The Importance of Reflective Spaces When Navigating the Approved Mental Health Professional (AMHP) Role: Findings from Research

One of the main responsibilities of the Approved Mental Health Professional (AMHP) is coordinating Mental Health Act (MHA) Assessments. This can include making applications for compulsory admission, and applying the guiding principles of the MHA including, the ‘Least restrictive option and maximising independence’ when considering alternatives to compulsory admission. A MHA assessment is usually requested during mental health crisis when alternatives to admission are exhausted. Literature refers to the controlling and coercive elements of the AMHP role, lack of community resources, and the increasing number of compulsory admissions direct from the community. There is less research on the wider role of the AMHP and its potential to avert crisis. Included in the main AMHP functions is the authority under section 115 MHA to enter and inspect, with ‘reasonable cause’, premises in relation to ‘mentally disordered patients’. This authority may enable AMHPs to intervene without coordinating a MHA assessment whilst meeting the legal obligation to ‘consider the patient’s case’ under Section 13 (1) MHA. The role of the AMHP as a ‘legal protector’ of human rights and their expertise in averting crisis is discussed. This article concludes with recommendations for AMHP practice.

The role of the Approved Mental Health Professional (AMHP) in England and Wales was intended to provide a social perspective as a ‘counterweight’ to a medical perspective when compulsory detention to psychiatric care is being considered as part of an assessment under the 1983 Mental Health Act (MHA). However, with few exceptions, there is relatively little written about AMHPs’ understandings of a social perspective and their experiences of applying this in practice. This article will discuss the findings of a small-scale qualitative study involving twelve AMHPs, highlighting the different accounts of how social perspectives may be understood and implemented. Some of the tensions that may arise when undertaking MHA assessments and the challenges of implementing a social perspective in practice will be considered. The conclusion will recognise the complexity of AMHP practice and the diverse ways in which AMHPs attempt to apply a social perspective. It is clear, however, that an understanding of social perspectives is firmly embedded in the practice of the AMHPs involved in this study.

The Mental Health Act as amended 2007 democratised who could qualify for the Approved Mental Health Professional (AMHP) role to include not only social workers, but psychologists, occupational therapists, and nurses. The amendments raised questions on how to appropriately train AMHPs from the professional groups without social work education to have adequate skills and decision-making capacity when considering the use of compulsory powers. Essential to the AMHP role is the obligation to ‘bear in mind the social perspective’, which incorporates the social dimensions to a persons mental health presentation and is considered a safeguard against the erroneous detention of service users. However, despite claims to further professionalise AMHPs there has been a difficulty defining what AMHP expertise is. This paper draws upon ‘theories of professionalisation’ to argue that the genericism movement and the adoption of New Public Management has limited the professionalisation of AMHPs and therefore adequate implementation of ‘the social perspective’.

Our perspective examines how the statutory nearest relative (NR) and AMHP (Approved Mental Health Professional) roles intersect within the context of the Mental Health Act (MHA) 1983 in England and Wales. Here we provide a professional and lived experience perspective which was developed from our conversations, reflections, and ongoing collaboration. Jamie is an AMHP and Anna is caregiver with lived experience of the NR role. Two key themes are identified and explored in this narrative piece. Anna describes the practical and emotional complexity of compulsory detention under the MHA from the NR perspective (‘I am always having to fight’) and Jamie reflects on AMHP-NR conversations in this context. Anna describes NR difficulties in navigating the process of compulsory detention, including the absence of support. Reflecting on the absence of the AMHP role in Anna’s experience (‘the invisible AMHP’) Jamie discusses how the social perspective on mental distress might also be invisibilized. Our collaboration also uncovers an important metanarrative (‘we should feel like a team’) for reimagining AMHP/NR conversations. We propose that AMHP-NR allyship can help to foreground the social perspective on mental distress in the context of decision making regarding compulsory detention.

The chapter seeks to address professional identity boundaries in light of considering the opening up of the Approved Mental Health Professional (AMHP) role to mental health nurses. It critically examines whether any of the doubts expressed about doing so have been realised. Drawing on data from a wider study of AMHPs, the chapter discusses the relationship between role fulfilment and professional identity from the perspective of mental health nurse AMPHs. Data was collected through audio-recorded semi-structured interviews with five nurse AMHPs and analysed using the methodology of interpretative phenomenological analysis. Fulfilling the role of an AMHP is interpreted in four stages: during the first two stages, a transition from ‘unclean’ to ‘honorary social workers’ is shown; in this perception of mental health nurse as AHMPs, it is claimed that the ascription of the professional role as honorary, or special, denotes a change in professional identity and also acceptance into it. In an extension of the metaphor, stages three and four indicate that, once clean, mental health nurses go on to use this shift in professional identity to challenge hitherto accepted professional boundaries and also begin to challenge how the AMHP role itself is fulfilled.

The role of the Approved Mental Health Professional (AMHP) under the Mental Health Act (MHA) 1983 in England and Wales is to respond to referrals for psychiatric detention and make an application for detention where they consider this necessary. This article reports the findings of my doctoral study into AMHP decision-making at the point of referral for an MHA assessment. The strengths-based methodology of Appreciative Inquiry was adopted, positioned in a social constructionist paradigm. Nine AMHPs working for one Local Authority participated in the study, including myself as an insider researcher. During four one-day workshops over five months participants defined their best practice, analysing emerging data together within the workshops using nominal group technique. Service developments included the creation of a triage role and a bespoke report to prioritise this decision within the service, opening avenues to change gears and buy time for a more thorough assessment at this point, and promoting greater collaboration with those referred. A multi-agency approach to searching for less restrictive options was advocated within an assessment pathway. The results of this study offer a research insight into this important area of practice, offering an evidence base to inform practice and policy developments.

The enactment of the Mental Health Act (MHA) 2007 introduced the role of the multidisciplinary Approved Mental Health Professional (AMHP) in England and Wales by amending The MHA 1983. The role can now be performed by a range of professionals including a psychologist, an occupational-therapist, a social worker or a mental-health/learning difficulties nurse. This amendment amongst other legal provisions replaced the earlier Approved Social Worker role. This is an exploratory qualitative research that aimed to identify if the decision-making relating to management and assessment of risk varied according to the professional background of the AMHP. The decision-making of 10 social work and 10 nursing AMHPs were examined through the use of an experimental vignette containing audio-visual and written materials in order for participants to reach a decision about whether or not to detain. Proposed detention rates between social work and nurse AMHPs were identical although variation was found across the whole sample in terms of the risks that were identified in the vignette. The paper concludes by arguing that these results suggest that differences in the way AMHPs reach decisions may well relate to a variety of individual differences rather than reflecting initial professional identity and training as so often argued in the literature.

Introduction: A major amendment to the Mental Health Act 2007 was to broaden the professional groups eligible to undertake specific roles under the Act. One such role was the approved mental health professional (AMHP), whose responsibility is to conduct assessments of people deemed mentally disordered to determine whether they meet the criteria for detention, known as ‘sectioning’. Traditionally, this role was undertaken by social workers. Although occupational therapists are now eligible to undertake the role, uptake has been low. Method: A critical literature review was conducted to explore the AMHP role and occupational therapy in order to develop an understanding of the fit between the two. A wide-ranging search identified 282 articles, 30 of which were relevant to the review question. Findings: Coding identified four overarching interrelated themes: values, social (work) perspective, independence of the AMHP role and impact on therapeutic relationship. Coherence exists between social work values and occupational therapy values so it is more likely that structural issues, rather than incongruent values, are impeding occupational therapists' uptake of the AMHP role. Conclusion: A register of occupational therapists employed as AMHPs, and further research exploring reasons for low uptake, is recommended.

The subject of race inequality in mental health has been scrutinised by policy makers and researchers for decades. Despite government initiatives such as ‘Delivering Race Equality in Mental Healthcare’, there seems to be an intractability in relation to the closing equality gaps. In the midst of this, one of the decision makers in compulsory mental health work – the Approved Mental Health Professional (AMHP) – is at the sharp end of the data that attracts the sternest criticism: the higher-than-average rates of detentions of racialised minorities. Though solutions may be found in attending to socio-economic obstacles to equality in mental health, practising AMHPs need to have the skills to critique and amend their own practice so that they can take account of the antecedents of poorer mental health in the lives of racialised people whom they assess, and to mitigate against the impact of their own unconscious bias and prejudices. This chapter revisits the data in relation to ethnic inequality in referrals, pathways and outcomes from Mental Health Act (MHA) assessments for racialised minorities. Drawing on the latest research, key decision-making points are analysed to identify where biases may be affecting practice. Attention is given to unconscious bias and individual skills in challenging models, practice and policies that institutionalise the disadvantage of racialised minorities.

Background: In England and Wales, the Approved Mental Health Professional (AMHP) has final responsibility for applying under the Mental Health Act 1983 to admit an individual compulsorily and convey them to psychiatric hospital. The AMHP role is challenging and legally accountable and unique to the UK context.Aims: To analyse the motivation of individuals to become AMHPs, and identify factors which may affect motivation.Method: Semi-structured interviews were conducted with 12 AMHPs from local authorities across Southern England. Ten participants were social workers, one was qualified as both a nurse and social worker, and one was a mental health nurse.Results: Participants identify career progression and professional development as significant as well as the status and independence of the role and enhanced job security. Social work participants value the Mental Health Act assessment as a contained piece of work, with a high degree of professional discretion.Conclusions: AMHPs are motivated by an increase in professional status and job security, but also exercising independent judgment and authority in a time-limited intervention is emotionally and professionally rewarding.

This chapter explores the multi-professional role of the Approved Mental Health Professional (AMHP), examining who can now be approved as AMHPs, and whether there is a difference in the way practitioners from different professional groups undertake the role, and in their own and others’ attitudes towards it. The chapter includes: details of the regulations that apply; an analysis of the strengths and weaknesses of diversification of professional background; working in partnership; some verbatim accounts by AMHPs from the differing eligible professions as to their views of the role. The AMHP role has, since 3 November 2008, been available to four professional groups, as listed in Schedule 1 to the Mental Health (Approved Mental Health Professionals) (Approval) (England) Regulations (SI 2008/1206) and the Mental Health (Approved Mental Health Professionals) (Approval) (Wales) Regulations (SI 2008/2436), thereby dissolving the exclusive domination by social work of the approved status. The Mental Health Act 2007 brought in this amendment (as well as others), with the aim of diversifying eligibility. AMHP status is attributed to a professional who is approved by a local authority (LA) to act and undertake the role. It offers a unique identity which is aligned to an eligible qualified professional, registered with the appropriate body. The departure from social work dominance of the AMHP role is crystallised in section 114ZA(2) of the MHA for England, and section 114A of the MHA for Wales, where it is stated that the functions of an AMHP are not to be considered to be ‘relevant social work’ for the purposes of Part 4 of the Care Standards Act 2000 (in England), and Parts 3 to 8 of the Regulation and Inspection of Social Care (Wales) Act 2016.

The rise in numbers of applications for people being formally detained in hospital is one of the reasons given for the independent review of the Mental Health Act in England and Wales. These figures have led to concerns that the legislation might be flawed, including in relation to the process of Mental Health Act Assessments. Discussed in this article are two of the roles involved: the doctor who is responsible for conducting a medical assessment and the Approved Mental Health Professional (AMHP) who is responsible for assessing the social circumstances and in addition making the application. Using data from a study into AMHPs and the lens of the sociological theory ‘dirty work’, we discuss shift, an aspect of dirty work not yet applied in this context. We focus on AMHPs’ perceptions of the behaviour of doctors as encapsulated in the verbatim phrase ‘role over’. We argue that AMHPs, including social workers, justify or, to play on the words of the verbatim quote, roll over. This finding adds to the understanding of behaviour as it is understood within psychiatric occupations, including social work, during Mental Health Act Assessments.

This article explores emotion management of mental health social workers when undertaking a statutory function. Using data from a larger study of the Approved Mental Health Professional (AMHP), its aim is to explore a role that embodies a policy (both literally and metaphorically) concerning the distribution of professional responsibilities. Using the methodological approach Interpretative Phenomenological Analysis (IPA), this article explores the psychological and emotional experiences of participants from their own perspective. Data were collected from twelve AMHPs of three different non-medical backgrounds through a semi-structured interview that included the opportunity for each participant to draw and describe a Rich Picture of their experiences as AMHPs. Through one pearl, a small piece of data emerging form the larger corpus, AMHP work is shown to involve an active use of dissonance providing new insights into the enactment of mental health work and the role played by emotion. “Pull”, refers to the active use of dissonance; the recognition and use of seemingly contradictory emotions that, crucially, co-exist. This article argues that current dialogue ignores the advanced management of emotion in role accomplishment and the value of AMHPs. The use of drawing alongside discussion of it, underpinned by IPA, has given rise to the pearl, “Pull”, and its interpretation the active use of dissonance.

The chapter will aim to explore why there is a need to create space at policy and practice level to accommodate the emotional needs of the Approved Mental Health Professional (AMHP). In a recent draft submission of a set of principles for AMHP services, acting as a form of guidance to local authorities and health managers, it dedicates little space to thinking about models for reflective space to support AMHPs in this multifarious and complex role. It speaks of the importance of health and safety, the risk of losing staff and ‘honest and open communication’. There is a growing recognition in social work about the value of reflective groups, yet little has been written about reflective groups and what model is both productive and sustainable, particularly in adult and mental health social work. The author argues that a reflective group underpinned by psychoanalytic ideas can bring value to the AMHP workforce. Using illustrations from two cases presented at an AMHP reflective group, run monthly (based on the Work Discussion and Balint models – both derived from the Tavistock Clinic). These cases will serve to illuminate how, through the reflective group, AMHPs have the opportunity to develop a deeper understanding of themselves and the interpersonal dynamics involved in the work. By having a bounded space for AMHPs that focuses on the anxieties and emotion of the participants, asking them to bring a case that is on their mind, while at the same time striving for a non-judgemental space, a ‘not knowing’ – a prelude to ‘getting to know’, a space for reverie and exploration – without there being a right way to do or have done and allowing imagination and curiosity to flow, will yield new lines of thought and enquiry.

The ‘social perspective’ was inserted into the Mental Health Act 1983 Code of Practice (2008a) to ensure that skills and perspectives associated with the Approved Social Worker (ASW) were adequately transferred to the broadened role of Approved Mental Health Professional (AMHP). Nonetheless, there is a lack of clear guidance on how the ‘social perspective’ should be enacted in AMHP practice which causes several misalignments with how AMHPs balance other obligations in their decision making. Aspects of the Least Restrictive Option and Human Rights Legislations (such as the European Convention on Human Rights) are inconsistent with the objectives of the ‘social perspective’ and have replaced the ‘social perspective’ as a dominant feature of AMHP practice. Consequently, the ‘social perspective’ has avoided a clear definition, and meaningful guidance on how it should translate into practice. The ‘social perspective’ is often neglected in law reforms and policy decisions limiting both commissioning advancing the ‘social perspective’ and reducing its safeguarding function to the service user.