|The Masked AMHP unobtrusively observing his AMHP trainee while she is leading a Mental Health Act Assessment|
AMHP trainees by definition are qualified and experienced workers. Our current intake consists of a mixture of social workers and nurses. My own trainee (or candidate as they’re known by our course), whom I’ll call Floella, mainly because it’ll wind her up, is exceptionally experienced. (Hi Floella!). She’s been a mental health nurse for over 30 years, working mainly with older people.
AMHP trainees are largely responsible for organising their own learning, with guidance from the practice educator. This means that during the 8 week placement, Floella has arranged a large variety of observation visits, and has also, in conjunction with the other trainees, arranged to shadow the local AMHP rota, in order to gain opportunities to shadow other AMHP’s conducting Mental Health Act Assessments.
Which is just as well, as until last week, the Masked AMHP had not had a single MHA assessment that coincided with Floella being present at my CMHT. Sometimes that’s how it goes.
AMHP trainees have to shadow a minimum of 6 MHA assessments. They also have to complete a fairly intensive and detailed portfolio (the course is after all at Master’s level), which much include evidence of an exhaustive list of competencies, all of which are essential in order to practice as a fully blown AMHP.
The practice educator has to directly observe the AMHP trainee conducting at least two pieces of work, which must be face to face contact with service users. The practice educator has to provide supervision, oversee the learning opportunities available to the trainee, and ensure that the portfolio meets the requirements of the course. All in 8 weeks.
This is in marked contrast to supervising a social work student on placement. For a start, the placement is a lot longer. A social work student may have no previous experience at all of mental health, and may therefore need a considerable run in time, during which they may merely observe, get used to the nature of the work required, and learn the specific protocols and paperwork. They will be working on placement towards developing fairly basic competencies, in contrast to the competencies required to practice as an AMHP.
So what of Floella? As I said at the beginning, being her practice educator has been a real pleasure. From day one she was able to provide evidence of her confidence and skills. All I have really needed to do is observe, facilitate, review her burgeoning evidence portfolio, and ensure that she is using her skills and knowledge in the appropriate way to inform her practice under the Mental Health Act.
Oh, and once or twice to remind her that the role of the AMHP is distinct from the role of mental health nurse. (Don't take a patient's pulse while undertaking a MHA, unless they're clearly comatose.)
As an AMHP trainee’s shadowing experience on MHA assessments progresses, they are expected to take on an increasingly active role in the assessments themselves.
And I needed to see that myself before the placement ended. I needed to observe her directly during a MHA assessment.
This is not to say that Floella had not seen the Masked AMHP in any sort of MHA related action. She had observed me presenting a report to a Managers Hearing. She had witnessed me revoking a CTO. She had attended S.117 review meetings. But no actual MHA assessments (that is, a request to assess a patient for admission under either Sec.2, 3, or 4).
So, since merely being in the physical presence of the Masked AMHP had not resulted in an actual MHA assessment materialising, I decided that we would base ourselves at AMHP headquarters for the day. This office is based at
If necessary, we could cold call the wards to see if they might like a Sec.2
patient considering for a Sec.3, or if
they had a brand new Sec.5(2) that needed reviewing. Charwood Hospital
Floella and I discussed her learning requirements. She had already had a good cross section of formal assessments, including obtaining a Sec.135 warrant, and an assessment of someone with learning difficulties. We concluded that it would be good for her to assess an older person, since although she was used to working with older people with mental health problems, the act of assessing as an AMHP under the MHA was a distinct function. We also thought it would be good to assess someone already in hospital for a Sec.3.
You never get what you wish you, do you?
But sometimes you do. We got a call late morning. An elderly man in his late 80’s. Ralph had been admitted to the older people’s unit about 6 weeks previously under Sec.2 suffering with severe depression. He had then remained as an informal patient and had appeared to be improving until his blood sodium levels plummeted because of his antidepressant. The medication had to be stopped, and as a consequence his mood dipped again, he stopped eating and taking fluids, he lost weight and became physically very frail. His Consultant wanted to detain him under Sec.3 in order to give him ECT.
Floella took charge of the assessment process, while I sat back with a coffee and observed.
She contacted the ward and spoke to the Consultant. She obtained background information. Ralph had a history of depression going back over 20 years, and had benefited from ECT in the past.
She contacted a Sec.12 doctor and arranged a time to undertake a joint assessment.
She identified and contacted the Nearest Relative, who was Ralph’s daughter, as Ralph was a widower. The NR did not object to the proposed Sec.3, although had some concerns about the ECT.
Floella checked out the legislation. Sec.58A of the MHA was introduced by the 2007 changes. It covers Electro-convulsive Therapy. ECT can be given in an emergency, or if the patient agrees, or if the patient lacks capacity but it is considered to be in their best interests. However, a significant change is that ECT cannot be given under any circumstances if the patient has made an advance decision concerning treatment.
Floella confirmed that no advance decision had been made.
We went to the ward and Floella led the interview. It was clear that Ralph was physically very unwell, was extremely depressed, and, although he showed no signs of dementia, he was clearly unable to give informed consent about treatment, and would be likely to refuse in any case.
Floella reached the conclusion that Ralph was suffering from a mental disorder “of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital”, that “it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section”, and that appropriate medical treatment was available. It is correctly not the role of the AMHP to reach a decision concerning the merits or otherwise of any particular form of treatment.
I agreed with her, and completed the application.
Floella then wrote the AMHP assessment report that should be left on the ward with the application, informed the patient and the NR of the decisions that had been taken, and the assessment was completed.
I think I’d like to take an AMHP trainee with me on every MHA assessment I am called to do.