AMHP‑washing: Is Section 13 at risk of becoming a veneer for systemic scarcity?
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By Tom Woodd
The important work by Simpson, Lewis and Mitchell (2024) has generated useful debate around referral thresholds and the need to slow things down. This work is rooted in a strong and principled value base. At its heart lies a commitment to a social perspective on mental health: challenging community and inpatient services to do more and do better; safeguarding civil liberties and autonomy; and providing a counterweight to a dominant medical model in which the boundaries of what is considered “healthy” continue to narrow.
Others on this blog — notably Tim Gorvett — have already articulated how these values and approaches are not necessarily novel, and that their primary contribution may lie in articulating more clearly what AMHPs already do, and why it matters.
My concern, however, is of something more noxious. These ideas are increasingly being drawn into the orbit of powerful and uncomfortable systemic forces. In particular: severe pressure on inpatient and community resources; siloed and defensively oriented practice; and a growing tendency for service development to focus on managing demand — on who can be “turned away” — rather than on how need is met.
The pressure on resources is real, and it undeniably shapes the landscape in which we work. However, there is a growing risk that the language and ideas of Section 13 are being co‑opted as a professional gloss — an AMHP‑wash — applied to system‑level responses to scarcity. In this form, they risk becoming a distorted mechanism for protecting beds and adding legitimacy to the idea that people will be harmed rather than helped by admission and care.
Clearly, we need to stand together and use our collective voice to demand good‑quality evidenced based care for all, expose the realities of resource scarcity, and resist being drawn into providing a smokescreen for the realities of rationing care. But if we genuinely want to work towards the values articulated in the Section 13 discourse, we also need to ask a broader question: what other ways, beyond the front door, might we meaningfully influence the service people receive?
Slowing down as relational practice
First, the emphasis on “slowing down” must be understood as applying across all our work, not solely at the point of referral. Slowing down is not simply about buying time or searching harder for alternatives to admission. It is about engaging with people as human beings.
AMHP interviews — and, crucially, all interactions within mental health work — are never neutral exercises in information‑gathering. They are deeply relational encounters, taking place in contexts of fear, trauma, conflict and uncertainty. Practitioners such as Rob Manchester, writing for the Critical AMHP blog and more recently in The British Journal of Psychiatry’s ‘Advances’ in a co-authored paper with Dr Tom Cant, have foregrounded the emotional labour inherent in this work, alongside the importance of reflective spaces and training that support AMHPs to remain present in such intensity.
This goes far beyond the idea of a no‑break assessment with transparent decision‑making. Embedding relational skills more firmly in AMHP education and day‑to‑day practice is not an optional extra: it is central to confident, ethical and humane mental health practice.
Moving beyond the “MHA or not MHA” binary
A second vital area is the need to challenge the unhelpful binary of “MHA or not MHA”. People do not live their lives within neat legal categories, and neither should our practice.
In pressured and fragmented systems — particularly where AMHP services operate as standalone functions — practice can become narrowly threshold‑driven. A social work perspective, by contrast, recognises the complex interplay between safeguarding, capacity, rights, strengths, risk, community support, NHS responsibilities, local authority duties, Voluntary, Community, and Social Enterprise sector provision, and the Care Act and section 117 frameworks.
When AMHP thinking is embedded across this wider landscape, the range of possible pathways expands, and conversations with individuals and their networks become more grounded, realistic and meaningful. For this to be possible, AMHP perspectives and skills must be genuinely integrated across services — and arguably across roles — rather than positioned as specialist expertise deployed only at the point of crisis.
With recruitment pressures drawing services further away from combined and generic roles, it is worth pausing to consider what is lost in that shift, and how we can support one another to think — and practise — more broadly.
Carers, families and social networks
Carers and social networks represent another significant, yet often underdeveloped, area of practice. AMHPs frequently encounter families and carers at moments when the balance shifts: when contact occurs that may not previously have been possible, and when communication may necessarily cut across a person’s expressed wishes.
Too often, our engagement in these moments becomes narrowly legalistic, focused almost exclusively on the formal powers and functions of the Nearest Relative. In doing so, we miss critical opportunities to support the wider network.
Many Nearest Relatives do not identify as carers at all, meaning their needs, pressures and entitlements remain invisible. Small but intentional acts — asking how they are coping, acknowledging stress, clarifying confidentiality, or considering a Carer’s Assessment — can make a substantial difference. Equally important are honest and sometimes difficult conversations with the person about the difference between sharing personal and general information, and about recognising family members as people with their own needs and voices.
These are not peripheral concerns. They sit at the heart of prevention, relational practice, and the development of genuine and sustainable alternatives to admission over the longer term.
If this resonates, colleagues and families may also wish to explore the new Resources for Nearest Relatives , coproduced with experts by experience, and bringing together clear, accessible resources aimed at improving understanding, confidence and support for Nearest Relatives under the Mental Health Act.
Transparency and shared understanding
Transparency is another area where AMHP practice could evolve in ways that genuinely support slowing down and improving longer‑term outcomes. The AMHP report sits at the centre of accountability, risk analysis and decision‑making, yet it is rarely shared with the person concerned or their network. See my other piece on this site - The AMHP report – who is it for? - for further discussion on transparency.If we are serious about relational practice, strengths‑based work and building understanding beyond the immediate crisis, then sharing reports — thoughtfully and appropriately — should become more routine. Used well, transparency can support trust, continuity and reflection, rather than functioning solely as a defensive record.
Co‑production as a core commitment
Finally, co‑production can no longer be treated as an aspirational add‑on. With the Patient and Carer Race Equality Framework (PCREF) establishing it as a national expectation, it signals a shift in how services should be designed, governed and held to account. Meaningful co‑production is not about involving people with lived experience in isolated initiatives; it is about shaping pathways, decisions and priorities in a collaborative and open way, rather than simply reflecting what systems feel able to offer.
Models such as Trieste’s mental health system and Peer-Supported Open Dialogue illustrate what this looks like when taken seriously. In different ways, both demonstrate that co‑production is not confined to formal structures but operates as an underlying value, shaping how distress is understood, how power is shared, and how decisions are made. The impact is cultural as much as procedural: reduced reliance on coercion, greater trust, and a move away from binary, adversarial framings of risk and responsibility.
For AMHP practice, this creates a clear challenge to move beyond “doing assessments”. If we are to counter the drift toward an AMHP wash, this requires active engagement with organisational culture and power, using our position to question how decisions are framed and to create space for lived experience and others whose perspectives are marginalised.
Resisting the AMHP‑wash
Taken together, these building blocks of an engaged social and critical perspective in mental health practice offer a practical and achievable platform from which AMHPs and AMHP services can broaden the meaning and application of Section 13. They provide a route to resisting its unhelpful distillation into a sophisticated vocabulary for resource rationing — and to reclaiming it as a broader expression of ethical, relational and rights‑based practice.