A call to improve co-production in AMHP services
By Jenny Daly
‘AMHP services should seek to embed the principles of co-production as part of their operations. Services should explore ways of ensuring the patient and carer experience and perspective are captured and harnessed, to support both development of services and to ensure this learning is not lost’
National AMHP Standards 6.2 (2018)
At an event to mark national co-production week at the beginning of July, I listened with admiration to residents speak about their active involvement as disabled people in decision making structures and strategy groups in Hammersmith & Fulham.
As an approved mental health professional (AMHP), it also made me query where were the voices of people who have been assessed and detained under the Mental Health Act? What were the channels for them to give feedback, be listened to and contribute their unique knowledge and experience to shaping and improving AMHP services?
It’s a question I would like to pose to AMHP readers of this blog – how are the AMHP services you work in actively using principles of co-production to improve their design, delivery and evaluation? The policy tells us this should be happening systematically across AMHP teams no less than other areas of health and social care practice. But is it? If not, why not? And how can we push for this critical engagement to get started and develop in a meaningful way?
These questions have occupied me for some time, as I believe they do many AMHPs. In 2025, I successfully applied for a National Institute of Health Research (NIHR) Research Support award, with the purpose of involving people with lived experience and carers, alongside AMHPs and Drs in co-designing a research question about MHAAs. I want to share with you some background and a flavour of the topics and questions that were raised.
Community Engagement & Involvement
NIHR describe community engagement & involvement[1] (CEI) as the active involvement of relevant communities, from the earliest opportunity and throughout the research process, ‘to improve the relevance, value and conduct’ of health and social care research. This emphasis on centring the knowledge of people with lived experience in research, aligns with the requirement that local authorities – the biggest employer of AMHPs nationally[2] - to involve people with lived experience in the improvement of AMHP services, as outlined in the National workforce plan for AMHPs (2019)[3].
What is your research question?
Early on, I learnt to parry the question about what my research topic was with ‘I don’t know yet’. I wished to lean into the ‘not knowing’, to illicit the views and knowledge of people, unlike me, who had been on the receiving end of a MHAA as well as the people who know them very well – their carers - and consider the gaps and areas for improvement as they saw it, through a lived experience lens. I wanted these views to be heard by practicing AMHPs and psychiatrists, to add their insights as professionals who assess people under the MHA, day in day out. The aim was for the different voices of experience and practice to hone a question(s) they felt merited further enquiry through research. As the project progressed, we became more open to coming up with topics for service improvement, rather than exclusively research. This was appealing because it was potentially more impactful on AMHP practice, in a more tangible and timely way.
The Advisory Group
I started by assembling a mixed advisory group, inviting people with lived experience of undergoing MHAAs, carers and professionals, ‘to explore and reflect on MHAAs from different positions and perspectives; co-create a research question(s) & a suitable design method to generate knowledge and insight and to improve the practice and experience of MHAAs. The group comprised ten people, eight women and two men, with some cultural and age diversity. There were three participants with lived experience of MHAAs (and detentions); 3 carers – two of whom also had lived experience of MHAAs; 2 AMHPs and 2 psychiatrists. Diversity in the group was important, given the continued disproportionate number of black people detained under the mental health act.[4] Louise Blakely, who acted as my research mentor, provided valuable guidance and knowledge of participatory approaches, drawing on her research on Mental Health Act assessments and service user experience.
The workshops
We met for three workshops in all. Acknowledging the reconfigured power relations, we began by drawing up value-based guidelines to recognise the unique insights and experience of each participant, who shared personal experiences of MHAAs, laying bear frustrations, anomalies, gaps and some good practice as they saw it.
The participants spoke about MHAA topics that they felt required further exploration and scrutiny in the workshops. The consensus was to explore the experiences of people who were assessed and/ or carers, whose voices are underrepresented in research on MHAAs as opposed to professionals. Reading through the transcript of the discussions afterwards, I could see a recurrence of specific and interconnected topics – see below.
Advocacy
There were critical differences in how advocacy was understood, had been experienced and who was considered best placed to act as an advocate - a family member, a professional advocate (IMHA[5]), the AMHP, the care co-ordinator or the person themselves. Participants concluded that there was a need for clarity on what was meant by advocacy because as one participant said, ‘it means different things to different people’. We wondered how advocacy was being evaluated and how findings were being used to shape how AMHPs promote advocacy. We also questioned the extent that AMHPs were meeting the 14.53[6], MHA Code of Practice requirement, to facilitate an advocate or family member joining the MHA and whether people awaiting MHAAs were aware that they could ask for this, and if they did - how was the impact being measured?
Information
A study to find out what information people with lived experience and carers wanted from AMHPs and in what format, at the time of assessment, to improve their ability to understand and participate in MHAAs was recommended by the group. This aligns with the guiding principle of ‘empowerment and involvement’ in the current Code of Practice, and ‘choice and autonomy’ in the new Mental Health Act 2025. Exploring this topic could lend itself to research, a feasibility study and evaluation.
The gap in suitable information was raised by a lived experience participant who recounted how lost she and her husband were the first time she was assessed and detained under the Act. They found the system unnavigable. She called for a ‘practical information pack…something tangible that people can take away with them’. The lack of a consistent approach to information provision resonated with all participants and was seen as a critical service process shortcoming to be addressed.
A carer participant wanted to know about the distress levels of their loved one; who was present at the MHAA? what questions were asked? What were the professional interpretations of risk and the reasons for the decision? The carer brought up the impossibility of accessing the AMHP’s report which might give her answers to the above, even via a subject access request (SAR). This spotlights the AMHP report, its content, use, target audience and accessibility. See Tom Woodd’s 2022 blog on this topic[7].
Participation, Involvement & Preparation
The question of who should be in the room during the MHAA was repeatedly brought up in the workshops. Another carer participant shared her sense of injustice when her family were not allowed to be present for the MHAA of her elderly father with dementia. She believed having an ally in the MHAA, whether it was a family member or a professional who knew them well, was an important way of countering the power imbalance that underscored MHAAs. This was qualified by the importance of involving the person in who they wanted in the room, and not to make assumptions about this. This harps back to 14.53 above and the question of whether AMHP teams are routinely practising, evaluating and learning from this.
A lack of preparation and joined up planning for MHAAs was seen as a consistent barrier to offering more agency to the person being assessed and involving carers in a more thoughtful way. Participants also questioned whether and to what extent people about to be assessed were being given the opportunity of ‘speaking to the AMHP alone’ (14.54 MHA Code of Practice) and what were the perceived benefits and challenges of this.
Conclusion
At the co-production event on 1 July, the call for ‘nothing about disabled people without disabled people’ as the basis for service improvement across local authorities was repeatedly made. The majority of AMHP services sit within adult social care, yet anecdotally many seem to exist in a professional bubble without any dialogue channels to capture and learn from the voice of lived experience and carers or even basic feedback mechanisms. This is alarming when you consider the power which AMHPs exercise on behalf of local authorities sits at the apogee of state led coercive control.
This blog is an invitation to local authorities to check their power and build processes to include the voices of lived experience and carers in the development of AMHP services in a planned and consistent way.
Can you contribute?
The author would like to hear from AMHP services that use co-production principles to involve people with lived experience and carers in service improvement, please contact - Jenny.daly@lbhf.gov.uk
References/Links
[1]Community engagement and involvement | NIHR
[2]The Approved Mental Health Professional workforce in the social care sector 2025
[3]National-AMHP-Service-Standards-2020.pdf
[4]Detentions under the Mental Health Act - GOV.UK Ethnicity facts and figures
[5] Independent Mental Health Advocate
[6] ‘If a patient wants someone else (eg a familiar person or an advocate) to be present during the assessment … then ordinarily AMHPs should assist in securing the person’s attendance.’ 14.53 - Mental Health Act 1983