Wednesday, 25 July 2012

Maintaining identity as a social worker in a multidisciplinary team

How do social workers recognise and maintain the core social work tasks in a multidisciplinary team? The Masked AMHP shares the advice he gave to one social work student.

You can read the Masked AMHP's recently published piece on the Guardian Social Care Network here.

Thursday, 19 July 2012

The Masked AMHP Reaches 100!

I even made my own cake!

This is the Masked AMHP’s 100th post!

When I created this blog back in March 2009, I had no idea whether or not I would be able to sustain writing it beyond a few months. Would I run out of things to write about? Would I simply get bored?  Would I be able to keep to my initial remit, which was to inform and entertain? Would anyone actually read the blog?

Well, I’ve now managed to keep thinking of things to write about for over 3 years. And people do seem to read, and even sometimes enjoy, the blog. When Blogger started to provide me with statistics, back in July 2009, I was gratified to discover that around 1400 people were accessing the blog every month. That was nearly 50 people every day! I am now getting around 10,000 page views a month, and the readership seems to be continuing to grow month on month. 

One of the things I love about blogging is the feedback you receive from readers. I’ve had many interesting, thought provoking and encouraging comments, from professionals, other bloggers and, importantly, from many service users. These comments have helped me to think that writing the blog has been worthwhile, and even useful to others. I’d particularly like to mention CB here, who used to write the awesome FightingMonsters blog. Not only was she my first Follower, but her early comments encouraged me to continue. 

By the way, I find the negative and argumentative comments on the blog just as stimulating in their own way. I have even used some as a springboard for discussing significant issues. (Hello, Monica!) 

(And I’ve even had a comment from someone who could only be Richard Jones himself, the author of the Mental Health Act Manual, the Bible of AMHP’s everywhere. It’s like suddenly discovering that God himself is actually listening to you as you say your prayers at bedtime. And has something to say about it.) 

I have had encouragement from other estimable blogs, including the sadly defunct Mental Nurse, as well as The World in Mentalists and The Not So Big Society. It’s always much appreciated when a post is recommended by others. 

I was very flattered when Guardian Select took an interest in the blog and included it in their directory, and in the last year I have had a number of pieces published in the Guardian’s Social Care Network. 

About a year ago I set up the Masked AMHP’s Facebook group. I had no idea what, if anything would come from it. Over that time, the group has evolved into an open forum for discussion about a wide range of issues relating to mental health. The membership is gratifyingly cosmopolitan and eclectic, ranging from AMHP’s and trainee AMHP’s through to bloggers, academics and importantly, service users. We even have a police officer and a chaplain!

The group has developed into a unique opportunity for people from all sides to come together and discuss how mental health, and the Mental Health Act, impacts on their personal and professional lives. At the last count, there were 325 members. So why not join? (Shameless Plug.) 

So what is next for the Masked AMHP? Should I write a book, and if so, what about? (I’ve been thinking hard about this.) Do readers have any preferences for the types of posts I write, or have suggestions for future posts? Should I start Tweeting? I’d be delighted to hear from you. 

In the meantime, I’ll have to see whether I have the inspiration, or the energy, to write another hundred posts. After all, I’m getting pretty ancient by now.

Thank you all for reading.

Tuesday, 10 July 2012

Should an AMHP Assess Someone They Know under the Mental Health Act?

Approved Mental Health Professionals can work in a wide variety of settings, ranging from community mental health teams, through to older people’s or learning disability social work teams, and some (although not many) even work  in children and family teams. Many social workers in Emergency Duty Teams, which provide emergency social work services out of normal working hours, are also AMHP’s.

Generally speaking, AMHP’s have to be on a duty rota as a requirement of approval. This can mean either setting aside a day a week when you are available in your work place to take calls for Mental Health Act assessments, or sitting in an AMHP office with a group of other duty AMHP’s, ready to take whatever chance throws at you.

Some AMHP’s take the view that they should only deal with MHA assessments when they are on the duty rota. If that is the case, it is fairly rare for anyone with whom they have been professionally involved to need to be assessed on the specific day that they are on the rota.

Some AMHP’s take the view that it is a matter of best professional practice to “consume their own smoke”, especially if they are based in a mental health team. In this case, they would expect to provide an AMHP service to the team’s service users. I tend to take this view.

There is a lot to be said for sitting in an AMHP office, mingling with your colleagues. You can enlist their advice or support when dealing with a call. If you don’t get a call, you can drink coffee and swap anecdotes. You can gain a great sense of camaraderie from being in the AMHP office.

But if you work in a community mental health team, in a way, you are always on call. You always have your AMHP hat on, or at least, you can whip it on and off at the drop of a hat, so to speak.

There are advantages to this. You can act as a consultant, giving a professional opinion in team meetings and case discussions. In a multidisciplinary team, you can be made aware of a situation which could potentially lead to a formal assessment and suggest ways to avert it. If your advice is taken, and it still ends up with you having to initiate a formal MHA assessment, then you can feel confident that all other avenues have been explored, and that there is no alternative.

If you have care coordination responsibility for the service user, you can make judgments as to whether at any particular moment in time that service user might need a formal assessment, and then act accordingly. If you have a rapport with the service user, then you can discuss your concerns with them, and may be able to persuade them to take action to avoid a potential admission, or at the very least to persuade them to accept admission informally.

But there are also disadvantages to this approach. A service user may be suspicious of you if they think that at any time you might whip out some pink forms and section them. You may also take the professional judgment that it may damage your ability to work with them afterwards if you are the AMHP who detains them.

In my experience, I have found that some service users have never forgiven me for sectioning them, and it has been difficult, if not impossible, to work with them afterwards.

However, I have also found that some service users have been very thankful that I took the action I did, and have continued to work with me afterwards. It can even work to our mutual advantage. If I am very familiar with someone’s relapse signature, then I can be frank with them and share with them the concerns I have if I see their early warning signs. They are more likely to take heed if they know that I know.

I have been in some situations where I am able to make judgments about someone’s mental state based on my extensive past knowledge of when they are well or unwell, being able to detect dangerous signs that an AMHP or other professional who does not know the patient might misinterpret.

Some of the people I have worked with exhibit signs that include extreme rudeness when they are unwell. One example that springs to mind is attending a ward review in which the patient refused to leave their room. We therefore took the ward review to him. He lay in bed looking at us for a few moments, then pointed to the alarm button on the wall and said, “If I want to see a doctor, I press that.”

However, when this person is well, he is warm, amiable and polite. But if you were not intimately aware of his relapse signs, you might simply regard him as being sullen and uncooperative.

(I expect there are some service users reading this who right now are fulminating and shouting at their computer screen: “Of course he’s rude! He didn’t want to be sectioned did he? And the only reason he’s polite later is that he wants to avoid being sectioned again!” To those people, I can only say that after a lot of experience you can learn to tell the difference. I do not automatically think that someone being rude to me is a sign of mental illness. If that were the case, a lot of Department of Work and Pensions officials would be languishing in hospital.)

Another area where acting under the MHA can be an integral part of your ongoing role as care coordinator/AMHP is with Community Treatment Orders. Increasingly often, I am finding that a potential eventual discharge on a CTO is being considered almost as soon as a patient has been detained under Sec.3. It can become part of the long term discharge planning process. It would therefore seem to me to be appropriate for me as their care coordinator to undertake the AMHP role in the CTO process, rather than someone coming in cold to make that decision.

I am currently managing several patients who are on CTO’s, where I was the AMHP that endorsed the application. It means that when the time comes to review the CTO, with a view to either discharging or extending it, I am fully aware of the past risk history, the progress and effectiveness of the CTO during the previous months, and am in a better position to assess the usefulness or otherwise of extending it. I can also better “own” the inevitable report for either a managers’ hearing or a Tribunal. Curiously, some of these patients see being on a CTO as a wholly positive experience; they seem to see it as insurance against returning to hospital.

Overall, then, I regard the AMHP role in connection with service users with whom I am professionally involved as a positive thing. It can, perhaps strangely, make the professional relationship stronger, and even lead to an increase in trust. I’ve written quite a lot in this blog about people I have assessed and/or detained on more than one occasion. The evidence I have is, that as long as you act with honesty and integrity, the service user will respect you for it.