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.
