I never had the privilege of meeting with, or talking to, Matt Simpson, for whom the recent AMHP Leads Conference was a dignified and quietly emotional tribute. From what people have said about him, and his way of working, I think he would be very pleased if AMHPs continued to wrestle with his writing about s13 consideration and practice, in a critical way.

Barbara Swan in her recent post on here reflects both on Matt’s work and her own sense that there are systemic pressures on AMHP autonomy. She says Matt’s article – Changing Gears and Buying Time, published in the British Journal of Social Work in early January 2024 – ‘explores AMHPs decision making at the point of referral and offers a different way of working which is thoughtful, comprehensive, strengths based and person-centred’.

It’s interesting that over the years discussions between AMHPs and our s12 colleagues have changed in response to the ever-decreasing alternatives. Over the last decade or so I suspect that the likelihood of admission carried out based on nature (i.e. to prevent a predictable relapse for example) is as rare as hens teeth – in most areas we don’t have the resources needed by those at acute immediate risk, let alone those that might be risky in a week or so (probably), and who would choose one of our acute inpatient units as a place to recoup and recover anyway? Something we can all agree on is that not all our wards are ideal environments for recovery.

Autonomy is a fundamental legal principle of mental health law and AMHP practice. There is no settled legal definition of autonomy; synonymous with self-determination, it’s traditionally described as the individual being sovereign over their own mind, body and self (Mill, 1859). Autonomy is important because it promotes the person’s wellbeing, integrity, dignity and self-respect and ensures the person’s voice is not ‘drowned out’. (Hughes, 2013). Throughout mental health law and practice the autonomous rights of the individual are considered significant in, for example, the guiding principles to the Mental Health Act (MHA), such as empowerment and involvement and the Mental Capacity Act (MCA) principles including the presumption of capacity and making as much effort as possible to help the person make their own decisions (Department of Health, 2015).

Huge numbers of experts by experience, professionals, voluntary sector contributors, civil servants and academics gave significant levels of their time and effort into the 2018’s Mental Health Act Review. Not just the Review, but also to the subsequent development of key reform concepts in the Bill, such as statutory care planning, introducing the nominated person, tighter criteria around CTOs, and other measures all aimed at reducing compulsion and promoting choice.

The sudden death of Matt Simpson has been a profound shock to many in the AMHP community across the country.

Matt was AMHP programme lead for Bournemouth University. He was also my predecessor as AMHP manager for Wiltshire Council, where he continued to act as duty AMHP, Friday after Friday, until two weeks or so ago. Even then, it was characteristic of Matt that he had been considerate enough to warn the current manager, Blair Percival, that he would not be able to attend that day.

Matt’s work, on what it means, legally and ethically, to ‘consider the patient’s case’ under s13(1) MHA, was far more than a PhD and the BJSW article listed at the bottom of this blog. It was rooted in many relationships in which much was achieved with quiet thought and few words. However, in withstanding pressure to detain people, particularly those whom he knew well, Matt could be passionate and persistent.

I’d guess I’m not alone in going through a mountain of drafts when it comes to doing a piece for this blog. The problem I have is that the challenge I set myself was to do a piece around the experience of being an AMHP during a global pandemic. As I’m sure you will all appreciate, not an easy task!

AMHPs vary, not just in the decisions we take, but in how we learn, practice, cope with stress and distress: deal with the dysfunctional pressures of our very own theatre of the absurd.

We differ too in why we became AMHPs in the first place, and in what we now make of ourselves in the mirror of those preconceptions. If we dare search there at all.

Part of the challenge of that looking glass may be that the AMHP role is only just beginning to recognize you: your racialized identity; your resilience in facing domestic violence, harassment, persistent microaggressions; your traumas transformed; your hidden experiences, unspoken of at work, but which speak clearly in all you do.

We have reached our first birthday and it feels good! This time last year we were frantically putting the finishing touches not only to the initial four blogs but to the website itself to make sure it looked the part as well as read the part. We were all new to this type of project and it was a bit of a leap of faith. How would it land and where would it take us? We didn’t really know but we wanted to find out.

What we did know is that we had set out on this journey with the intention of creating ‘a forum for us to examine, celebrate and contest what motivates us and what holds us back in the work we do … [It was to be a] place where we can connect with our professional standards, with new ideas, and with each other in all our humanity and diversity … The Critical AMHP seeks to capture and learn from multiple, diverse voices’. A lofty aim perhaps, so now seems as good a time as any, at this first anniversary, to reflect on whether or not we have met this goal, whether we can go further and to think about new areas for these reflections.

When I receive a request to undertake an assessment on a child, the first thing I do is mentally run through the list of available Section 12 CAMHS doctors and start dialling them almost immediately (as the list is fairly short, it’s a pretty straightforward task!). Am I embracing this task with such enthusiasm because the Code of Practice says that I should?  I can tell myself this (and others if they ask) but the truth of the matter is that assessing children and young people is often filled with so much complexity, dilemma, resource battles and uncertainty that I am filled with the overwhelming desire to have the “right people” at the “right time” in the “right place”. A task that is so much easier said than done.

Inspired by Jon Mitchell's seminar on the 6th June this year and further buoyed by Robert Lewis’ impassioned comments towards the end of the talk, I have undertaken an informal review of the blog site considering the fundamental question that was posed during the seminar-‘What type of AMHP do you wish to be?’

In reviewing all twenty blogs published since September 2022, a number of threads or conceptual themes begin to emerge that may assist us in formulating something of an answer.

At the heart of this reflection is something to do with the ethical contradictions we tussle with as AMHPs and the effect of these on our decision-making. I pick out themes of power, the imposition of the state apparatus and legally informed duties creating issues of professional coercion and control for service users and AMHPs alike.

As a ‘rectification’ I’m sure we all have an assessment that stays with us. An experience that is omnipresent, pinballing through one’s mind. The assessment I consider in this piece I regularly think about due to the multiple dynamics and narratives intertwined into the assessment.

Section 135 (s.135) is not my favourite section of the Mental Health Act 1983 (MHA). I don’t know any Approved Mental Health Professional (AMHP) who relishes the thought of executing a s.135 warrant. Quite the opposite. We do what we can to avoid such an oppressive use of power. Section 135 warrants must rank as one of the most challenging and testing sections of the MHA ethically, practically and emotionally. The coercive nature of the Act, and the power we wield, is perhaps at its starkest and clearest to AMHPs when we are walking up the path to someone’s house with the police in tow, warrant in hand. The effects for the person and their family can be devastating.

Frustratingly in my both my professional and personal experience, it remains a little-known fact in wider society that it is Approved Mental Health Professionals who hold the legal power to detain a patient under The Mental Health Act 1983 (MHA).

Psychiatrists can recommend that a patient be admitted to hospital under The Act, but they do not have the legal authority to deprive a patient of their liberty. Interestingly, this legal myth can be perpetuated by psychiatrists themselves as was recently evidenced on the Radio Four series Is Psychiatry Working? when Dr Femi Oyebode spoke about detaining patients.

Mental Health Act (MHA) assessments are challenging.  By their nature they indicate that some kind of crisis is occurring. Time is often limited in the MHA assessment interview.  Questions put to the patient by the Approved Mental Health Professional tend to be restricted to those evidently pertinent to the decision regarding whether an admission is necessary.

Race is always present in encounters because we are now all racialised beings. The times when it potentially becomes most invisible are when all those present are white. The presence of anyone from a minoritized racialised group in any situation forces race to be visible.

I’m an AMHP who detains few people, and who tries to persuade others to use detention less too. Since the very identity of the AMHP seems to be that of a detainer this is quite a challenge. How far should you resist detention? What are the arts involved in doing so? How do you learn or teach them? Who do you become as this negative capability increases?

I was heartened recently to see an article in The Independent which highlighted the significant issue occurring in A&E departments across the country where people who require mental health assessment and possible admission under the Mental Health Act are left waiting for days and sometimes weeks without any legal safeguards (Thomas, 2022). As an AMHP, I was impressed that this issue had been covered by a national newspaper and highlighted the human rights issues for many people in mental health crisis who are left waiting in A&E

I wanted to write about a story which will seem almost unbelievable to most AMHPs and others involved in mental health crisis support at the moment.

Just before Christmas I was on an AMHP shift and was called to do an assessment in A&E where a family had brought their relative due to their bizarre and agitated behaviour. This included the person repeating certain phrases, making threats to kill a close friend without any apparent reason that they could explain; they were highly restless, unable to sit still and had difficulties sleeping. I could see from the records and discussion with the crisis team that the person had experienced similar difficulties at other times in their life and hospital admissions under the Mental Health Act had been required on occasion.

Suddenly mid-afternoon, two psychiatrists and an AMHP were let into my flat saying that they had to assess me. They asked me a series of questions about my beliefs of grandiosity and paranoia. At the time, believing I was the next Einstein, and far more problematically, that there were dark forces operating around me I was deeply unsure who I could trust, or more precisely who the CIA (whom I saw as the enemy) had got to.

I was midway through my AMHP training and was leading the assessment for one of my direct observations. I had been surprised to see the police arrive in a group of eight. I had, after all, done my own risk assessment. There was no suggestion Andy was a threat to professionals.