Tuesday, 5 September 2017

Who Can Apply for a Sec.135(2) Warrant?


Our AMHP Service has from time to time had problems with Magistrates and others who are convinced that only an AMHP can apply for a warrant under Sec.135(2).

This is incorrect.

The text of Sec.135(2) is as follows:

(2) If it appears to a justice of the peace, on information on oath laid by any constable or other person who is authorised by or under this Act … to take a patient to any place, or to take into custody or retake a patient who is liable under this Act …to be so taken or retaken—
(a) that there is reasonable cause to believe that the patient is to be found on premises within the jurisdiction of the justice; and
(b) that admission to the premises has been refused or that a refusal of such admission is apprehended,
the justice may issue a warrant authorising any constable to enter the premises, if need be by force, and remove the patient.

In contrast, Sec.135(1) permits a police officer to enter the premises of someone who appears to be mentally disordered and is either being ill treated or neglected, or, living alone, is unable to care for themselves. Only an AMHP can apply for such a warrant. The purpose of this warrant is in order to enable the assessment of the person in question.

A Sec.135(2) warrant, on the other hand, is specifically for the purpose of removing a mentally disordered person and taking them to hospital. No assessment is required or needed. This would typically be used when a detained patient was refusing to return from Sec.17 leave, or a CTO patient who was being recalled to hospital and who was objecting to this. In other words, they would have to be already “liable to be detained”.

The Reference Guide states:

A warrant may be applied for by a police officer or any other person who is authorised to take or return the patient to any place or take them into custody.(para7.14)

A police officer is first on the list, which is logical, as it is only a police officer who can execute the warrant. Although an AMHP would be regarded as an authorised person, we need to look at Sec.18(1)(c) for more details. This gives an exhaustive list of those who are authorised to return or readmit people who are either liable to be detained or who are subject to a CTO and have been recalled. These patients can be returned “by any approved mental health professional, by any officer on the staff of the hospital, by any constable, or by any person authorised in writing by the managers of the hospital.”

So as well as a constable and an AMHP, other people who can apply for a Sec.135(2) warrant include hospital staff, local authority employees, and community staff such as care co-ordinators in community mental health teams. Richard Jones points out that even Mental Health Act Administrators have made applications under Sec.135(2). (1-1330 Mental Health Act Manual 19th Edition)

I have to say I find it surprising that a magistrate, having the support of a Court Clerk, may still insist that the applicant has to be an AMHP.

I find it less surprising that community staff, wishing to recall a resistant CTO patient are ignorant or this. But I am always happy to explain to them that they can go through the process of applying to the court for a warrant, rather than an AMHP from our AMHP Service.

We already have more than enough to do.

Wednesday, 23 August 2017

What happens when a hospital tries to prevent a nearest relative from discharging a patient?

Our AMHP Service recently had this rather contentious scenario.

Gerry was in his 20’s and was detained under Sec.3 MHA in a hospital for people with learning disabilities.

His mother, the Nearest Relative, had been unhappy for some time about the standard of care and treatment Gerry was receiving. This culminated in an incident in which he incurred significant bruising as a result of restraint by hospital staff. This incident triggered a safeguarding investigation.

She decided to exercise her right as NR under Sec.25(1) MHA to order the discharge of her son, by giving 72 hours’ notice in writing to the hospital, as required by this section. She sent this letter by registered post.

This section also gives the Responsible Clinician the power to bar such an order by the NR, by preparing a report within the 72 hour period of notice.

But Gerry’s RC did not do this.

Gerry’s mother duly arrived at the hospital after the 72 hours had expired, in order to take her son home.

At this point the ward psychiatrist detained Gerry under Sec.5(2) MHA.

The hospital then requested an assessment under the MHA.

I talked to the nearest relative. They told me that, while in the past they had had difficulties managing Gerry at home, they were now in a position to care for him, at least for a limited time. In fact, a community based residential placement had been found for Gerry, and they were just waiting for a bed to become available, which was going to happen in the near future.

The NR sounded like a grounded and sensible person, who was receptive to accepting support in the community.

I spoke to Gerry’s social worker, who knew him and his parents well, and he confirmed that there would unlikely to be any problem in Gerry returning home.

So this was my thinking. Assuming an AMHP assessed and concluded that the grounds for detention under the MHA were met:
  •  It would not be possible to make an application under Sec.2, because the patient had been detained under Sec.3, diagnosis and treatment needs were known etc.
  •  It would not be possible to make an application under Sec.3, because the NR would object.

The only other option left for an AMHP in that situation would be to apply for the displacement of the NR. But this could only be done it there was evidence that the NR was acting unreasonably.

In the circumstances, there was no evidence at all that the NR was acting unreasonably; quite the contrary.

Of course, if the Responsible Clinician had exercised their power to prevent the discharge, the NR would have been disappointed, but the AMHP Service would never have become involved.

We presented this to the Responsible Clinician, who instantly agreed with all the points, and rescinded the Sec.5(2) without the need for a formal assessment.

The NR and her partner were understandably delighted with this news, and Gerry went home that day.

And that is what AMHPs are for: to safeguard the rights of patients and their relatives, to apply a social perspective to the law, and to act as a constraint on the unfettered powers of the doctors.

Tuesday, 15 August 2017

What Happens When the Professionals Involved in a MHA Assessment Disagree?

A member of the Masked AMHP Facebook Mental Health Forum recently posted about a situation in which a hospital psychiatrist had objected to an assessing AMHP concluding that it was not appropriate to detain the patient under the MHA, and demanding that another AMHP conducted another assessment. The issue was whether or not a psychiatrist had a right to do this.

This raises some interesting issues about what should happen when mental health professionals involved in a MHA assessment cannot reach agreement about what should happen with the patient.

The MHA has little to say about procedures relating to differences of opinion, and there is little, if any, case law on the subject.

However, it must be borne in mind that the AMHP is the professional with responsibility to making an application for detention under Sec.2, 3 & 4 MHA.

An AMHP does not have to act on the medical recommendations provided. By their nature, they are “recommendations”. It is at the AMHP’s discretion whether or not to make an application based on those recommendations.

Sec.13 (2) MHA States:

Before making an application for the admission of a patient to hospital an approved mental health professional… [must] satisfy himself that detention in a hospital is in all the circumstances of the case the most appropriate way of providing the care and medical treatment of which the patient stands in need.

The AMHP’s duty is to consider “all the circumstances”. The Code of Practice goes on to say:

AMHPs may make an application for detention only if they have interviewed the patient in a suitable manner,  are satisfied that the statutory criteria for detention are met, and are satisfied that, in all the circumstances of the case, detention in hospital is the most appropriate way of providing the care and medical treatment the patient needs.(para14.49)

The AMHP must give due regard to the first overarching principle when making decisions regarding the detention of people under the MHA, which is to always go for the least restrictive option. The Code of Practice makes it clear that “where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained.” (para1.2)

Furthermore, the Code of Practice says: “There is no obligation on an AMHP… to make an application for admission just because the statutory criteria are met.” (para14.103)

It must be remembered that the AMHP exists as a check on unimpeded decision making by medics. The AMHP’s role is to employ a social perspective when making assessments of people with mental disorder.

To give an example, I recently assessed a person whose GP wanted detained under the MHA on the grounds that they had stopped taking their antipsychotic medication several months previously. The GP had not actually seen the patient, as they had missed an appointment.

When I assessed the person at their own home (they readily let us in), it became clear that there was some evidence of paranoid delusions. However,  these were not in any way impinging on their ability to look after themselves and to live a full and meaningful life. Neither was their reluctance to take medication having any adverse effect on anyone else.

I declined to use the MHA, on the basis that people have the right to be quietly mad, as long as it is not affecting themselves or others, and it was therefore disproportionate.

Although the Code does give some advice on resolving disagreements between professionals (para14.109 & 14.110), it does not offer advice on what to do if any of the professionals are unwilling to accede to a decision.

For guidance on this problem, it is necessary to turn to Richard Jones in the Mental Health Act Manual (19th Edition). He observes:

If the AMHP decides not to make an application, it would be improper for that decision to be reviewed by another AMHP in the absence of any change in circumstances, fresh evidence or concern that the AMHP had acted unprofessionally. (p117)

However, he does offer suggestions as to how such disputes may be resolved by stating:

If the decision not to make the application was made by an AMHP with little knowledge of the patient, there should be no objection to that decision being reviewed by an AMHP who has an extensive knowledge of the patient’s history and current situation. A procedure which allowed for the automatic review of a decision of an AMHP not to make an application would undermine the independent nature of the AMHP’s role.

Interestingly, he does not consider that an AMHP has similar restrictions. In a situation where an AMHP is not satisfied with a refusal by a doctor to provide a medical recommendation, he has this to say:

If a doctor who has been approached with a view to making a medical recommendation decides not to do so on the ground that the statutory criteria are not satisfied, there is nothing to prevent an AMHP from taking steps to see whether another doctor might be willing to provide the recommendation. (p114)

When it comes to consideration of Community Treatment Orders, it seems that the AMHP still holds the upper hand.

The Reference Guide states that before a CTO can be made an AMHP “must agree with the responsible clinician’s opinion that all the criteria are met and agree that it is appropriate for the patient to become a CTO patient.”(para26.14)

The Code then states:

If the AMHP does not agree with the responsible clinician that the patient should go onto a CTO, or if they do not agree with the conditions attached to the CTO, then the CTO cannot be made. A record of the AMHP’s decision and the full reasons for it should be kept in the patient’s notes. The responsible clinician should not approach another AMHP for an alternative view. (para29.25)

So it appears that a doctor’s hands are largely tied when it comes to disagreeing with an AMHP’s decision not to detain; but an AMHP may still persist in searching for a doctor prepared to make a medical recommendation if the AMHP believes that the patient should be detained under the MHA.

Tuesday, 8 August 2017

How do you Establish which Local Authority is Responsible for Making an Assessment under the MHA?

Try the Masked AMHP's quiz..
This post is prompted by a situation I encountered recently while working as the duty worker for our local AMHP Service. It related to a dispute with an AMHP from another local authority concerning who was responsible for responding to a request to make an assessment under Sec.3 MHA for a patient detained under Sec.2 MHA.

Briefly, this was the scenario.

The patient (P) normally lived in our area (Local Authority A). P was admitted informally to a private specialist hospital located in Local Authority B, without any involvement with our local AMHP service. P was subsequently placed on a Sec.5(2) by the hospital, and an AMHP in Local Authority B assessed and detained under Sec.2 MHA for assessment.

P was then transferred to another private specialist hospital in Local Authority C. That hospital subsequently requested an assessment for detention under Sec.3 for treatment.

The question was: which local authority was responsible for undertaking this assessment?

Was it:
A)  Local Authority A
B)  Local Authority B
C)  Local Authority C

To answer this question we need to look at what the Mental Health Act itself says, and also the Reference Guide and the Code of Practice.

At times the wording in the MHA can be a little confusing, and Sec.13, which is concerned with the duty of AMHPs to make applications for admission or guardianship.

Sec.13 says:

(1) If a local social services authority have reason to think that an application for admission to hospital … may need to be made in respect of a patient within their area, they shall make arrangements for an approved mental health professional to consider the patient’s case on their behalf.
(1A) If that professional is—
(a) satisfied that such an application ought to be made in respect of the patient; and
(b) of the opinion, having regard to any wishes expressed by relatives of the patient or any other relevant circumstances, that it is necessary or proper for the application to be made by him, he shall make the application.

Then it gets even more complicated in Sec.13(1B), which invokes Sec.13(1C). Here it is in all its convoluted beauty:

 (1B) Subsection (1C) below applies where—
(a) a local social services authority makes arrangements under subsection (1) above in respect of a patient;
(b) an application for admission for assessment is made under subsection (1A) above in respect of the patient;
(c) while the patient is liable to be detained in pursuance of that application, the authority have reason to think that an application for admission for treatment may need to be made in respect of the patient; and
(d) the patient is not within the area of the authority.
(1C) Where this subsection applies, subsection (1) above shall be construed as requiring the authority to make arrangements under that subsection in place of the authority mentioned there.

Bear in mind in reading this that Sec.13(1A), (1B) & (1C) were inserted into the MHA by the 2007 Act specifically  in order to clarify the situation regarding local authority responsibility for assessments under Sec.3 MHA.

Thankfully, the Reference Guide offers an easy to understand translation. Para8.16 states:

Local authorities must arrange for an AMHP to consider a patient’s case on their behalf, if they have reason to believe that an application for admission to hospital may need to be made in respect of a patient who happens, at the time, to be within their area. It does not matter whether the patient lives in the area.[my highlighting]

Crucially, Para8.18 continues:

In certain cases, local authorities must also arrange for an AMHP to consider the case of a patient who is in a hospital outside their area. This applies where the patient concerned is already detained for assessment on the basis of an application made by an AMHP acting on behalf of the local authority in question. If that local authority has reason to think that an application for admission for treatment may now be needed for the patient, it is that local authority, rather than the one for the area in which the hospital is, or where the patient lives, which is under a duty to arrange for an AMHP to consider making the further application. [my highlighting]

The code of Practice spells this out even further. Para14.37 says:

If a patient is already detained under section 2 as the result of an application made by an AMHP, the local authority on whose behalf that AMHP was acting is responsible for arranging for an AMHP to consider the patient’s case again if the local authority has reason to believe that an application under section 3 may be necessary. This applies even if the patient has been detained outside that local authority’s area.

To go back to the original scenario, the correct answer is Local Authority B, the local authority that initially made the Sec.2 application, even though the patient, who did not normally live in their area, is now in a hospital in another area.

So when I was contacted by the AMHP I mentioned at the beginning of this post, I reminded him of what Sec.13 said. He countered by suggesting that it was not appropriate for his local authority to undertake the assessment, but it was appropriate for ours to do it.

He was clearly relying on the last sentence of para14.37, which reads:

These duties do not prevent any other local authority from arranging for an AMHP to consider a patient’s case if that is more appropriate.

However, that does not place any obligation on our AMHP service to consider the case, which I pointed out.

He replied that it would involve a 2 hour journey to get to the hospital 80 miles away. My response was to point out that one of our AMHPs would have to travel 150 miles, which would take at least 3 hours, for a patient about whom we had less knowledge than Local Authority B. He then concluded that they would probably decide not to accept responsibility for the assessment.

As I thought that it was an interesting response for a local authority to refuse to undertake a task that was their legal duty, I decided to write this post.

But what about Local Authority C? P was definitely in their area, and not far for them to travel? Surely they would do the assessment on behalf of Local Authority B?

Unfortunately not. I had already had dealings with C’s AMHP service in the past, following a request for a Sec.3 assessment for a patient that we had detained under Sec.2. Their policy was to refuse any requests where they did not have a duty to respond. In that situation, an AMHP did have to travel 150 miles, and take an entire day, to do the assessment.

It’s all to do with duty versus power. Where AMHP’s have a duty to act, they have to act. Where they have the power to act, such as a situation where a patient in Local Authority X is taken by police under Sec.136 to a Sec.136 suite in Local Authority Y’s area, they could choose to do the assessment or not, while the AMHP in Local Authority Y would have to do it.

Our local authority, being a large, predominantly rural county, has several private hospitals which accept patients from all over the country. It is not uncommon for patients to be admitted under Sec.2 to these hospitals, and then be required to be assessed under Sec.3. Our AMHP service policy is generally to do these assessments, as long as the responsible local authority asks us nicely.


But we don’t have to.

Tuesday, 1 August 2017

Who’s Responsible for Finding a Bed?

"Good news -- we've opened a new ward!"
An AMHP has a number of powers: one of the most important is the power to make an application for detention to hospital under Sec.2, 3 & 4 of the Mental Health Act.

The trouble is, this power is meaningless if there isn’t a hospital identified that can receive the patient.

But let’s be clear from the start: although AMHPs have responsibility for the overall management of the assessment and subsequent admission, AMHPs are not responsible for finding a suitable, or indeed, any hospital bed.

This is stated unequivocally in the Code of Practice (para 14.77)

If the doctors reach the opinion that the patient needs to be admitted to hospital, it is their responsibility to take the necessary steps to secure a suitable hospital bed; it is not the responsibility of the AMHP.

While it goes on to say that “in some cases, it could be agreed locally between the local authority and the relevant NHS bodies and communicated to the AMHP that this will be done by any AMHP involved in the assessment,” this is only subject to local agreement.

Usually, the doctor’s duty to find a bed is delegated either to the local Crisis Team (CRHTT) or a bed management team, both of which will be employed by the local Mental Health Trust.

For example, our local AMHP Service arrangements are for the AMHP to notify the relevant  bed management team of the need for a bed. There are separate bed management teams for adults and older people.

While in the past it was a matter of course that a bed was available prior to going out to make an assessment, nowadays, it is increasingly common for AMHP’s to be making assessments under the MHA for people in the community where no bed has been identified at the time of the assessment.

This is, of course, because of the huge number of psychiatric beds that have been closed in the last 7 years. This might not have mattered had there been a corresponding increase in community mental health services designed to reduce the need for hospital admission, but as there has at the same time been an actual reduction in community based front line staff, this has resulted in an even greater need for patients to be assessed in crisis and requiring a hospital bed as a matter of urgency.

While the AMHP is often in the firing line, and frequently receiving flak for the failure to find a bed in an emergency, behind the scenes the underlying cause for this appalling situation is the failure of the Clinical Commissioning Groups (CCGs) to comprehend and fulfill their legal requirements.

CCGs were created by the notorious Health & Social Care Act 2012. They replaced Primary Care Trusts, and are allegedly GP led.

There are three problems with CCGs:

·        Firstly, GPs are not necessarily the best people to be responsible for running an entire local NHS service. Otherwise, they would have gone into management, rather than being GPs. This may seem obvious to most people; but not, unfortunately to the Coalition Government that introduced the changes.

Secondly, CCGs tend not to cover the same geographical area as the PCT’s. For example, our large geographical county used to be covered by one PCT. There are now 5 separate CCGs covering the same area, all with different local arrangements and priorities.

Thirdly, unlike the PCTs they replaced, CCGs seem to be blissfully unaware of their legal duties under the MHA.

In particular, CCGs generally appear to be ignorant of Sec.140 MHA. As the Code of Practice points out:

CCGs are responsible for commissioning mental health services to meet the needs of their areas. Under section 140 of the Act, CCGs have a duty to notify local authorities in their areas of arrangements which are in force for the reception of patients in cases of special urgency or the provision of appropriate accommodation or facilities specifically designed for patients under the age of 18. The arrangements should include details of which providers in their area can receive patients in cases of special urgency and provide accommodation or facilities designed to be specifically suitable for patients under the age of 18.(para14.78)

Para14.79 of the CoP additionally, and unambiguously, states:

[NHS England] is responsible for the commissioning of secure mental health services and other specialist services. NHS commissioners should work with providers to ensure that procedures are in place through which beds can be identified whenever required.

What does this mean? Surely it means that in emergencies, for example, when an AMHP requires a hospital bed for a patient who has been assessed to be at intolerable risk if not detained under the MHA, then there will be a bed available for the patient within the area covered by the CCG.

It surely also means that when a bed is required in these circumstances for someone under the age of 18, then a bed should be available.

And NHS commissioners should be able to identify secure mental health beds (and other specialist beds, such as beds for children) “whenever required”.

But as every AMHP knows, this is not the reality.

There are frequently long delays in finding and providing beds for patients assessed under the MHA, and these beds are often hundreds of miles away. Locally, we have had cases of elderly people waiting so long for a bed to be found that the medical recommendations, which are valid for 14 days, have expired before a bed is found, meaning that a fresh assessment has to take place.

There is also a national shortage of suitable beds for under 18’s. Our local MH Trust has 10 beds for young people, but there are currently another 30 under 18’s placed in beds outside the area.

So what can an AMHP do in such circumstances?

In extremis, our local AMHPs have come up with some interesting solutions to the problem of assessing a patient as requiring admission under the MHA, but having no bed to admit the patient to. This often involves use of the Sec.136 suite.

One imaginative example was the case of a 15 year old child, living at home, whose behaviour was totally out of his parents’ control. The police were in attendance because of his violence and damage to property. The AMHP and two doctors assessed, and the doctors provided a medical recommendation for a Sec.2. There was no bed, but the AMHP felt that it was too dangerous for the child to be left at home while a bed was sourced.

The AMHP’s solution was to arrange for the patient to be taken to the local Sec.136 suite. While I was unsure of the precise legal authority for this transfer, the AMHP considered that it was a case of urgent necessity for the child to be in a safe place, and it was certainly in the child’s, and the parents’, best interests.

This remarkably concentrated the bed managers’ minds to the extent that a bed was found within a couple of hours, and the patient was able to be detained.

Another AMHP found themselves in a similar situation with another child. The child could not be left at home because of the risk factors, but no bed was identified. On this occasion, the bed management team’s solution to having no suitable children’s psychiatric bed was to arrange for the child to be admitted, under section, to a children’s medical ward in the local general hospital. Once a more appropriate bed was identified, the patient was then transferred.

A recent blog post by Mental Health Cop posits the idea that there may be another way of facilitating admission. His suggestion is based on the requirement in Sec.13(1A) if an AMHP is satisfied that an application under the MHA ought to be made, and that it is necessary and proper for the AMHP to make it, then “he shall make the application”. This lays a legal duty on the AMHP to make an application in these circumstances.

He then quotes at length from the biennial reports of the Mental Health Act Commission, the predecessor of the CQC, which used to have responsibility for overseeing the practice of the MHA. It is suggested that “in an emergency the [AMHP] should complete the applications, making it out to a hospital specified by the relevant health authority in the notice required to be given under Section 140 of the Act, and convey the patient to that hospital.”

The MHAC is suggesting not just that this is an option available to the AMHP, but that there is a legal imperative on the AMHP to take such action.

While this may have a certain attraction to the AMHP, dealing with a crisis situation, sitting in the home of a patient who really cannot in all conscience be left there, in practice there are many difficulties in following this course.

Not least of these is following guidance that relates to a different MHA (although the MHA is still known as the 1983 Act, it was heavily amended by the 2007 Act, which removed Approved Social Workers, at whom the MHAC guidance was directed, and replacing them with AMHPs.).

I would certainly be reluctant to turn up at a hospital quoting this guidance and invoking Sec.140, expecting the hospital managers to instantly find a bed.

I am afraid that I don’t think that this is a practical option for AMHPs to take. Ultimately, I still think the best option in such circumstances is, whether an application is made or not, to take the patient to the local Sec.136 suite.


In fact, just yesterday, one of our AMHPs , using a Sec.135(1) warrant, took an elderly patient to the Sec.136 suite and informed the bed managers that the patient would remain there until a bed was found. A bed magically appeared within an hour.

Thursday, 6 July 2017

How to Become an AMHP 2: The Interview

AMHP courses are almost invariably only open to employees of local authorities or mental health trusts. Even before having an interview, a candidate has to fulfill certain requirements.

As an example, my local authority stipulates that, as well as having at least 2 years’ post qualification experience, your line manager has to be prepared to allow you to undertake the training, with the commitment of time that that involves. All courses require a period of full time training, which will take you away from your day job for several months.

There is an expectation that you should have a sound knowledge of Care Act legislation, as well as safeguarding and mental capacity issues. Although it is not essential for a prospective AMHP trainee to have experience of working in a mental health setting, there is an expectation that they should shadow experienced AMHP colleagues while undertaking formal assessments under the MHA.

The putative AMHP then needs to make a formal application, and has to provide a written record of their continuing professional development (CPD) over the last 2 years, especially linked to mental health, with a reflective commentary, as well as providing a reflective analysis of their experience of shadowing a MHA assessment.

Social workers from any field are eligible to train as AMHPs. Clearly, working in a mental health team is relevant, but social workers working with older people and people with learning disabilities will also be in a position of working with people with mental disorder.

Although few children’s services social workers train as AMHPs, or are allowed to train by their line managers, these social workers are always welcome, as the Code of Practice advises that AMHPs with experience of working with children and families are ideally required when undertaking MHA assessments of young people under the age of 18.

Having overcome these initial hurdles, the prospective AMHP has to have a formal interview.

I have to confess that I have never had to undertake one of these interviews myself. This is because when I started to practice (back in 1981, as a Mental Welfare Officer under the Mental Health Act 1959), the requirements for acting as a MWO were somewhat less stringent. (If you want to know what it was like back then, have a read of my blog post about my first MHA assessment here.)

Members of the Masked AMHP Facebook group are often asked for guidance on how to prepare for the interview.

Those who have successfully managed the interview and have gone on to qualify often kindly offer hints and tips.

Here are a few of these hints and tips, taken from the threads on the Facebook group:

  • Look at the guiding principles in the code of practice.
  • Have some knowledge of current research into mental health and the AMHP role.
  • You will have extensive awareness already of the importance of narrative practice, partnership working and contingency planning - just expand on these and look at what it means to interview a service user in a suitable manner - whereby you will aim to reduce a service users anxieties to help inform the assessment and facilitate communication.
  • Demonstrate that you are aware of the importance of the role and its importance for adherence to the Human Rights Act.
  • Show that you have a basic awareness of the role and that your values are compatible with the role.
  • Stress the importance of informal admission as an example of striving for the least restrictive option. 
  • They won't expect you to have a detailed knowledge of the law or indeed the Code of Practice, but it is good to have a basic understanding and awareness of the role.
  • If your basic belief is that you would never section anybody, then you are probably not suited to managing the conflicts inherent in the role.
  • You must be aware of and ready for the time and effort commitments involved in the training, as the course will cost your employers several thousand pounds per candidate.
  • Give examples of anti-oppressive practice in your current role.
  • Awareness of and willingness to work in situations of risk.
  • Demonstrate your commitment to learning.
  • Try and just be yourself, as that demonstrates what you can bring to the role.

Finally, have a look at some of the relevant posts about the AMHP role on this blog:


Wednesday, 28 June 2017

How to Become an AMHP

The Masked AMHP's AMHP Warrant. Honest
Members of the Masked AMHP Facebook Mental Health Forum quite often ask what is entailed in becoming an Approved Mental Health Professional. I also get a number of people emailing me asking about it. Here, then, are some guidelines about the process.

Who is eligible to become an AMHP?

In order to be eligible to train as an AMHP, you have to be a qualified professional. Eligible professionals are social workers, mental health nurses, occupational therapists and clinical psychologists. Professionals will need to have at least 2 years post-qualification experience in order to be considered for training.

The Health and Care Professions Council (HCPC) is responsible for approving training courses for AMHPs. They state:

The criteria for approving AMHP programmes are designed to equip individuals with the threshold skills necessary to engage in safe and effective AMHP practice. They set out the processes and procedures that education providers delivering AMHP training must have in place, and the knowledge, understanding and skills that an individual must have when they complete their AMHP training.

AMHP training courses are almost invariably provided by universities. They may take different forms, and be of different lengths, but will generally last for between 6 and 12 months. They may be part-time, or have a combination of part-time and full-time modules. A practice placement, during which trainees are placed with AMHPs and take part in Mental Health Act assessments, is an essential and integral part of the training process.

At present, there are 20 universities and training consortia providing a total of 32 different qualifying programmes. All the courses are at postgraduate level, and the successful candidate will be awarded a range of qualifications: from a Postgraduate Certificate to a Postgraduate Diploma up to a MA or MSc degree.

How do I get onto an AMHP course?

The Code of Practice, para14.35, states that local authorities are responsible for ensuring that sufficient AMHPs are available to carry out their roles under the Act”. Your employing authority must therefore maintain an AMHP service that can fulfil their legal obligations. The local authority will therefore be responsible for paying the course fees and would have to authorise you to undertake the training. This would generally involve writing some sort of reflective piece relating to their experience and desire to train as an AMHP, as well as a formal interview involving the local authority and the academic lead of the course.

What if I don’t have a local authority prepared to give me the training?

I have to say that it is almost impossible for someone to train independently as an AMHP. 

Almost.

While nearly all courses will refuse to take an independent student, the course on which I teach did take such a student this year. They, of course, had to pay the full cost of the course out of their own pocket, and also pay for a placement with the local authority sending students to the course.

At the end of the course, unless the student was prepared to work for the local authority as an AMHP, they would not actually be approved, but would be given the necessary evidence to show a prospective employer that they have successfully completed the qualifying training.

What does the training entail?

I teach on one of these AMHP training courses, so I will describe in more detail this particular course. The course is based within the university School of Social Work.

The course is at post-graduate level, and successful candidates receive a Postgraduate Diploma and will also receive credits towards a Master’s degree.

There is an initial part-time period of occasional days in university from October to December, then a full time segment from February through to June. There is a month of intensive teaching of the law and practice relating to AMHP practice and mental health, then a two month placement period, during which the candidates are placed with AMHPs and have to shadow at least 6 MHA assessments during the course of the placement.

The AMHP trainees then have to produce a portfolio, which must include evidence supporting a range of competencies, which are stipulated in the HCPC guidance. These competencies cover seven broad areas of practice: 
  • knowledge
  • autonomous practice
  • informed decision making
  • equality and diversity,
  • communication,
  • collaborative working, and 
  • assessment and intervention.

There is also a Law Test, which consists of case studies covering a cross section of the sort of assessments that AMHPs are likely to encounter, with questions designed to elicit the AMHP’s knowledge of law and practice.

Phew! Then what?

This is not, however, the end of the process. The HCPC points out:

Successful completion of an approved programme only makes an individual eligible to be approved to act as an AMHP. Only those who have completed approved training and have been approved to act as an AMHP by a Local Social Services Authority in England may perform the functions of an AMHP.

This means that, having completed the course, the LA in which they will be practicing has a panel meeting, during which each candidate if formally approved. They will then be issued with a warrant.

In our local authority, the newly warranted AMHP is then expected to undertake three Mental Health Act Assessments, during which they will be shadowed by an experienced AMHP. They are then deemed to be fully competent to practice independently.

See also the next post : The Interview