Even though every formal assessment under the Mental Health Act 1983 is different, the actual procedure tends to follow a typical pattern.
Assessments have a similar structure, or series of
steps, which have a logical sequence, and need to be followed if the assessment
is to meet legal, ethical and professional standards.
The steps are as follows:
1 The Referral
2 Gathering Information
3 Organising the
Assessment
4 The Interview
5 Reaching a Decision
6 Completing the
application ( if one is to be made)
7 Arrangements for the Admission
8 The Admission
9 The Aftermath
In this video I illustrate these steps by referring to a real assessment I undertook: Robina, a woman in her early 80’s living alone, with steadily worsening dementia.
Thank you for this.
ReplyDeleteYes, the assessing doctors are invariably those retired psychiatrists who queue for the £180+ fee> plus travel expenses. They spend maybe 20 minutes “active listening” plus maybe even 10 minutes “discussion” with the AMHP...
BTW They don’t like being challenged about what specific experience they have of MH/ASD!
I may have missed things (or you may have left them out) but here’s what you seem to take for granted, like other AMHPs I’ve met:
1 You rearrange the assessment time to suit the assessing doctors before you call the Nearest Relative to see what might suit her.
2 So who knows the background best? Before the assessment you discuss the background with the professionals you can actually get hold of, but discussion with the Nearest Relative has to wait till the assessment itself.
3 Avoidably, you’re on familiar terms with the two assessing doctors. What pre-assessment “ice-breaker” do you do together to guard against groupthink?
4 Robina is very clear what she wants – to stay in familiar surroundings with familiar people. Maybe you left out the bit where you try to resource live-in domiciliary care?
5 Post-assessment you discuss things in a huddle with fellow professionals. Then *after* you’ve decided what to do, you “discuss” things with the Nearest Relative. Which has more influence?
Full marks for giving the relatives a lift to the admitting hospital and a lift home. I have never known an AMHP consider how relatives are going to get to (never mind home from) an assessment. And it can be a struggle even to find out which hospital has admitted your loved one.
Sharp comments above, I know you work within laws and within/across bureaucracies. Not easy. But important to keep resetting the focus clearly on individual and family.
Thanks for your comments. I always consult with the NR before the assessment if they are available, and try to keep them informed of what is happening, but the timing of an assessment is generally down to the availability of doctors.
DeleteSince Robina did not think there was anything wrong with her, and had already rejected her normal home care, that was not an option.
The NR is often a party to the "huddle", but we are often discussing arcane aspects of the law which may not be appropriate for the NR.
Whether it happens or not, the AMHP should assist relatives, including letting them know where the patient is being admitted and a contact number. In my experience, the AMHPs I know are usually very good at this.
Thank you for replying. I’m not sure you fully understand my concerns.
ReplyDeleteA couple of examples from your reply:
A) "I always consult with the NR before the assessment if they are available"
But not about the timing of the assessment. I agree your efforts to contact the NR may be handicapped if your referrers haven't kept the NR "in the loop", but I wonder whether you track how many calls you make to get the assessing doctors lined up as opposed to the number of attempts you make to contact the NR?
B) “we are often discussing arcane aspects of the law which may not be appropriate for the NR”
I think NRs are well able to decide for themselves what aspects if the law they don’t want to tackle, and will be happy to sit patiently while the professionals sort that out and return to join them in the main discussion.
C) “Since Robina did not think there was anything wrong with her, and had already rejected her normal home care, that was not an option.”
But Robina also (predictably) rejected admission to hospital, especially without anyone familiar to stay with her. Should the remorseless pressure of due process so easily suppress her human feelings? Reading your posts, I'm sure you could find other options, or is the AMHP always constrained by the inflexibility of locally commissioned services?
Given the NR is the only “advocate” legally entitled to be in the assessment, I think far more effort is needed to involve this family representative.
Yes, there are cases where the family &/or the person being assessed reject involvement, and probably more where they’re so exhausted by preceding events they feel unable to make much input, but not in your example.
PS I think you have a discussion group on Facebook, but I’m afraid I don’t do Facebook.
BTW I notice you make no comment on my point about groupthink among professionals.
What happens if someone refuses the interview
ReplyDeleteIt does happen. You do your best to engage them in some form of conversation, and at least get to observe their behaviour. Then you have to consult with relatives and professionals who know the patient to get background information, and reports of recent behaviour, and try to reach a conclusion. If you cannot, and the risks are not too great, then you would consider attempting to interview them on another day.
ReplyDelete