Thinking Differently About the Mental Health Act

The discussion paper “‘MHA Assessments’ and s13(1) MHA 1983” challenges many of our core assumptions about what a ‘Mental Health Act assessment’ actually is, as well as examining the role of the Approved Mental Health Professionals who co-ordinate the process. The suggestion here is that our way of assessing people may itself contribute to excess detentions: that changes to AMHP practice are required, and to the organisation of AMHP services, if we are to detain fewer people.

Of course, many other issues contribute to the over-use of detention, and they often do so long before any referral for an MHA assessment is made. Lack of resources, risk aversion, structural racism, and organisational dysfunction are amongst the most obvious. But in situations where such factors are already at work, and mental health services feel unable to cope, (or to discharge the person), referral for MHA assessment can become a default response: an insurance policy that protects professionals from blame. Indeed, the demand for such assessments can become a kind of human diazepam: an antidote to professional anxieties. The trouble is that these assessments may then be undertaken in a similar spirit, and result in detention even when this makes the situation, and the person, worse rather than better.

The authors argue that an AMHP has greater flexibility in how she can ‘consider the patient’s case’, as the words of s13(1) MHA put it, rather than by automatically arranging what we have become used to calling an ‘MHA assessment’. Indeed, they contend that it is the role of the AMHP not merely to prevent detention, save where this truly necessary, but to prevent harmful or unhelpful forms of assessment too. This can often be achieved by slower, and more thorough responses to referrals than has been usual in recent times. This may involve seeing the person without doctors, or making decisions not to detain on the basis of inquiries undertaken without leaving the office. In some cases, deeper inquiries may reveal a stronger basis for detention than was evident in the referral itself: part of the problem lies in the generally poor quality of MHA referrals.

Of course, the ability of an AMHP to respond, where appropriate, to referrals in slower and more creative ways, will depend on the ability of her AMHP service to organise itself to support these styles of practice, and to resist relentless pressure. The more ‘MHA assessments’ that an AMHP service uncritically provides, the more referrals it will receive. The quicker an AMHP service responds to referrals with ‘MHA assessments’, the greater the expectation of further rapid reactions. Here, urgency usually relates to the needs of the system rather than the person alleged to need assessment.

This paper looks at the fundamental importance of decisions made right at the point of referral, a stage on the pathway to detention that has tended to be overlooked in expositions of the law and AMHP practice. The authors suggest that an AMHP needs to be viewed as a ‘considerer’ before she is seen as a possible ‘detainer’. They recognize that struggling mental health services will often exert pressure on AMHPs through various ‘referral games’, and they identify a range of ways in which AMHP services can respond skilfully to counteract this.

But why get involved in such ‘games’ at all? The authors suggest that the AMHP, entrusted with the task of detention, needs to be supported to fully use her skills to resist the use of the MHA, in a system that is all too ready to see those powers used.

We need constantly to ask, ‘who are we for?’ as we examine each referral[1]. We need to improve the quality of face-to-face assessment using emerging practice approaches[2] [3], while avoiding interviews which would be counterproductive. We need to address the disproportionate application of MHA powers to racialised people through the recognition of potential ‘racist processing’ within the referral process[4]. We need to recognize the lived experience of being assessed under the MHA, and to learn from those we detain in conversations free of the stresses imposed by the assessment process[5]. We need to slow the referral process down and enable AMHPs to support each other with the emotional challenges of some of the most demanding decisions in mental health[6].

If we can take the time to see people more as they are, rather than as framed by the MHA or through the anxieties of mental health services, then outcomes can often be different.

Link to the full s13 (1) e-book:

AMHP Leads Network - Resources Page (padlet.com)

Link to the s13(1) resource pack (containing a summary of the e-book plus some practice-based examples and tools):

AMHP Leads Network - Resources Page (padlet.com)

2024

 “‘MHA Assessments’ and s13(1) MHA 1983” has a launch event 1200-1300 on 17th July, hosted by the AMHP Leads Network.

Booking link for the launch is here: : https://forms.monday.com/forms/b958199d428c61c2a4fa6890d0ecb98c?r=euc1

[1] Hemmington J (2023b): Approved Mental Health Professionals’ Experiences of Moral Distress: Who Are we For’?, The British Journal of Social Work, https://doi.org/10.1093/bjsw/bcad258

[2] Manchester R (2022): Could these be the key elements of dialogical Mental Health Act interviewing? Critical AMHP Blog 26/09/2022 https://www.the-critical-amhp.com/blog/blog-post-two-x437a

[3] Perry N (2024): s13 Consideration and Solution Focused Practice – the ‘why’ and the ‘how’? www. https://www.the-critical-amhp.com/blog/s13-consideration-and-solution-focused-practice-the-why-and-the-how

[4] Sewell H (2023a): Frames and boundaries of race and ethnicity in MHA assessments. In Hemmington and Vicary (2023).

[5] Blakley L, Asher C, Etherington C, Maher J, Wadey E, Walsh V &  Walker S (2021) ‘Waiting for the verdict’: the experience of being assessed under the Mental Health Act, Journal of Mental Health, 31:2, 212-219, DOI: 10.1080/09638237.2021.1922624

[6] 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, The British Journal of Social Work, 2024;, bcad271, https://doi.org/10.1093/bjsw/bcad271