Monday, 18 August 2014

When is a MHA Assessment Not a MHA Assessment?

A: When there are alternatives.

Not very funny, I know, but then neither are the inappropriate requests we sometimes get when on AMHP duty.

Take Babs, for example.

Babs was a lady in her 70’s living alone. A call came through to the AMHP office from her social worker insisting that she be assessed under the Mental Health Act.

The social worker said that Babs had been referred to social services by a neighbour because for a week or so the neighbour had been passing food to Babs through her window.

Babs had called out to the neighbour one day, asking them to get her some food and waving some £5 notes out of the window. She said that she had lost her key, and couldn’t open the door to get out. The neighbour at first did what she was asked but became increasingly concerned about the situation.

The social worker visited Babs and managed to help her get a new key. She arranged for a keysafe to be fitted, so that a spare key could be kept, and home carers could then be sure of getting access.

But Babs then said she didn’t need any home care. The social worker was concerned that Babs was not getting adequate nutrition, and called for an assessment under the MHA.

There was, however, only sketchy evidence that Babs had a mental disorder. In any case, the local procedure was for the older people’s intensive support team to become involved. Their function was specifically to avoid hospital admission, and could offer intensive home support and assessment, including the use of the MCA to provide alternatives to hospital admission if the person was assessed as lacking capacity.

The social worker huffed and puffed a little, but eventually agreed to making a referral to this team.

Formal MHA assessment avoided. After all, it had to be necessary to explore the least restrictive options before considering detention.

A few days later, the AMHP office phone went again. This time it was a worker from the older people’s intensive support team. She was requesting a formal assessment under the MHA for Babs.

The conversation went something like this:

Masked AMHP: Hi there, how can I help you?

IST worker: I’m at Babs’ house. Our team’s been visiting her daily for the last few days. When I called today, I couldn’t get any reply. I tried to use the spare key, but she had a door chain on. I called the police, and they’ve managed to get in. I found Babs in bed. She was not happy to see us, I can tell you.

MA: So what’s the exact problem today?

IST: Well, we’re planning to set up home care to go in twice a day, but they won’t be able to get in if she puts the door chain on.

MA: Does Babs have a mental disorder?

IST: Well, it’s not at all clear. She seems a bit depressed, and her memory’s poor.

MA: So let me get this clear in my mind. You’re asking me to visit Babs with two doctors with a view to detaining her in hospital under the Mental Health Act, because you’re concerned that home carers may not be able to get in the house because she might put her door chain on?

IST: Ye-ees…

MA: Are the police still there?

IST: Yes, they are.

MA: Is it possible that they could persuade her to let them remove the chain, so that this situation won’t happen again?

IST: Well, that would be a solution. If we can get her to agree to that, then we could carry on with out home care plan.

MA: And that would be the least restrictive option. And then she wouldn’t need to be admitted to hospital.

IST: That’s right. I tell you what I’ll do. We’ll see if we can get her to have the chain removed, and then I’ll get back to you.

MA: That’d be great.

Thirty minutes later:

IST: Everything’s fine. We’ve removed the door chain, and she’s agreeing to the home care. I’m happy to withdraw my request for a MHA assessment.

MA: That’s great.


  1. Why did the home care team insist on being able to open the door themselves? If that meant that they wouldn't always have been able to provide their services, so be it. I certainly wouldn't want such people to open the door any time they please.

  2. I hope nobody breaks in for the sake of all involved. Wouldn't a remote locking/intercom system work better? It would give Babs more control over her living space and better security without preventing keyholders from getting in?

  3. This lady was in bed, asleep. Surely the Home care team should of told her what time they would be visiting, and if so, then if they can't get in, phone her, then obviously if there is no answer then you take the next step of seeking out an open window or shouting through the letter box, but not calling in the police.