We might have always done it, but we can now explain it – responding to Tim Gorvett’s piece on s13 consideration.
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By Nick Perry
I have sat on my hands for a few weeks, worrying that it might be bad form to respond to Tim Gorvett (SPEAKING IN PROSE & THE REDISCOVERY OF S.13(1) MHA 1983 — Blog Home) when it is obviously for John Mitchell and Robert Lewis to have their right of reply.
But we AMHPs aren’t supposed to be deterred by bad form, nor any residual feelings of inadequacy regarding our expertise in French literature! Let me aim to be one of those energetic and creative AMHPs that Tim talks about in his closing comments, and send in my thoughts, for what they are worth… Here goes.
Tim says that:
‘As practicing AMHPs, we haven’t got a lot of time, or headspace, or emotional energy, for that matter, to take up an unpopular stance in a debate about ill-defined and rather abstruse points’.
I say, we are supposed to have autonomy as well as independent liability. If we take our professional power, we can choose how much time and headspace we create for ourselves. Let’s do that; because if we do (and make the space for time alone – COP 14.54) then both we and the person being assessed will benefit.
Tim says, ‘we mustn’t make a fetish of [considering the case] -it is what we do all day, every day.’
I say, we might do, but prior to Matt, John and Robert’s intervention, we didn’t routinely describe our approach in this way. The way we explain what we are doing, as we work with partner professionals, can make a material difference to the experience of the person being assessed. The fact that MHA 1983 work starts when the AMHP begins to consider the person’s situation on behalf of the local authority is extremely important. The fact that a wider, acculturated understanding – over decades – of an ‘MHA assessment’ being ‘an AMHP and two doctors’, means that what Tim says is only half true.
If the outcome of embracing s13 consideration is the request for ‘yet another d*****d report’ this could be welcome if our systems were to change away from a bureaucracy built around the engagement of s12-approved doctors; and was instead built more routinely towards decisions not to need them.
Tim wonders aloud in his piece:
‘It can be difficult to see why such a piece of work would not be better informed, by the AMHP meeting with the patient, and taking into account recommendations made, or not, by qualified medical practitioners, as well as the views of the patient’s relatives.’
I agree with him, up to a point. I think it is often crucial for AMHPs to have ‘eyes-on’ within pieces of s13 consideration work, and I will come back to this in my case example.
Where I agree with Tim without reservation is in him reminding us of the significant professional bravery required to take a s13 consideration approach to MHA 1983 work. I acknowledge sincerely the lived experience coming through his words of watching AMHPs buckle under intense emotional pressure, as well as through moral injury, especially when assessments have had tragic outcomes. We AMHPs take responsibility for our work. It’s the way we are built, and it speaks of the values we hold dear. If we take this approach we will lose colleagues along the way. It will hurt; and cause us anxiety; and such words should not be written glibly.
And he is obviously right about the differences in service format and pressures around the country, from big cities to provincial settings where tea might still be served; and that ‘slowing down’ an assessment process may not have immediately obvious benefits for people where the system has so little to offer by way of useful, less restrictive alternatives to unpleasant environments of emergency care.
I agree especially if AMHPs in such circumstances have not had the training to be an intervention in themselves. This is where I strongly believe a step change in our AMHP training and communicative practices is required. As I have argued in other pieces on this site (and a recent book: Perry, 2025), the fit between s13 consideration work and Solution Focused Practice is more important than ever.
It is my strong view that through seeing people face to face (where it is safe to do so); within a s13 framework; asking questions which prioritise their best hopes from our talking (George et al., 2012); we can both respond quickly, whilst slowing decision-making down.
By way of example, I share a recent anonymised piece of s13 work following a referral from Police Custody. The person was known to services but not well known – with a last contact seven years ago. There is reporting on the system of a developmental difficulty. Lena (not her real name) has been arrested for verbal violence in a public place. She has been in Custody for a few hours by this time. It was the middle of the day; there weren’t many doctors about in any case. I decided to go and see her on my own.
Following an explanation of the role of the AMHP, I have asked Lena her best hopes for the outcome of our talking together. Lena says she wants to get out of Custody; see her son; and get some help.
Here is a bit more of the anonymised report:
‘AMHP and Lena have spoken about her son Kai (3 years old) who she wants to be able to return to - Lena is not clear who is looking after Kai but assumes that this is her mum and dad. Lena says that she has been looking after Kai full time and last worked (in retail) in 2023. She would like to work again but not in the same setting. Asked whether she has a good relationship with her GP, Lena says that she does and that she is always willing to see her GP should she have any support needs. Asked whether she felt it was reasonable for Sammy [Custody nurse] to have been concerned, Lena agreed and said that she had been growling and acting like a gorilla. Lena has explained that this was fun but was also due to her being upset.
‘Lena is prescribed an anti-depressant by her GP and she confirms that this is helpful and addresses low mood. Lena did not present with any unusual behaviours, nor was she distracted in the conversation that we had. She is able to understand and weigh information in my opinion and able to express her wishes effectively. She may need Appropriate Adult support at Police interview but is able to consent to the AMHP's suggestion of a referral to the local Crisis Team. Lena has consented on the basis that she realises she has been having highs and lows recently and difficulties managing her anger. She says that she can attend the CRHT base for assessment if this is a requirement.
‘Lena is future focused and wants to be able to return home to care for her son. She has not spoken of self-harming and is more likely to be a risk of impulsive behaviours towards others (although people she knows, rather than members of the public). It is the view of the AMHP that she does not need medical examination under the MHA 1983 and that there are less restrictive ways of supporting her than considering compulsory admission. It will be the AMHP's recommendation to Police colleagues that family is contacted and the welfare of Lena's son Kai is confirmed (with any onward referrals as need be). It would be ideal if family could collect her from Police custody when the Police process is completed.’
A referral to the local Crisis Team was made, but for various reasons the team was not able to respond quickly. Lena got into another scrape in the community and returned to Custody within days. After the Crisis Team had caught up with her in Custody (following this further arrest) and after she was detained as the result of a second referral for MHA 1983 work, I was asked to join a professionals meeting to explain why I had attended the first time without doctors?
I was able to explain the s13 approach of our team, and the intention to provide a least restrictive response (which Lena had consented to).
I was also able to explain the impact for my AMHP colleague of having seen a less restrictive intervention fail; thus making a decision to detain more straightforward.
It ended up being a good conversation. Senior managers in the Trust are now more aware of local efforts to work in a way that is consistent with our s13 duty.
About the Author:
Nick Perry is an interim co-chair of the AMHP Leads Network; has just published a book with Routledge: Solution Focused Practice and Mental Health Crisis: Inclusive Support; and launches a new online module on Solution Focused Practice at the beginning of October: Solution Focused Practice for Health and Social Care Settings.
References:
George, E., Iveson, C. & Ratner, H. (2012). Solution Focused Brief Therapy – 100 Key Points & Techniques. Routledge.
Perry, N. (Ed.). (2025). Solution Focused Practice and Mental Health Crisis – Inclusive Support Towards Safety and Hope. Routledge.