MHA Reform and the Invisible AMHPs: Why ethical and relational AMHP practice is absent from the Bill

"House of Lords Chamber" by UK Parliament is licensed under CC BY 3.0.

By Jamie Freeman

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As I write, the Mental Health Bill is in its final ‘ping-pong’ stage between the House of Lords and the Commons and is expected to receive Royal Assent in the coming weeks. Here at the Critical AMHP blog, we are publishing a short series that critically examines the reforms through an AMHP lens: the good, the bad, and the indifferent. For my part, I represent the indifferent. I feel like the Bill should matter—certainly it is overdue. So why, then, do I feel so indifferent?

This should be an exciting moment for Mental Health Act (MHA) reform. The research and practice landscape is shifting in important ways. For example, Section 13 work is being spotlighted as a key AMHP function (Mitchell 2022; Simpson 2024; Simpson, Lewis and Mitchell 2024). Research is increasingly recognising the ethical nature of the AMHP task (Kinney 2009; Abbott 2022; Hemmington 2024). And exciting therapeutic models are being reimagined in the context of relational AMHP practice, including Open Dialogue (Manchester 2022; Cant and Manchester 2025) and Solution Focused Practice (Perry 2024; Perry 2026). Taken together, these developments sketch out a modern AMHP practice—legally literate, relational, and ethical.

However, this modern AMHP practice does not seem to appear in the Bill, nor in the formal debates that shaped it. I don’t see a modern MHA which reflects this practice-led reform. Even with colleagues working hard behind the scenes, the AMHP voice appears to be largely absent.

The Wessely Review (Modernising the Mental Health Act) felt meaningful—and the case for change it set out in 2018 is, if anything, even sharper now. Detention rates have remained stubbornly high and the racial disparity in detention rates remains shameful. Black people are detained at four times the rate of white people and are more than 8.5 times as likely to be made subject to a Community Treatment Order (CTO) (Mind 2025). As AMHPs, we act as the gatekeepers for the MHA and compulsory admission, and we are entrusted with significant statutory powers. In turn then, we must also be accountable. We contribute to the continuing structural violence and systemic injustice of the MHA. We are literally signing off on this. Arguably, this has been the steer for more relational and ethical approaches to AMHP practice. Certainly, AMHPs are going to need to form a meaningful part of any solution. How is it, then, that the AMHP voice appears to have been marginalised when it comes to reform?

AMHPs, I suggest, are largely invisible. Pithouse (1984) described social work as an invisible trade. Social work practice is usually private and unobserved, and outcomes are often ambiguous and unspoken/unclear. Our social work is often made visible in shared spaces, for example in conversations with colleagues, supervision, or reflective spaces (Pithouse 1984; 1998). Morriss (2017) examined how AMHPs and their social perspective can become invisibilised in healthcare settings. When AMHPs were seconded to NHS Mental Health Trusts, they reported that their social work was difficult to define and often went unseen, particularly in the absence of social work supervision spaces. When I think about how this operates in AMHP practice, I often think about how I introduce myself or explain my role. It takes some thought, and a little time. I’m not only a social worker and I’m certainly not an AMP. But if I introduce myself as an AMHP, this is meaningless to most people. I compare this against how a doctor introduces themselves at the beginning of a typical MHA interview—“and I’m the psychiatrist.” The medical model provides a clear and coherent narrative. It is understood and doesn’t require further explanation. The psychiatrist is simply the psychiatrist. Importantly however, the medical model does not provide meaningful solutions when confronted with the structural violence of how the MHA is operationalised. Here, there are no simple answers. The picture is both complex and opaque.

In my view, complicated is what AMHPs do best. As stated, there has been a real push to recognise and highlight this more recently. However, it is also important to remember that this stance has been historically advocated. Larry Gostin (1983) set out the role of the Approved Social Worker/ASW (forerunner to the AMHP) in A Practical Guide to Mental Health Law. He writes “It would be wrong for the role of the ASW to be relegated to that of a statutory office exercising a purely administrative/legal responsibility. Rather, the ASW should be concerned with all the aspects of professional social work practice necessarily implied by his statutory obligations: the personal interview (requiring sensitive communication with the patient and his family); the investigation of the least restrictive treatment and care settings (requiring a detailed knowledge of services provided by the local authority and voluntary organisations); and the prevention, wherever possible, of the use of compulsory admission through crisis intervention and management, as well as support for the patient and his family.” (Gostin 1983, page 26). This is the space that we have been occupying for more than 40 years. Albeit, perhaps, quietly.

I feel indifferent about the Bill because it lacks an AMHP voice. It appears (at least on the face of it) that there has been very little meaningful AMHP consultation. And I think that collectively we need to think about our role in this as a profession. We are invisible because what we do is complicated. But we are experts at doing the complicated. Perhaps we need to develop more expertise in explaining this complicated thing. Andrew Pithouse and Lisa Morriss both recognised that the social perspective is made visible in shared and reflective spaces. In these spaces we might better develop a louder collective voice. For me, it is important that I tread lightly through people lives. Collectively though, perhaps we need to be better at stomping about in parliament.

References

Abbott, S., 2022. A Study Exploring How Social Work AMHPs Experience Assessment under Mental Health Law: Implications for Human Rights-Oriented Social Work Practice. British Journal of Social Work, 52: 1362-1379.

Cant, T. and Manchester, R., 2025. A suitable manner? Seven key elements of a dialogical approach to the Mental Health Act assessment. BJPsych Advances, 31(5): 290–298.

Gostin, L., 1983. A Practical Guide to Mental Health Law. The Mental Health Act 1983 and related legislation. London: Mind Publications.

Hemmington, J., 2024. Approved Mental Health Professionals’ Experiences of Moral Distress: ‘Who are we For’? British Journal of Social Work, 54: 762-779.

Independent Review of the Mental Health Act 1983, 2018. Modernising the Mental Health Act: Increasing choice, reducing compulsion. Final report. London: Department of Health and Social Care.

Kinney, M., 2009.  Being Assessed under the 1983 Mental Health Act—Can it Ever be Ethical? Ethics and Social Welfare, 3(3): 329-336.

Manchester, R., 2022. Could these be the key elements of dialogical Mental Health Act interviewing? Critical AMHP Blog. Available at: https://www.the-critical-amhp.com/blog/blog-post-two-x437a

Mind, 2025. Mind responds to annual Mental Health Act statistics 2024/25. Available at: https://www.mind.org.uk

Mitchell, J., 2022. An AMHP’s Journey Through s.13(1) MHA. Critical AMHP Blog. Available at: https://www.the-critical-amhp.com/blog/blog-post-three-x4xfh

Morriss, L., 2017. Being Seconded to a Mental Health Trust: The (In)Visibility of Mental Health Social Work. British Journal of Social Work, 47: 1344-1360.

Perry, N. 2024. s13 Consideration and Solution Focused Practice – the ‘why’ and the ‘how’? Critical AMHP Blog. Available at: https://www.the-critical-amhp.com/blog/s13-consideration-and-solution-focused-practice-the-why-and-the-how

Perry, N. 2026. Helping AMHPs to be AMHPs – Solution Focused Practice under the Mental Health Act 1983 (as further amended). In: Perry, N. (ed.). Solution Focused Practice and Mental Health Crisis. Inclusive Support Towards Safety and Hope. Abingdon: Routledge.

Pithouse, A., 1984. Social Work: The Social Organisation of an Invisible Trade. PhD thesis. University College Cardiff.

Pithouse, A., 1998. Social Work: The Social Organisation of an Invisible Trade. Aldershot: Ashgate.

Simpson, M., 2024. Changing Gears and Buying Time: A Study Exploring AMHP Practice Following Referral for a Mental Health Act Assessment in England and Wales. British Journal of Social Work, 54(2): 797–816.

Simpson, M, Lewis, R. and Mitchell, J., 2024. ‘MHA assessments’ and s13(1) MHA 1983: ‘New’ AMHP practices within existing law. A discussion paper. [E-book]. Available from: AMHP Leads Network - Resources Page