Taking the Leap: Reflections of a newly qualified AMHP
By Natasha Barry
I have worked as a social worker in Adult Mental Health services for the last six years and was approved as an Approved Mental Health Professional (AMHP) in March of this year. At the beginning of my training, I was slightly nervous as the whole process felt somewhat like a baptism of fire. Now I am really pleased I made the leap from social worker to AMHP and to be in a position where I have heightened abilities, skills, and knowledge to fully support my clients, team, and service. I feel the training has been particularly essential to working within mental health services and understanding the systems within which I work, including how my clients are supported.
Throughout my short time as an AMHP, I have found the role to be one of fundamental poise, interchangeable skills, and values to support clients when at their most vulnerable. AMHPs strive to support the client to be seen and heard in a holistic manner and I think that this is the heart and soul of the role. We are required to ensure the client is supported in a rights’ focused, person-centred and lawful fashion. As a duty AMHP, you can be faced with many competing pressures which in my experience can make the role more challenging: pressure from family members, care teams, doctors, time constraints, bed availability, referral demand on the day, the list goes on. At this point the ability to remain impartial and level-headed becomes a key feature of the role.
The AMHP role is fast paced requiring that I constantly adapt my approach based on the needs of the person being assessed. To date, I have assessed older adults, adolescents, refugees, people with learning disabilities. The decisions and approaches taken require flexibility and adaptability which can often be difficult to navigate and emotionally draining. l have learned to take my time and not make quick fire decisions but instead give each decision the time and weight it deserves and not to get overwhelmed by the pressures and challenges. Here, I cannot emphasise enough the importance of sharing and seeking support from colleagues to manage the stress of the role and the difficult decisions we have to make. I think this is the best way to process the often traumatic stories we hear from the people we assess and the difficult situations we can find ourselves in as AMHPs. The role is indeed a stressful one and the pressures unfortunately are persistent. Yet in my mind, the role brings with it a sense of calmness and collectedness to a Mental Health Act Assessment (MHAA) and I hope this is something I have embodied in my work so far.
AMHPs are often caught between the complexities of human relationships and their legal duty to the person of concern and their nearest relative. It is important to remain human in our approach and place ourselves in the client’s position, not becoming caught up in what can often become a very process driven experience, always remembering the person at the centre of all that we do. We are required to delve amongst behaviour, history, and personality to determine what is in client’s best interests but also ensure their rights are upheld. By developing as robust an understanding of the person as is possible, the AMHP tries to ensure that the outcome is a just and proportionate one. Whilst a MHAA is undoubtedly a difficult experience for clients, they are often necessary, and the end goal is to ensure that their experience is one of care and support regardless of the outcome.
Whilst this element of the work is not always easy to achieve within the systems in which we work, it is also the area of the work which I enjoy the most. The process of gathering information about the person of concern, getting a sense of their history and who they are as a person, what has led them to this point, whilst approaching issues with open-mindedness which we hope will ultimately result in the best outcome for that person. We don’t always get it right. And whilst it can certainly be challenging, I am left feeling assured that I have done my best for the client and utilised all the resources and knowledge available to me.
As an AMHP, I often find l have to disrupt the status quo to ensure that clients’ rights are upheld. I am guided not only by the legal remit but also a moral compass, standing firm when detention is not in a client’s best interests or ensuring that clients are aware of their rights. Often, we see issues of “veiled compliance” in mental health services, an example of this is Community Treatment Orders (CTOs). Many people believe they will be recalled to hospital if they stop taking their medication when this is not the case. At times, there seems to be a need for clients to believe this misrepresentation of a CTO’s power to ensure compliance, even if it means the person is misinformed and essentially deceived. The duty of the AMHP is to ensure that this, and other types of veiled coercion, do not continue by undertaking our duty to inform clients of their rights. This is something I have come to be exceptionally conscious of and aim to ensure that information such as this is communicated in a way which is accessible and understood by clients to ensure their equality and rights are upheld. It has left me less then favourable with some medical colleagues, but I have held firm in my knowledge of the law and reiterated the importance of clients having choice, control, and involvement in their care, even if this contradicts what professionals may want. These are, after all, some of the guiding principles in the MHA Code of Practice.
The training has consolidated my understanding of this legislation and mental health services which in turn has allowed me to support mental health colleagues to navigate the complex arena of mental health legislation - I feel that this is invaluable to me as a professional. The AMHP role has also afforded me the opportunity to advocate for my clients in a way I had been unable to do previously.
When I initially became approved, I felt quite assured in my knowledge and expertise and felt able to undertake the AMHP role with confidence. However, I quickly realised one of the biggest challenges would be having the ability to back myself, my skills, and knowledge and to be assertive in a system which is often hierarchal in nature. I have had my expertise and knowledge called into question by a variety of professionals since I was approved - be this admin staff querying my knowledge of the law, other professionals cutting my assessments short or not permitting me to ask the questions which I think are vital to the assessment. Initially, this knocked my confidence particularly as a newly qualified AMHP. However, as I progress in the role, my confidence in these areas is building. Whilst we always seem to deal with hierarchy in our multi-disciplinary teams, there is and should be no hierarchy in a MHAA: the only person of importance is the client, working in their best interests and upholding their rights. I am not naïve enough to think I know it all and look forward to both my knowledge and expertise continuing to increase as I gain more experience.
A MHAA is multifaceted, as is the role of the AMHP. There is much to balance and contend with. From the moment a referral is received to the moment a decision is made to detain a client or otherwise, the AMHP is required to dedicate their robust knowledge and skills to try to ensure a justifiable and fair conclusion is reached. To always act in good faith and without prejudice, in the best interests of the client. I feel privileged to be able to support people at some of the most difficult times in their lives and to now have an enhanced level of skill, ability, and knowledge to do this. The process can indeed be arduous and emotionally complex not just for the client but for us as AMHPs also. This makes self-care, reflective practice (we have a monthly AMHP reflective practice forum), support from colleagues (both informal and formal) and a good work/life balance even more important to ensure we can continue to support our clients and undertake our roles to the best of our ability. I would love to see more of an emphasis on the AMHP role in mental health services generally in order to support colleagues and other professionals to understand what we do.