Views on the AMHP contribution to Mental Health Act assessments

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By Greg Slay

There is much we can learn as AMHPs about our professional practice from the feedback we get from third parties. I have had an interest in this area throughout my professional career. For many, our exposure is limited to when such feedback comes from an AMHP in training and on their practice placement. As assessors, are we satisfied the person has been interviewed ‘in a suitable manner’?  And, has there been meaningful engagement with the Nearest Relative such that a next steps decision based on ‘all the circumstances’ present [S.13 (2) Mental Health Act] can be made? As AMHPs we are indebted to the late Matt Simpson for reminding us that the proper and effective use of S.13 does not automatically lead to a mental health hospital admission outcome, nor should it.

Triangulating the answers to these questions with direct feedback from those people who themselves have had a Mental Health Act (MHA) assessment can only be to our advantage. But how can we best go about getting this feedback, bearing in mind the sensitivities associated with MHA work?

In Jill Hemmington’s 2024 article on communicative practices the relative dearth of the voices of people who have experienced MHA detentions in the published research was mentioned. Some may know of Louise Blakely’s research in the then Southern Health NHS Foundation Trust area. Her research, undertaken pre-pandemic, had been jointly developed by a team of professionals and people with lived experience of their own MHA assessment.  The research looked at the assessment stage and concluded that whilst assessment and detention under the Act are some of the most coercive civil processes, the Kafkaesque nature of those assessments does not help or often provide a positive experience for anyone. In particular, the role of the AMHP was either not remembered or understood by the service users interviewed by Blakely’s research team.

Following the introduction of the Care Act a decade ago I personally had developed an interest in seeking feedback from service users who had had a Care Act assessment. The NHS Friends and Family Test looked promising as a basis for this. On closer inspection it seemed that this approach worked sub-optimally when patients were directed to score a series of very bland statements about the quality of the care and support they had received. So we did not go down that route locally and in fact turned our attention to other feedback loops such as embedding feedback through a Customer and Carer Group reviewing our broad Care Act activities.

It was in November 2021 that I decided it would be good to formalise our feedback arrangements about the AMHP contribution in MHA assessments. I decided that to make this a meaningful exercise it would be best if this was co-designed by people with their own recent personal experience in this area. Getting their involvement was a task in itself: we worked with a local service user-led organisation to identify people who could help with the design work, to test out various proposed questions, confirm the final selection to be used, and to make recommendations as to the actual survey approach to be followed. The proposals were then discussed and signed off by our Mental Health Service Quality Assurance Group and our Quality Assurance Management Board (Adults) in November 2022 and implemented over the course of the 2023-24 financial year.

It was agreed to fund a print survey with a series of questions offering a yes / no / not sure responses, as well as one area offering scope for a free text feedback contribution. An accompanying cover letter booklet explained the approach adopted and provided information about the Council’s Data Privacy notice and data controller responsibilities, as well information about whom to contact in the AMHP Service with any queries. A reply-paid envelope was provided so that respondents were not out of pocket. Whilst we knew that every adult who had had a MHA assessment during the survey period had been sent a survey pack, the surveys were designed to be completed anonymously and those returned would not be traceable back to individual service users / customers / patients.  In parallel, we designed and implemented a similar survey approach with Nearest Relatives.

In fact, our approach has been one of the first large scale local authority surveys into the AMHP contribution in MHA assessments. It has been a really valuable exercise to do, as it has shone a light on how AMHPs are seen by service users at that specific time. What we have found particularly helpful has been the way the questions – and answers - zero in on how AMHPs identified themselves and explained the assessment process, how they looked beyond the immediate situation to the strengths and wishes of the person being assessed, and how AMHPs balanced legal responsibilities with support for wider mental health improvement. And yes, it is possible to do this with people who are in crisis. Many respondents acknowledged this through their free text commentaries, with observations such as: ‘I was able to participate and understand what was happening’; ‘I was listened to every step of the way through my ‘crisis’ as a bi-polar long sufferer’; and ‘I was treated with respect and I was asked whether I needed anything else.’

The crisis timing and the emotional intensity of many assessments may have affected some of the results. For instance, only 57% of respondents recalled that the AMHP had shown their photographic identification on arrival. When the assessment team may have comprised a range of professionals, perhaps accompanied by police officers or other emergency service personnel, identifying and remembering who the AMHP is may have been difficult. One person said they did not like being surprised by the team of professionals arriving unannounced to do an assessment. I was surprised there were not more such comments. Better and more meaningful ongoing involvement of community mental health and social care services could mean that AMHPs spend less time providing and operating in isolation as an emergency service for the majority of people receiving an assessment.

One area often overlooked appears to have been to talk about what might be expected in a mental health hospital setting. I mentioned this to a few AMHPs some of whom thought it best not to talk about inpatient care in generalities. But it seems that a number of survey respondents felt that AMHPs providing reassurance about the therapeutic benefits of being in hospital would be useful. Some respondents (and many Nearest Relatives, it seems) looked to the AMHP to provide descriptions about what to expect and an objective overview of the therapeutic benefits.

These survey findings have been used to inform reflection by AMHPs in their AMHP practice development days and in professional supervision. The written information given to people following their assessment has been refreshed and updated (booklets covering various scenarios and legal rights have been published in standard and easy-read formats. The rights booklet for Nearest Relatives also includes advice about carer assessment and support). We need to provide accurate information - and we also need to check that people have really understood it. The mental health system is complicated enough without AMHPs unwittingly adding more complexity to the mix. As one respondent said, ‘It’s hard to remember…because I was feeling very unwell and they don’t make things easy to understand when there are many thoughts buzzing in my head and distracting my conversation.’ But these results surely provide a strong foundation on which to continue to build a centre of practice excellence by AMHPs – both locally and nationally – and a summary has therefore now been published in Professional Social Work.

References

Simpson, M.  (2024). Changing Gears and Buying Time: A Study Exploring AMHP Practice Following Referral for a MHA Assessment in England and Wales. British Journal of Social Work, 00, pages 1–20. https://doi.org/10.1093/bjsw/bcad271

Hemmington, J. (2024). How conversations can empower and involve: Building the evidence for Approved Mental Health Professionals’ communicative practices. Qualitative Social Work, 0(0). https://doi.org/10.1177/14733250241268731

Blakely, L.; Asher, C.; Etherington, A.; Maher, J.; Wadey, E.; Walsh, V.; and Walker, S. (2022). Waiting for the verdict: the experience of being assessed under the MHA. Journal of Mental Health, 31 (2), pages 212-219. https://doi.org/10.1080/09638237.2021.1922624

Slay, G. (2010). The vital equilibrium: the role of the Approved Mental Health Professional. In: Gilbert, P. (ed.).  'The value of everything: social work and its importance in the field of mental health.'  Second edition. Lyme Regis, Russell House Publishing.

Tell us about our rights in mental health assessments. Professional Social Work magazine, March / April 2025, page 6. [ https://basw.co.uk/about-social-work/professional-social-work-psw-magazine/digital-editions]

About the author:        

Greg Slay is a recently retired former Mental Health Quality Assurance Lead and AMHP with West Sussex County Council. Linked-In: https://www.linkedin.com/in/greg-slay-47514152/

Zowina Green is the AMHP Service Manager with West Sussex County Council from whom further information can be sought (email: zowina.green@westsussex.gov.uk)