The Road to Research

"painting on wall of girl blowing question marks" by Matthew Paul Argall is licensed under CC BY 2.0.

By Jenny Daly

I’ve been working as an AMHP in London since 2019.  Prior to this, I had never imagined myself as an AMHP, I’d been working as a social worker in a community mental health team for five years. At which point I found I was next in line to go on the AMHP training.  Despite my ambivalence about being an AMHP, once I started the training, I enjoyed the learning experience immensely. I remember one of our teachers compared the AMHP role to a human rights champion for the person being assessed.  On getting through the course, I was added to the local AMHP duty rota on top of my social work role.   I continue to practice as an AMHP about once a week. 

I found the transition to working as an AMHP difficult, and five years later it is one that I continue to feel conflicted about. I rarely feel like I’m championing a person’s human rights. On a bad day my unease feels more like being complicit in an uncaring and oppressive system that fails to deliver a fair, nuanced and compassionate response to people going through a mental health crisis and reinforces the structural discrimination and disadvantage faced by certain racialised and economically disadvantaged groups.  Furthermore, the mental health act assessment system seems incapable of listening and learning from people who have experienced assessment under the act, no matter how skilled and compassionate individual AMHPs are.  

I have come away from some MHAAs, despondent and emotionally crushed,  with doubts about my decision to apply for the person’s detention in hospital under the mental health act. Or not to have done so, depending on the context.  On rare occasions these feelings can fester causing rumination for days.   However, in my experience, post assessment reflection of any depth - let alone follow up with the person assessed at a later stage - isn’t built into the duty system, which is always orientating AMHPs to the next referral, screening and potential assessment.

While the familiarity of the role may have taken the edge off some of my anxieties, I still often feel like a cog in a rusty machine, going through the motions of the role in a closed system, cut off from any possibility of transformation by learning from lived experience and the potential for developing more emancipatory practice.

In the last few years, I’ve been drawn to critically reflective spaces - like this one –– as well as research carried out by a small body of AMHPs that has opened up discussions of power inequity in MHAAs (see Hemmington, J, 2023), is actively curious about the experience of the person being assessed (see Blakely’s blog: https://www.the-critical-amhp.com/blog/blog-post-four-ena79) and articulated how the interview part of the assessment can be more dialogical (see Manchester’s blog: https://www.the-critical-amhp.com/blog/blog-post-two-x437a).Interviewing a small sample of people to learn about their experience of being assessed under the mental health act, Louise Blakely, a mental health social worker, collaborated with (and paid) ‘service user researchers’ who themselves have had lived experience of mental health act assessments. In a follow up article, she positions herself as an Insider/ outsider researcher and reflects on the narratives of the interviewees and how this has elicited change in her practice.

Inspired by these questioning voices, at times I have found myself fantasising about carrying out some research on similar themes ie making MHAAs more inclusive and less brutalising for the person, and also the assessors. There was never time however, I’m not a researcher and didn’t have any academic contacts or a forum to explore these ideas. Roll on the next AMHP shift. 

In October 2023, I saw an email about funding from the National Institute of Health Research (NIHR) aimed at promoting social care practitioner led research.  It was for the ‘Doctoral Local Authority Fellowship Scheme’ (DLAF) programme.  The local authority (or voluntary sector organisation with links to them) would be funded to release successful applicants from their normal role to carry out PhD research.  I wasn’t interested in doing a PhD, but I was curious to find out more, maybe the funding would allow me the time to consider and formulate some of my questions. Maybe I could use the time to carry out a discrete piece of research on AMHP work in the borough I work in.  Maybe I could involve people who have lived experience of being assessed under the mental health act to play an active part in the research? 

A colleague suggested I speak to the borough’s research lead who was based in the Public Health team, a role I’d previously been oblivious to. I contacted hm for an initial discussion. He listened with interest to some of my dilemmas and frustrations of the AMHP role alluded to above. I spoke about the inherent tension for AMHPs, with the significant coercive powers they (we) hold, trying to work in an inclusive, relational and humane way in a time pressed and process led system that seems defended against the emotional distress of people in a mental health crisis, and their families.  He was immediately encouraging. I explained that I didn’t want to do a PhD, and he helpfully didn’t see this as a barrier to applying for PhD funding.  He was right, it was important at this point to take it one step at a time. 

It was October and the application had to be submitted by early December. There was much to do. This included developing a specific research question. While I knew I was interested in researching how MHAAs could be more inclusive and co-produced between the assessing team and the person being assessed, my ideas were still inchoate and required further honing.  Ideally, I would have liked to involve people with lived experience to help me develop the research question that would form the basis of a PhD.  With the deadline looming, there was no time for this however, since I didn’t have established links with relevant interlocuters. I couldn’t just start contacting people with local lived experience of MHAAs, I’d need to follow a strict ethics policy and comply with data protection legislation.

I needed to establish a supervisory academic support team and come up with a 5000-word research design plan outlining my methodological approach and the reasons for choosing this. With my lack of research experience, this felt the most daunting part of the application.  My employer also had to support the application.

From my initial contact with the borough’s research lead, to every tentative reach out since then, to academics, successful DLAF researchers, perspective academic supervisors and mentors and staff who worked in research support services, I was taken aback by the encouragement and support I received. (Some of the fellowship researchers spoke openly about being unsuccessful at their first attempt and using the feedback from the panel to strengthen their applications and re submit.) Early on I emailed Jill Hemmington, a practicing AMHP lead and researcher whose research and critical enquiries into questions of power inequity, coercion, and their impact on people being assessed and AMHPs, have resonated with many of my own questions about the work.  Within hours she had responded, offering practical, academic and technical assistance to completing the application.  Later I contacted Louise Blakely whose research I mention above, and she responded with similar interest and generosity.

A couple of weeks before the deadline, I contacted a London based social work professor to ask if she would consider supervising my research, a named experienced PhD supervisor is a requirement of the application.  Picking up on the small mountain I had still to climb, she suggested I consider applying instead for pre-doctoral fellowship (PLAF) funding, expected to be announced in the new year. As the name suggests, the PLAF is pitched at applicants who are at an earlier stage of their research journey. The starting point is to have a strong set of ideas for a prospective PhD project rather than a well refined research question. Successful PLAF applicants will spend the duration of the funding period - one or two years, depending on how many days a week are spent on research – developing a robust research question and undertaking methodological design training to underpin this.

The pre-doctoral funding was announced in January 2024, and I submitted my application for the end of March deadline.  If successful I would like to explore some of the well-established user led mental health research knowledge base involve people with lived experience, to bring their insights and knowledge to developing the research question with me.  (I am aware of my privilege in being able to apply for this funding, which people with lived experience, unless they also work as social care practitioner are not).

The title of this piece is perhaps misleading, I won’t know if I have been successful for another few weeks. Regardless of the outcome, the experience of applying for the funding has been entirely worthwhile.  It has opened my eyes to an exciting landscape of NIHR funding for social care practitioners, including AMHPs with little or no research experience, to develop the skills to do innovative research.  By developing a research base which is pivoted to the narratives of people with lived experience, we can potentially enrich AMHP knowledge and impact positively on how MHAAs are carried out in a way that everyday practice in this area seems systematically fortified against.

Useful Link:

Research Programme for Social Care | NIHR

References:

Hemmington, J. (2023) Approved Mental Health Professionals’ Experience of Moral Distress: Who are we For? In British Journal of Social Work 54(23) (December 2023)