Sunday, 19 July 2020

Violet

During my years practising first as a Mental Welfare Officer, then as an Approved Social Worker and then as an AMHP, I’ve been in a few tight spots (being chased round a bungalow by an old man with dementia brandishing a shotgun being one that springs to mind). However, I have only rarely been actually physically assaulted.

I like to think that’s because I know how to keep myself safe and de-escalate potentially violent situations, but perhaps luck also has something to do with it. When I look at the situations in which I was assaulted, generally I can recognise that I’ve made mistakes of judgment (although sometimes they are completely unpredictable).

The Masked AMHP tells the sorry tale of when he was ambushed by a little old lady in his latest YouTube channel video. A warning to always be vigilant during MHA assessments.



Saturday, 11 July 2020

June: An Assessment Under the Mental Health Act 1959


As the British Association of Social Workers has been celebrating its 50 years of existence, there has been a lot of discussion about whether or not social work was better back then. (By the way, I joined BASW as a student member in 1978.)

Over the years I’ve been writing this blog, I’ve written several posts about my experience of social work in the early years of my career (which started as an “Assistant House Parent” in a children’s home in 1975).


This post is a description of an assessment under the Mental Health Act 1959 Act that I witnessed in 1976, when I got my first job as an actual social worker.

A comparison with the way in which assessments by AMHPs under the MHA 1983 are conducted today shows the huge changes in philosophy and practice that have taken place over the intervening years.


Saturday, 27 June 2020

"You'll have a cup of tea..."





Another story from my long career as a social worker, ASW & AMHP. In which the Masked AMHP is held hostage during a MHA assessment.

Friday, 19 June 2020

Death & Fire Bunnies


The latest video from the Masked AMHP's YouTube Channel. This is about helping an old lady who had just lost her husband, and at the same time avoiding the sledgehammer of a MHA assessment.

You can see it here.

Saturday, 6 June 2020

Dolores and her Cat


During lockdown, and as I slide into retirement, I’ve been looking back over my career as a social worker and an AMHP.

I started as an unqualified generic social worker in 1976. I first began to practice as a Mental Welfare Officer under the old Mental Health Act 1959 in 1981. When the 1983 MHA came into force in September 1983, I became an Approved Social Worker.

I became a dedicated mental health social worker in 1988. When the MHA 2007 amended the 1983 Act in 2008, I became an Approved Mental Health Professional.

During that time I’ve undertaken approaching 700 assessments under various MHA’s.

On my new Masked AMHP YouTube channel I have begun to reminisce about some of my experiences.

If you’d like to hear about Dolores and her Cat, you can find it here.

Saturday, 30 May 2020

Review: The Approved Mental Health Professional Practice Handbook



The Approved Mental Health Professional (AMHP) Practice Handbook, Kevin Stone, Sarah Vicary, Tim Spencer-Lane; Policy Press, 2020

I will begin by saying that I think this is a very good book. I'm in no doubt that it will be an invaluable resource to assist trainee AMHPs in understanding and learning the AMHP role, and will also serve as a useful reference guide for practicing AMHPs to assist with certain aspects of mental health law.

The book is divided into three parts: the AMHP in context, the AMHP in practice, and AMHP theory.

The first part covers the unique practice context of the AMHP, the ethical context, and social perspectives in mental health, including the multi-professional context of the AMHP role, this role being open not just to social workers, but also mental health nurse, occupational therapists and clinical psychologists.

The second part focuses on practice issues. This includes the process of completing an assessment under the Mental Health Act, including the sections of the Act involved in detention in hospital; the associated risks and challenges; the interface between the MHA and the Mental Capacity Act; and the AMHP's involvement in community provisions under the MHA, including CTO's guardianship and s.117 aftercare.

The third part examines upholding rights and anti-oppressive practice; the importance of resilience, in managing to survive in this demanding role; and decision-making, including involvement of family members and other professionals, arrangements for transport to hospital and facilitating reflection on the role.

Each chapter begins with a clear explanation of the aim of the chapter, including explicit notes on relevant law, which AMHP competencies are covered by the chapter, and case studies to aid reflective activities, concluding with key messages of the chapter, a brief review of knowledge, and recommended further reading.

The book combines sound academic principles with reference to competence indicators, skills and practice, providing copious and relevant referencing throughout, as well as reference to other related legislation. There is throughout a good selection of practice examples to aid learning and reflection.

There are a few other handbooks for AMHPs, most notably The Pocketbook Guide to Mental Health Act Assessments by Claire Barcham, which is now into its second edition.. The Pocketbook Guide is more basic than the book in question, and perhaps more explicitly practice oriented, and is aimed more at students than practitioners. This book, by comparison, takes an academic research led approach but directly applies this to practice.

The structure of the book is clear and logical, leading the reader from the basics of Mental Health law and practice through to an analysis of theoretical perspectives of mental health and mental disorder, and into actual practice considerations and the application of theory to practice.

Throughout, there is a logical connect with the core AMHP competences, which will be very helpful for trainee AMHPs to evidence their competencies for their coursework, as well as assisting experienced AMHPs to compiling an AMHP Record of Achievement for statutory reapproval. It will also provide a very valuable resource for AMHP courses.

Tuesday, 7 April 2020

NHS Legal Guidance on the Use of the Mental Health Act in Light of the Coronavirus Act


NHS England has issued Legal Guidance on the use of the Mental Health Act during the coronavirus pandemic. You can find the full document here.

It begins by stressing that:

There are currently no changes to the Mental Health Act 1983 legislation and colleagues should continue to adhere to the MHA Code of Practice as it currently stands until further notice.

It makes clear that there must be a clear distinction between the principles of the MHA and possible requirements to manage people infected by the coronavirus:

MHA powers must not be used to enforce treatment or isolation for any reason unrelated to the management of a person’s mental health.

Schedule 8 of the Coronavirus Act, relating to amendments to the MHA 1983, is not in force (and may never be). The guidance clearly states that these powers

will only be enacted if it is deemed nationally that the mental health sector is experiencing unprecedented resource constraints that put patients’ safety at significant risk.

It also makes it clear from the outset that there will be no changes to the current Mental Capacity Act.

It continues to hammer home the message that:

It remains the case, even in the wake of the emergency powers, that the MHA should only be used ‘with respect to the reception, care and treatment of mentally disordered patients and other related matters’. Under no circumstances can the MHA be used to enforce treatment, restrictions or isolation that is unrelated to the management of a person’s mental health.

The guidance suggests a number of actions that those involved in the care and treatment of people with mental disorder can and should take to ensure that the word and spirit of the MHA are respected.

One recommendation is that at a local level there must be additional resources provided to maintain an adequate supply of s.12 doctors to conduct assessments under the MHA.

One of the ways it suggests is that the Department of Health and Social Care will extend the licences of s.12 doctors and approved clinicians. These licences will be extended for 12 months.

S.140 MHA gets a mention, stating that there should be local systems “to ensure s140 agreements in relation to bed availability are in place and updated in light of COVID-19”.

The guidance goes into some detail in stressing how people with learning disability and/or autism should be treated, reinforcing the recommendations in the Code of Practice by stating that “caution should be taken when determining whether an individual with a learning disability and/or autism is detainable under the MHA.”

One key statement relates the requirement that people with learning disability should be exhibiting “abnormally aggressive or seriously irresponsible conduct” in order to meet the threshold for detention under the MHA. It states unequivocally that:

non-compliance or difficulty in gaining compliance with any restrictions and interventions required for the management of COVID-19 is not interpreted as adequate grounds on which to detain them. Further, the fundamental principle that the MHA is not for the treatment of physical disorders must be borne in mind where there is no association between a person’s physical and mental disorder.

It also recognises that:

The emotional and behavioural responses of people with autism to the constraints, uncertainties and significant changes in daily living as a result of the management of COVID-19 may also provide a diagnostic challenge in assessments under the MHA.

It goes on to stress:

It is essential that the support of health and social care service practitioners with particular experience and expertise in learning disability and/or autism is sought wherever possible to enable appropriate, reasonably adjusted assessments.

With reference to use of the MCA, it recognises that the impact of the Coronavirus “may result in a justifiable need for restrictive practice in particular circumstances”. But it also stresses that the principle of employing the least restrictive option should always be paramount:

Any use of restriction must be proportionate to the risks involved and providers should refer to their ethics committees where required.

I remain hopeful that the current MHA can continue to function as it currently is, without the need for the emergency changes in the Coronavirus Act. AMHPs and other mental health professionals need to work together to ensure that all the principles underlying the MHA and the Human Rights Act are never dispensed with because of operational difficulties arising from this national health emergency.