AMHP reapproval and ‘relevant training’: A tokenistic tick-box exercise, or an opportunity for critical and radical engagement?

by George Mearns

As AMHPs, we are all aware of our statutory requirement to complete a minimum of 18 hours annual training which has been agreed with the approving Local Social Services Authority (LSSA) as being relevant to our role as an AMHP. I recently undertook some research into the issue of AMHP re-approval (see Mearns, 2023) and this experience really made me think critically about the issue of ‘relevant training‘. How do I feel about my annual AMHP refresher? Do I see it as an administrative-bureaucratic tick-box exercise - “what, legal update……again”? Or does it make me genuinely feel inspired and motivated, a real opportunity to set my own training agenda and reconnect with core AMHP values, to improve my practice in terms of ethical, antiracist and practice-focused solutions?

My research was a narrative literature review into AMHP reapproval and opportunities for improvement, which identified several themes as being relevant to improving reapproval processes - (1) policy guidelines (2) service user and carer involvement (3) the social perspective (Mearns, 2023). The review also identified best practice guidelines from the literature base in terms of what should be considered as ‘relevant training’ to the role of an AMHP when it comes to re-approval, namely that AMHPs should be subject to specific training and development around the needs of groups who may be vulnerable to discrimination by the MHA assessment process, and that AMHP professional development should emphasise an understanding of social trauma and the value of service user and carer experience (DoHSC 2019).

However, what also really interested me about the issue of relevant training in particular was the specific language that Parliament used when prescribing the regulations for AMHP approval and reapproval. The particular wording in Regulation.5a indicates the potential for individual AMHPs to be actively involved in constructing their own training agendas as part of reapproval. And this in turn presents an opportunity for practitioners to advocate for more critical and radical approaches to AMHP annual training, in alignment with anti-oppressive and antiracist perspectives.

The Mental Health (AMHP) (Approval) (England) Regulations 2008 (DoH, 2008) set out the broad process for AMHP approval and reapproval. Regulation.5(a) states that ‘in each year that the AMHP is approved, the AMHP shall complete at least 18 hours of training agreed with the approving LSAA as being relevant to their role as an AMHP’ (my emphasis). The use of the preposition “with” is of fundamental relevance to the interpretation of Regulation.5(a) as, in my view, it critically alters the dynamic between the LSAA and AMHP. The AMHP is not simply a passive recipient of relevant training, where the relevant training in question is decided solely by the LSSA; but instead, the AMHP becomes an active participant in defining exactly what training is to be deemed ‘relevant to their role’. Had the Regulations elected instead to use the phrase ‘agreed by the LSAA’, then the emphasis would have been on the LSAA itself as being the sole arbiter of what constitutes relevant training. However, the explicit use of the preposition ‘agreed with the LSSA’ reframes the process to specifically include the AMHP as being an integral decision maker in deciding, alongside the LSAA, what training should be deemed relevant to their role.

This is not merely a matter of semantics. The Regulations are after all a statutory instrument and as such are “just as much a part of the law of the land as an Act of Parliament” (HCIO, 2008). The specific words employed quite literally constitute the will of Parliament, so clarity as to their meaning and implication is paramount. We only need to consider cases such as the Devon judgement to appreciate the degree to which the courts forensically interrogate words/phrases in the statute to establish precisely this (see Devon, 2021). If Parliament had wanted the LSSA alone to decide what training is relevant to the AMHP’s role, they would have said so in the Regulations. The specific wording Parliament elected to use instead indicates, to me, that the intention was to foster a collaborative, dialogical process between AMHP and LSAA in deciding this issue together. This distinction perhaps reflects the unique role of the AMHP - that of an independent, autonomous decision maker who acts on behalf of the LSSA (and not merely as an officer of the LSSA acting under the instruction of their employer).

But what relevance does this interpretation for me? If we accept that individual AMHPs should have a direct role in deciding what annual training is relevant to their role, then the next logical questions to ask are:

·       ‘what type of AMHP do you want to be, who are you for?’ (see Mitchell’s blog on this site posing this question); and then - 

·       ‘what type of annual training do you need to develop your practice in this way’?

For example, are you interested in dialogical MHA assessments (see Manchester, 2021); do you want to know more about perspectives on s.13(1) AMHP practice (see Simpson, 2024; see Mitchell, 2021); are you passionate about antiracist perspectives and MHA assessments (see Sewell 2023), about NHS England’s patient and carer race equality framework (NHS England, 2023), about service user experience (see Blakley, 2022)? Who are you for (Hemmington, 2023)?? And what specific training do you need to consolidate your practice as an ally of service users and carers in this way? Are there other more radical, critical and ethical approaches to AMHPing that are important to your personal practice and relevant to your role that you want to explore in more depth??? If so, then r.5(a) is a valuable tool for individual AMHPs to advocate and negotiate with their approving LSSAs to commission and provide genuinely radical and critical training opportunities as part of the statutory requirement for ‘relevant training’ for AMHP reapproval. AMHP practice is multi-faceted, comprising clinical, procedural and legal aspects alongside the moral/ethical and sociological/structural aspects. Individual AMHPs and their employing/approving LSSAs may well place a different onus on these different aspects of AMHP practice. Is your LSSA prioritising a narrow, legalistic interpretation of AMHP practice and relevant training, perhaps reflecting their more corporate, administrative priorities in terms of AMHP reapproval? And is this at the expense of more radical training opportunities which you feel are just as relevant to your role? In the current economic climate of shrinking public service budgets, then r.5(a) is perhaps an even more valuable tool than ever for AMHPs in making the case for the importance of bespoke and individualised training.

In summary, it is too easy to see AMHP re-approval as a dull and prescriptive process, a mere tick box exercise for administrative purposes. However, applying a critical lens to the issue via a discursive analysis of r.5(a) indicates the potential for AMHP re-approval, and the issue of relevant training in particular, to become a more radical process in which the AMHP should play a central role in directly contributing to and influencing their own training agenda, treating it as an opportunity to engage with critical, radical, antiracist and anti-oppressive perspectives.

References:

Department for Health (DoH). 2008. Mental Health (AMHP) Regulations 2008. London: DoH.

Department of Health and Social Care (DoHSC). 2019. National Workforce Plan for AMHPs. London: DoHSC.

Devon Partnership NHS Trust v Secretary of State for Health and Social Care. (2021). EWHC.

House of Commons Information Office (HCIO) (2008). Factsheet L7 Legislative Series: Statutory Instruments. London: HCIO.

Manchester, R. (2021). Could these be the key elements of dialogical Mental Health Act interviewing? Critical AMHP Blog. https://www.the-critical-amhp.com/blog/blog-post-two-x437a

Mearns, G. (2022). What Does the ‘A’ Stand for? Exploring the Process of AMHP ‘Re-Approval’ and Opportunities for Improvement: Themes from a Narrative Literature Review. Practice, 35(5), 389–403. https://doi.org/10.1080/09503153.2022.2129047

Mitchell, J. (2022). An AMHP’s Journey Through s13(1) MHA. Critical AMHP Blog. https://www.the-critical-amhp.com/blog/blog-post-three-x4xfhhttps://www.the-critical-amhp.com/blog/amhpersonality-disordered

NHS England (2023). Patient and Carer Race Equality Framework. NHS England: London. https://www.england.nhs.uk/long-read/patient-and-carer-race-equality-framework/#:~:text=The%20CQC%20has%20developed%20a,caring%2C%20responsive%20and%20well%20led.

Sewell, H. (2023). Mental Health Act Assessments: No trace of race. The Role of the AMHP in antiracist practice. The Critical AMHP Blog. https://www.the-critical-amhp.com/blog/mental-health-act-assessments-no-trace-of-race-the-role-of-the-amhp-in-antiracist-practice

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. https://doi.org/10.1093/bjsw/bcad271

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