Taking a “Cheeky Look” at Case Records: Balancing Curiosity and Ethics in AMHP Practice
By: Dr Renée Aleong
Introduction
As a social worker and social researcher, my journey has been filled with many eye-opening discoveries. During my PhD in Social Policy and Social Work, funded by the Economic and Social Research Council, I explored the disproportionate involuntary detention of Black people under the Mental Health Act (MHA). I thought I had a solid grasp of the complexities involved in Approved Mental Health Professional (AMHP) practice. However, an unexpected finding emerged: what I now call the ‘cheeky look phenomenon’ (Aleong, 2023).
Though not initially part of my research focus, this quiet, unofficial practice, what AMHPs themselves call a 'cheeky look’ raises important questions about ethical boundaries, emotional investment, and professional curiosity. But what exactly is the ‘cheeky look phenomenon’? It describes AMHPs checking a person’s case record after their statutory involvement has ended, not as part of their designated responsibility, but out of concern, curiosity, or a desire to learn. While this act may seem harmless, it exists in ethically uncertain territory. This blog explores this dilemma and its wider implications.
A Cheeky Look: What’s really going on?
Professional curiosity is encouraged in social work, asking questions and seeking deeper understanding can improve outcomes (Phillips et al., 2024). However, curiosity sometimes extends beyond the boundaries of formal practice. My research revealed that for many AMHPs, this curiosity can manifest in an unexpected way – what they describe as “taking a cheeky look” at case records after their statutory involvement has ended.
This desire to know what happens next can be strong, prompting AMHPs to revisit the case records of individuals they’ve assessed, even after their formal involvement has ended. Many AMHPs acknowledged this behaviour, often citing the absence of a formal follow-up mechanism. This absence of feedback can be frustrating, especially when they’re making decisions that deeply affect vulnerable individuals, particularly those from racialised communities. The ‘cheeky look’ provides reassurance, but it’s also a way to learn - informally, yes, but learning nonetheless.
AMHPs explained:
"I want to see how my decision develops and has impacted someone’s path."
“It will be useful to learn from people going through the experience of being sectioned.”
These reflections highlight how deeply these AMHPs care about both their decisions and the individuals they assess. While this curiosity often stems from genuine concern, it raises ethical concerns about maintaining professional boundaries. Given the significant impact their decisions can have on people's lives, it's understandable that AMHPs would want to follow up. However, the informal practice of "taking a cheeky look" remains largely unspoken because it blurs the boundary between professional responsibility and personal involvement.
Emotional investment: Where the lines start to blur
Emotional investment refers to the personal attachment or commitment we develop toward our work, the people we work with and the outcomes we hope to see (Fineman, 2000). This goes beyond mere professional duty, involving a deep concern for the wellbeing of those we seek to help. For AMHPs, this emotional investment can drive them to seek closure or reassurance by revisiting case records, even when such actions are not professionally justified.
The emotional pull of seeking closure or reassurance can be especially strong for AMHPs, who are tasked with making crucial decisions during MHA assessments. These decisions can have a huge impact on someone’s mental health journey and, at times, their freedom. The weight of those decisions is significant, and can contribute to compassion fatigue (Huggard, 2003), a state of physical and emotional exhaustion caused by constantly being exposed to others’ suffering. Similarly, AMHPs may face vicarious trauma (Sabin-Farrell & Turpin, 2003), where hearing about other people's traumatic experiences begins to impact their own emotional well-being. In these circumstances, the need for closure or resolution can become overwhelming, and that's where the lines start to blur between professional responsibility and personal involvement, leading to the temptation to check service-user case records.
What role does emotional labour play in AMHP practice?
Emotional labour involves regulating emotions to maintain professionalism during stressful interactions (Morris, 2016), whereas emotional investment is a deeper, personal connection rooted in care and responsibility for positive outcomes. In AMHP practice, these two concepts frequently overlap. An AMHP might be emotionally invested in a person’s well-being while also working to maintain professional objectivity during an assessment.
This emotional pull can lead AMHPs to seek closure by informally checking case records without a legitimate reason. While AMHPs are expected to move on after making critical decisions, the weight of those decisions can linger, prompting difficult questions: 'Did I do the right thing?' The instinct to 'check in', however well-intentioned, can blur the line between professional responsibility and personal involvement (Doel et al., 2010; Shevellar & Barringham, 2015).
A key challenge is defining what constitutes a ‘legitimate reason’ for accessing records post-assessment. Is emotional investment sufficient justification? Does the justification diminish the further removed an AMHP is from the original assessment? How do AMHPs distinguish between maintaining continuity of care versus stepping outside their statutory role? Without explicit guidance, these decisions are left to individual discretion, creating inconsistencies in practice.
I am not suggesting that AMHPs require rigid approval for every action, but rather highlighting the absence of a clear framework defining when and why accessing records post-assessment is appropriate. This ambiguity forces AMHPs to interpret their responsibilities based on personal judgment, organisational culture, or their understanding of ‘duty of care.’ The issue is not about questioning AMHPs' professionalism or intentions but rather ensuring ethical and consistent practice.
It could be argued that any professional involved in an MHA assessment has a justified reason to check patient records for continuity of care. Maintaining up-to-date knowledge on an individual’s journey through statutory services may be considered as part of the AMHP role, particularly when future assessments (e.g., transitioning from Section 2 MHA to Section 3 MHA) are likely, however, perspectives vary. Some AMHPs see checking records post-assessment as a professional obligation, while others view it as exceeding their remit once their formal involvement ends.
The lack of explicit guidance on what ‘duty of care’ entails for AMHPs leaves this issue open to interpretation. This variability means that while one AMHP may feel a moral and professional duty to follow up, another may see it as stepping beyond the legal and ethical boundaries of their role. This lack of clarity is at the heart of the ‘cheeky look’ phenomenon. It highlights an area of practice that requires further discussion and clearer guidance to ensure AMHPs navigate their professional responsibilities with confidence and ethical integrity.
Lack of formal follow-up mechanisms
During my research, I explored the AMHP role from an external perspective, offering a viewpoint distinct from those within the profession. I found that, unlike other healthcare professionals who have established follow-up processes, AMHPs do not have formal mechanisms to track the long-term outcomes of their decisions. In healthcare, structured follow-up systems exist to ensure continuity of care and inform future practice. For example, general practitioners (GPs) routinely receive updates from secondary care services on their patients' progress, while psychiatric teams conduct multi-disciplinary reviews to assess treatment effectiveness. Similarly, in hospital settings, clinical audits and patient outcome tracking enable healthcare professionals to reflect on interventions and improve care pathways.
By contrast, AMHPs often operate in fragmented systems, with no structured way to review how their assessments influence service users' journeys. Without such mechanisms, many AMHPs are left questioning whether their decisions had the intended effect, particularly for the most vulnerable and marginalised individuals. One AMHP articulated this frustration:
"It’s frustrating not knowing if we’re perpetuating the same patterns, especially with marginalised groups. We make critical decisions, but without follow-up, how can we learn or improve?"
The lack of formal follow-up mechanisms could leave some AMHPs with lingering uncertainty about the impact of their decisions, creating both ethical and emotional discomfort. This gap in practice underscores the need for structured reflection and systemic feedback, ensuring that AMHPs can engage in professional learning without overstepping ethical boundaries.
The impact on racialised communities: Where curiosity could make a difference
The disproportionate involuntary detention and re-detention of Black people under the Mental Health Act (MHA) is a longstanding issue and was a central focus of my PhD research (Aleong, 2023). Many AMHPs I spoke with shared concerns about ethnic disproportionality in compulsory detentions, as well as the absence of formal follow-up mechanisms. Without structured feedback, AMHPs struggle to fully understand the broader impact of their decisions on racialised communities.
Research suggests that people from Black ethnic groups are more likely to engage with mental health services post-hospitalisation if they feel understood and supported (Gillispie et al., 2005). However, AMHPs often lack insight into whether their decisions facilitate meaningful support or perpetuate systemic inequalities. This disconnect was a source of frustration for many AMHPs, who felt they had little opportunity to reflect on their practice in the context of systemic or organisational trends.
One AMHP reflected:
"We want the best for people, but we’re often left wondering, How did they do? Did they stay well, or did we miss something important?"
This points to the need for a more formalised mechanism, not necessarily for individual case follow-up, but to provide AMHPs with aggregated data and outcome analyses. This could enable practitioners to engage in reflective practice, identify patterns, and address systemic issues such as discriminatory or oppressive practices.
Bridging the Gap: The Role of Structured Reflection
A structured follow-up mechanism does not mean AMHPs should be personally responsible for long-term case tracking, but it could provide valuable insights through:
Aggregated Data Analysis – Anonymised detention and re-detention data across demographics, helping AMHPs situate their practice within broader systemic patterns.
Feedback Loops – Periodic updates on general trends in service-user outcomes, such as post-detention engagement with mental health services.
Collaborative Forums – Opportunities for AMHPs to reflect collectively on decision-making patterns and share best practices to mitigate racial disparities.
While AMHPs alone cannot resolve systemic disparities, these mechanisms would allow them to better understand the impact of their decisions within the broader mental health system. Importantly, they may also improve service-user experience by fostering a sense of being seen, heard, and understood within mental health services.
Although such changes may seem abstract or difficult to implement, the lack of structured support for AMHPs in this area remains a critical gap. Exploring feasible ways to provide AMHPs with meaningful feedback without overstepping professional boundaries, could lead to more informed, reflective practice and ultimately contribute to reducing ethnic disparities in detentions under the MHA.
A case for formal follow-up: A dream or reality?
While AMHPs in my research expressed a desire for formal follow-up mechanisms, their statutory role is outlined within the MHA, which defines their responsibilities specifically for the assessment and detention process. Once an AMHP completes these statutory duties, their role officially ends, with ongoing care passed to other healthcare professionals. Establishing a formal follow-up system would necessitate legislative changes or a significant redefinition of AMHP responsibilities within the MHA. This presents a legal challenge, as expanding the statutory role of AMHPs risks blurring the distinction between their duties and those of healthcare professionals who oversee long-term care.
Additionally, such a shift would have to align with existing data protection laws, such as the General Data Protection Regulation (GDPR), to ensure the privacy and confidentiality of case records. Extending AMHPs' access to individual case and clinical records post-assessment could raise privacy concerns, especially if the follow-up is not explicitly tied to statutory responsibilities.
Given the workload pressures on social worker AMHPs, practical implementation would also need careful consideration. The emotional and logistical demands of these responsibilities mean that finding time and resources for formal follow-up might be unrealistic under current structures. To implement such a system effectively, additional support or restructuring of AMHP workloads would likely be necessary.
Looking ahead: Fostering ethical curiosity in AMHP practice
Addressing the ‘cheeky look’ phenomenon requires more than individual discretion, it calls for structured reflection and ethical consistency. AMHPs must navigate the fine line between emotional investment, curiosity and professional responsibility, ensuring their actions align with ethical practice. As a regulated profession, social worker AMHPs operate within defined professional standards (Social Work England, 2019), reinforcing the need for clear guidance and structured reflection to support ethical curiosity while maintaining public confidence.
By fostering a culture of reflection, transparency, and accountability, AMHPs can continue learning from their decisions while upholding professional integrity. The challenge is not just about following rules, it’s about shaping practice that is ethically sound, reflective, and ultimately, in the best interests of those they serve.
For more insights and discussions on social work and AMHP practice, connect with Renée on Dr Renée Aleong | LinkedIn Let's continue the conversation! #AMHP #socialwork #socialresearch
References
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Picture used - "Close-Up Shot of a Man Looking at Window Blinds" * Free Stock Photo (pexels.com) photo by Cottonbro Studio