officers were what we would now call AMHP’s. MWO’s were created by the Mental Health Act 1959, which introduced the concept of the independent lay person who made final decisions about detention in hospital based on the recommendations of doctors.

Of course I said yes. I was completely new to social work, and keen for experience.

The assessment was on a lady in her 50’s. She was the manager of a social security office. Her GP had rung Gordon because neighbours were reporting that she was wandering around in her garden dressed in nothing but her nightie. It was a chilly November morning, so this was a matter of some concern.

Gordon told me that she was known for this. She would go for months or years without any problems, then one day would wake up and be completely bonkers. A spell in hospital invariably sorted her out.

We met the GP at her house, a nice bungalow in the countryside. We didn’t bother to knock on the door, since we could see her wandering around in the garden in a diaphanous negligee. To see a woman of that age (or any woman come to that) so scantily clad was at the time quite a shock to me, but Gordon took it in his stride.

Gordon put on a rather scary fixed smile which I assume he thought was reassuring and the three of us approached her.

“Hello, June,” he said, “What seems to be the problem?”

She turned and looked at us. She looked at me with an interest that alarmed me. This was the first mad person I had ever seen. What might she do?

“I came out to see the fairies,” she eventually replied. “They’re everywhere. They’re so lovely.”

“Yes, they are, aren’t they?” Gordon replied. I assumed he was “humouring” her. “Why don’t we go inside? It’s quite chilly out here isn’t it?”

She allowed herself to be led through the garden into her house, her bare toes sinking into the damp grass as she went.

Gordon and the GP had a discussion in her kitchen. It didn’t take long. The GP filled in a form and then Gordon filled in another form. This was known then as a Section 29, when someone was detained with only one medical recommendation. Under the 1983 Act it would be a Section 4, which should only be used in cases of dire emergency. However, in those days it was almost impossible to get a psychiatrist to leave the safety of the ward, and Section 29’s were a not uncommon way of getting people to hospital, when the consultant would then convert it to a Section 25 at his leisure.

“Why don’t we go for a ride in my car?” Gordon asked June. “Just put on your coat and come with me.”

“Where are we going?” she asked.

“Just for a nice ride,” he said reassuringly.

I knew even then that this was not the right way to relieve someone of their liberty. Shouldn’t you always tell the truth, even to someone who seemed to be quite literally “away with the fairies”?

Throughout the drive to the hospital, Gordon continued with a stream of reassuring lies, and as we drew up outside the ward he told her that “it would only be a few days. You’ll have a nice rest and be right as rain in no time.” He knew she would probably be in there for several months; hospital admissions generally seemed to be much longer than they are now.

Gordon’s approach seemed to me to be dishonest and underhand. I did not feel he gave June the proper respect. I resolved that I would do my best never to deceive, mislead or patronise a mental health patient, should I ever become a Mental Welfare Officer.


  1. we should aim for the maximum honesty but there are times when this aim is compromised by risk considerations. we don't give people notice we are planning to assess them under the mh act if to do so would put them or others at risk.
    enjoying your blog, good to hear from someone with so much experience.
    J, AMHP south east

  2. Yes, it's really interesting. I'm still very new to it so it's always useful to read of others' experiences..