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 Charwood Hospital .
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.
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.
Love having AMHP trainees helps my practice as well when we debrief and have to explain why i did xyz
ReplyDeleteI'm an AMHP Trainee. I've had 5 assessments in the first 4 weeks of placement, of which I led 3, it's quite busy! I can now pick and chose which assessments to go out on that will give me the best learning. I'm a very lucky bunny, some of the other Tr-AMHPs on the course have still not been out on one.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteAt least it is better than sending her back to the course with 6 section 4 assessments under her belt... although she would probably get a brownie point from the local authority for the money she saved on medics.
ReplyDeleteSorry about the removal of my comment abpove by the way, damned typos in it.
and another lol...sheesh
ReplyDeleteWhile you enjoy observing, do you ever take into consideration what the poor trainee is going through? I had my observation recently and believe you me I lacked the joys you speak of.
ReplyDelete