Tuesday, 21 June 2011

Why Be An AMHP?

Blogger provides a lot of interesting data relating to the readership of one’s blog, not least of which is the rough geographical location of visitors. Although predominantly my readers originate in the UK, there are a lot of people in the USA who follow The Masked AMHP, and I even seem to have a significant readership in South Korea, among other more unexpected places. One of the other interesting pieces of data is the search keywords that people have used that have led them to the site. “Diogenes Syndrome” somewhat surprisingly is by far the most popular search term (I suppose people living voluntarily in squalor worries a lot of people), but quite close behind is the question: “Why be an AMHP?”

I suppose that most of the people asking search engines this question are British mental health practitioners trying to make up their minds about whether or not it’s worth undergoing the fairly extensive training necessary to become an Approved Mental Health Practitioner. When the new role of the AMHP was created, it meant that not just social workers, but also nurses, occupational therapists and clinical psychologists could all apply to become AMHP’s.

I have to say that of the numerous occupational therapists I have met and worked with over the years, none have ever shown the slightest inclination to undertake this function. It’s just not really the sort of thing someone wanting to be an OT would tend to consider.

(Mischievous imaginary scene #1: 
CMHT Manager: “What was the outcome of your assessment of Joe Bloggs under the Mental Health Act yesterday?”
Occupational Therapist: “We had a lovely discussion about arts and crafts and then we made a macramé plant pot holder together.”)

I also cannot imagine a clinical psychologist wanting to take on this role – most psychologists I know only ever see patients in their clinical base, and then only if the patient actually wants to see them.

(Mischievous imaginary scene #2: 
CMHT Manager: “Could you go out and assess Joe Bloggs under the Mental Health Act?”
Clinical Psychologist: “I can put him on my waiting list, but does he actually want to be sectioned?”)

Our local AMHP course, which has just finished, had 3 community mental health nurses. While I and other AMHP’s involved with the course, were initially sceptical that nurses could take on board the social perspective that is second nature to most social workers, and were particularly worried that nurses might have difficulty in adopting the autonomy that is essential in the AMHP role, we were impressed and reassured at the enthusiasm and willingness to learn new skills that the nurse candidates displayed during their practice placements.

So why be an AMHP, then? Perhaps I can begin to answer that question by giving some of the reasons why I am an AMHP.

Some of the service user readers of this blog might suggest that the main reason why anyone would be an AMHP is so that they can fascistically exert power over helpless mental patients who don’t really have anything wrong with them and are just trying to get on with their lives in their own idiosyncratic ways. Surprisingly enough perhaps, that is not why I am an AMHP.

The AMHP role is a complex one. It is also unique among the tasks of social workers (and other mental health professionals) in that the AMHP is acting as an autonomous professional rather than an agent of their employees, whether is be a local authority or an NHS Trust. An AMHP cannot be told by a manager to “go out and section” someone. All they can be asked to do is to conduct an assessment under the MHA and reach their own conclusion based on all the evidence.

Going back to my time as a generic social worker in the 70’s and 80’s, I recall in child protection meetings being told to go out and apply for an Emergency Protection Order on a child, or to initiate care proceedings. In those circumstances, the social worker is merely doing what they are told, executing the corporate decision of the agency, regardless of their own possible misgivings.

I have to say that one of the things I enjoyed about working as a generic out of hours emergency duty worker was the autonomy. Whatever the case, whether it be a report of child abuse, a elderly person requiring emergency care, or a request for a Mental health Act assessment, there were no managers around to tell you what to do or what not to do. You could make your own executive decisions, carry them out, then pass the case on to the local area the following day.

If you would like more autonomy in your job, then being an AMHP can provide that. Of course, a consequence of the autonomy you have as an AMHP is that you have to take full professional responsibility for your decision, whatever it may be, and its consequences.

AMHP’s have an in depth knowledge of law and have a responsibility for upholding the law when conducting assessments under the MHA. They can use that knowledge to ensure that the rights of those being assessed are protected, and can provide a counter to the medical model of mental health, introducing a more rounded social perspective to the process. They need to use their knowledge not just of mental health legislation but also the Human Rights Act. This can give them the confidence to disagree with the doctors, and to seek out and suggest alternatives to hospital admission.

Even though some patients subjected to this assessment process may regard that assessment as a foregone conclusion, the AMHP will draw on all the information available on that individual, not just the medical and clinical factors. This includes their individual social and cultural circumstances, the possible risks and protective factors, as well as their knowledge of mental illness and the legal process, in order to try and reach a just and equitable conclusion which will balance the rights of the patient with their possible need for protection and treatment. As a social worker, if you can pull all that off, I think that’s pretty cool.

The AMHP role does indeed consist of a range of powers, but the AMHP has a range of duties as well. The following lists are not exhaustive, but include the main powers and duties.

Powers include:
  • The power to make an application for compulsory admission to hospital under Sec.2, Sec.3 or Sec.4
  • The power to make an application for guardianship under Sec.7 
  • The power to convey the patient to hospital or to authorise others to do so 
  • The power to enter and inspect premises – other than a hospital - where someone is not receiving proper care 
  • The power to apply for a warrant to search for and remove patients or persons living alone in need of care under Sec.135(1) 
  • The power to remove and return patients within UK, or to take or re-take detained patients absent without leave (S.18 and S.138) 
Duties include:
  • The duty to interview the patient “in a suitable manner” (Sec.13(2)) 
  • The duty to respond to a request by a Nearest Relative to assess someone under the MHA (Sec.13(4)) 
  • The duty to consult the patient’s Nearest Relative when considering a Sec.3 (or guardianship) 
  • The duty to inform the patient’s Nearest Relative when detaining under Sec.2 
  • The duty to interview a person removed to a "place of safety" by police under S.136 
  • The duty to consider an application for a patient to be made subject to Supervised Community treatment under Sec.17A 
That’s quite a list, I suppose. There are some fairly awesome powers in there (as well as some onerous duties), but of course power does not come without responsibility, and if you do not feel comfortable with the idea of exerting some of those powers when absolutely necessary, or of having to carry the can for those decisions, then being an AMHP is probably not for you.

The training is fairly rigorous. Our local AMHP course is based in the School of Social Work at the local university. It is equivalent academically to post graduate level, and can give credits towards a higher degree. That may be both an incentive and disincentive, depending on how much you might enjoy academic work. The course extends over several months, including taught modules and a practice placement, which means that candidates are away from their normal workplace for an extended period. Candidates have to submit a number of written assignments, as well as a portfolio giving evidence of their competence to practice. And they have to take a law exam.

However, at the end of all that, the new AMHP is in possession of an impressive breadth and depth of knowledge and skills, which they can then use and develop in their day to day work, as well as when being called upon to undertake AMHP duties. I have said before on this blog that your skills and knowledge as an AMHP can inform and enhance your entire professional outlook.

Qualifying as an AMHP and being Approved is not, however, the end of it. AMHP’s have to be re-approved every 5 years. They have to show evidence throughout that time that they have practiced as an AMHP, that they have had regular supervision of their practice, and that they have undertaken at least three days’ refresher training each year during that time. That may be regarded as onerous, but it also allows the luxury of uninterrupted time when you only have to consider matters of pure professional interest, unhindered by the pressures of one’s day to day job.

And what about the pay? Although contracts for AMHP’s vary with different employers, there is always an acknowledgement that the AMHP has a senior and exacting role, and AMHP’s are rewarded monetarily in various ways, either through enhanced increments to basic pay, or by a separate monthly AMHP payment. But when you consider that I as an AMHP receive less per month for all that responsibility and expertise than a Sec.12 approved doctor does for making a single recommendation under the MHA, then it is not exactly a way to get rich quick.

So why be an AMHP? For me, I like the autonomy, the ability to reach my own conclusions independently of outside pressures, the use of knowledge and experience in a crisis, the necessity to think on my feet, to manage situations of extreme stress while remaining calm and in charge of the process, and the satisfaction of knowing that I have done the best I can in often very difficult situations. And then, hopefully, to see someone recover and be able to function as an individual again.

One day I was in conversation with a woman whom I had assessed under the MHA in the past on several occasions. Sometimes I had had to detain her against her will, and on other occasions she had agreed to informal admission. She suddenly said to me: “I want you to know that I’m really grateful to you for sectioning me. I was really ill then, but didn’t know it. I couldn’t have been left like that. You helped me to get better.” That’s what makes it all worthwhile.

14 comments:

  1. As someone who does a reasonable amount of S12 work, I'd echo your thoughts.

    The skill set that AMHPs possess in spades relative to some other health professionals is a willingness (indeed, a definite active desire) to make positive decisions. A willingness (and ability) to stand up, take responsibility, and make a judgement call.

    The health service is becoming increasingly dominated by a trend to remove decision-making ability from individuals and invest it instead in systems/processes and larger organisations, as a proxy marker for good governance and quality control (I won't go into my thoughts as to whether it actually delivers on that objective!)

    Good AMHPs - indeed, good S12 assessors too I think - are still able to (and enjoy) working more independently, while still maintaining high quality decision-making.

    Keep up the interesting blog!

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  2. The Masked AMHP24 June 2011 22:03

    Thanks for your comments, beyondanomie. I value them/

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  3. Great post (again!). It's certainly nailed some of the reasons I enjoy the role (although I really dislike the actual assessments.. but that's another story). I definitely think it's about being independent and responsible for your own decisions and having a role in the process of preventing unnecessarily hospital admissions.
    I like to say that I don't 'decide to section people' because I can't - I need medical recommendations - but I CAN make decisions NOT to section someone - even when I have the medical recommendations and that's the key.
    There's also a kind of connection between AMHPs when we meet, even virtually, or from different boroughs and organisations because it's kind of hard to explain the role to someone who hasn't been involved in it.
    Although we do still have the odd consultant who seem to think all we will do is sign the relevant papers... .. .
    And I also agree about the positive outcomes. I've had people approach me and tell me that the decisions I made about compulsory hospital admissions at certain points, 'saved their lives'. And the gratitude actually happens more often than people might imagine.
    I also found the process of the training to be some of the best training I've ever accessed (including initial social work qualification!). I don't think there is better training related to mental health work and mental health law available (although that might depend on the university!)

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  4. Can mental health nurses be AMHP? Your stuff interests me and I'm starting my studies soon!

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  5. The Masked AMHP9 July 2011 22:50

    Hi Seaneen. Since the amendments to the MHA in 2007, mental health nurses, occupational therapists and clinical psychologists, as well as social workers, can train to be AMHP's. In fact, our recent local AMHP course had 3 out of 10 candidates who were nurses. So have a go!

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  6. There are some Occupational Therapy AMHP's out there, me being one

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  7. I am an OT.
    I do not do arts and crafts.
    I am currently on stage one of the AMHP course. Interestingly we were told there were 12 placed on the course, but out of 20 people who applied to get on it, only 8 were seen as having the right qualities to complete the training. me being one of them.

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  8. The Masked AMHP17 July 2011 20:59

    I'm really glad to hear that OT's are training as AMHP's. There are none in my neck of the woods. I take back my imaginary scene! But I've yet to hear of a clinical psychologist who wants to be an AMHP. Anyone out there want to say different?

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  9. I am glad you take back your scene, as I don't even know what a mecrame basket is! being an OT on the AMHP training has certainly ruffled a few feathers at my place of work, and I guess it has made me more determined to be a 'good' amhp.

    There are no clinical psychologists on the course but several nurses. I think we all have the skills and knowledge, it's just we have come from different backgrounds and use different models etc. As an OT I strive to keep people independent at home, and I am happy to stand up for service users who I do not feel need to be detained. I work independently in the community on a team of all social workers so I regularly have to fight my own corner!

    keep up the blog, i really enjoy reading it (despite the basket weaving comments)

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  10. Hi,
    I am an LD nurse currently in training to be an AMHP and wanted to say how useful I have found your blogs. They always give an explanation of the AMHP role from an 'easy to understand' point of view in amongst the huge framework that is the MHA!
    Thanks :)

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  11. That's right: there has been very little uptake from Psychologists to work as an AMHP. I think it's possibly because they see the role of the AC/RC more as a career progression.

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  12. Interesting blog and comments. I will definitely be looking into the AMHP training in the future. It's good to see it attracts people from all backgrounds, a mix of experience and ideas is good in any profession.

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  13. Hi! I liked your blog. I just wanted to say I am training to be an OT and am already keen to return to uni in a few years and do AMHP training!
    Your article has really helped clarify a few things about the role and given me more inspiration!

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  14. I like this blog; I am very keen to AMHP training however our trust won't second anyone to do it (I'm an RNLD in liaison psychiatry). When the act was changed to allow the other professions to do AMHP training no-one came up with any joint funding or joint working between the NHS and local authorities.

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