I’ve got to know a fair number of AMHPs in my time. In fact, I’m going to come clean on this occasion – some of my friends are AMHPs and I’ve been known to take refreshments with them on a clear evening. Tony now owes me at least one beer for writing this for #AMHP17! … incidentally, it’s pronounced ‘amp’, before we get much further in to all this. I’ve been known over the last few years to go out of my way when they ask for inputs on CPD events because a clear understanding of who these people are, what they do and the circumstances in which the operate is crucial for operational police officers. I also think the opposite is true: they need to know more about the police and the learning we’ve gone through over the last ten or fifteen years. I’ve had some of my most interesting professional disagreements with some AMHPs(!) but in all fairness, it was usually based on things I’d learned from other AMHPs who had been kind enough to help me get my head around things when I first started working properly on this stuff.
I will forever treasure the disagreement about the grounds for s135(1) warrants which became necessary in February 2014 … my favourite, ever s135 story and I got to be the duty inspector for it! AMHPs helped me win that debate with another AMHP and it meant resolution of a siege that had gone on for 9hrs without anyone being seriously injured when there was a point we thought someone may get killed. AMHPs are the mental health professionals who get the decent legal education – and they are the non-medical people, to protect the rights of those who could become embroiled in coercive mental health care. They are vital to the system – in many respects they are the system.
Yet we have a problem – when I ask in a room full of police officers or paramedics “Does everyone know what an ‘AMHP’ is?”, a good number of people will have no idea. Some of those who do won’t necessarily know what the acronym ‘AMHP’ stands for – it is Approved Mental Health Professional. Not ‘Accredited‘ mental health professional, no, No!! … not approved mental health ‘Practitioner‘ … no, No, NO!!! – these won’t do at all. In fact, it is getting the acronym badly wrong that usually winds them up a complete treat. It’s not quite as funny as the reaction from our dear friends in green being referred to as ‘ambulance drivers’, but you get the general idea! “Accredited Mental Health Practitioner”, usually works best – just in case you ever need to know ……
AMHPs are easy enough to identify as a breed: they will not be some walking stereotype wearing brown sandals or bearing leather elbow patches on a checked tweed jacket – there’s no need here for poor stereotypes about social workers, involving bean bags or joss sticks. A better stereotype, however, might be the one fully-loaded with the standard-issue AMHP kit: a lanyard of some kind, possibly with an IT security dongle and a pen hanging from it; a well-thumbed copy of Richard Jones’s Mental Health Act manual, replete with coloured post-it notes or pages marked with highlighter pen; and a hardback A5 diary, page-per-view, stuffed with folded pages of A4 and elastic bands wrapped around it. If you were to search the boot of their private vehicles, you’d probably find emergency food and drink and an extra jacket, jumper or a blanket. These things are the cuffs, baton and CS of AMHPing, it would seem – the basic tools of the trade.
More seriously, I couldn’t be clearer about this: these people are absolutely crucial to the operation of the mental health system and as I usually tell them, I wouldn’t do their job for all the money in the world. They are put at the centre of so many aspects of how our system operates at key points of crisis and whilst enjoying almost all the responsibility for things, they usually have absolutely none of the authority whatsoever to direct organisations and resources around the outcomes they must ensure. They are completely reliant upon the NHS, the police and the ambulance service to know their roles and pull their weight. Some AMHPs spend their days working as mental health social workers in community mental health teams, not specifically undertaking the AMHP role until they need to pull on their capes (or blankets) as their CMHT has a need for it. In addition, they may perform a ‘duty AMHP’ role for the area for a few days each month. Elsewhere, there are permanent ‘AMHP hubs’, where a certain number of AMHPs are AMHPs every day and do little else beyond this important statutory role. Ideally, there should be an AMHP available 24/7 for urgent MHA assessments and assessments under s136 – it is the latter where officers are perhaps most likely to meet an AMHP.
I’ve mentioned they are the ones with the formal, examined legal knowledge: they must do this to qualify and many of them are quite formidable legal eagles, it must be said – I’ve been grateful over the years to several of them who’ve let me buy them coffee and helped me get my head around the legal issues. They undertake a certain amount of CPD each year to ensure they remain up to date with developments in the law, some of this being run by specialist solicitors firms or university law departments. It was thanks to AMHPs that I learned a lot when I first worked in this area around mental health law – it was an AMHP who first properly explained the Mental Capacity Act 2005 to me (thanks, Matt!) and who introduced me to Richard Jones’s Mental Health Act manual. This is a major publication, usually updated each year to keep current, and is often regarded as the last word on how to interpret mental health law. Most AMHPs are given a copy by their employer each time a new edition is published. One claim to fame on the manual: Professor Jones once emailed to say my blog had made him change his mind on a couple of police-related issues on s135 MHA and he amended his manual accordingly!
QUICK FACT CHECK
On the role played by our AMHP friends, did you know, for example –
- It’s not the Doctors who ‘section’ patients under the Mental Health Act 1983 – it’s the AMHP?
- An AMHP can decline to make an application, even if each Doctor thinks it vital – that’s how important and legally significant they are.
- They act independently when it comes to making statutory decisions – regardless of who their employer is. Like police officers cannot be directed to arrest someone if the officer honestly believes the grounds are not satisfied, they cannot be directed to ‘section’ someone.
- 95% of AMHPs are mental health social workers.
- Most of the other 5% are mental health nurses.
- AMHPs carry a warrant card and have legal powers that the rest of us don’t have – it’s a criminal offence to obstruct an AMHP in the course of their duty – see s129 Mental Health Act 1983 – and this includes failing to follow any instructions to withdraw from a Mental Health Act assessment.
- Contrary to popular policing myth: AMHPs do not request police support in the majority of the MHA assessments they undertake – it varies by area, but roughly 1 in 3 MHA assessments in the community involve the police.
- AMHPs are NOT responsible for finding ‘beds’ for patients! – such duties fall to the lead Doctor in the MHA assessment.
- Blaming an AMHP for a lack of beds is like blaming the police for a lack of AMHPs – it’s pointless, and it just won’t help. All they can do, is pass the police’s frustrated message to the DR or bed manager.
- There are similar roles in Northern Ireland and Scotland to the English and Welsh ‘AMHP’:
- Northern Ireland still use term previously used in England and Wales until 2008, Approved Social Worker – and only social workers may do the role in NI.
- Scotland has Mental Health Officers who play an analogous role to the AMHP under Scottish mental health law.
- AMHPs have powers to enter premises to check on anyone thought to be mentally disordered, under s115 MHA – however, they can’t force entry in order to do so.
- They also undertake a whole host of MHA work that the police or paramedics rarely see – this includes attending hospitals to consider other types of legal decision.
- Perhaps a s2 patient in hospital needs reassessment for detention under s3 MHA; or perhaps a s3 patient needs consideration of a Community Treatment Order ahead of discharge? – AMHPs get involved in all of this and much more besides.
The 29th June is #AMHP17 day, promoted by the Adult Principal Social Workers Network as an awareness raising day for this most important of roles – I’m often not a fan of ‘awareness days’ but I’m right behind this one. If you get the chance to discuss things with AMHPs whilst you’re at jobs requiring police support, try to take the time to learn a bit about their role, its highlights and its frustrations. I always encourage 999 staff to understand: whilst the police and ambulance service are busy arguing about who will attend an MHA assessment to assist in conveying a patient, there is an AMHP, recently abandoned by the two Doctors, who is still with the patient and the family, trying to keep things safe whilst #Team999 are busy working out whether the ambulance will come before the police arrive or whether the police will dispatch officers before the ambulance is available.
We often create a catch-22 in which the AMHP and patient are trapped where we refuse to dispatch one emergency service until the other confirms they are en route! << This is the single-biggest frustration AMHPs voice in my direction, in the hope I can encourage officers in particular to help break the deadlock. If you’re a control room sergeant or an operational cop and you can help do this, please do – AMHPs who favour the police’s support are AMHPs who may go that extra mile for us in other circumstances, so build trust and relationships where you can because we also need them to help us.
So this is why experienced AMHPs have emergency food and clothing in their boot, in addition to their basic AMHP-kit! – it’s not uncommon to hear tales from AMHPs that they started an assessment at 3pm, had concluded the decision-making by 5pm after a difficult assessment and were still there at midnight trying to get #Team999 to break the catch-22 deadlock, all the while conscious that the longer the delay, the more likelihood that the hospital may have to give away the bed to someone who needs it and who can actually get there this side of Christmas.
But if you want to get to know an AMHP well, you could ask them to explain to you something about their very favourite topic: who is the Nearest Relative under the Mental Health Act? In order to undertake their legal decision-making, AMHPs have to identify and engage in discussion with patients’ Nearest Relatives for various purposes under the Act. Nearest Relatives have a host of weird and wonderful rights and authorities under the Act and working out who this is for a particular person can be very simple – so my wife is my NR and I am hers, but I am also my mother’s NR (she is widowed and lives alone) and I’m also my son’s NR (because I am older than my wife).
But sometimes it is a nightmare and AMHPs are obliged to obsess a little over this important safeguard of patient’s rights. Failure to get this correct can invalidate someone’s legal admission to hospital and occasionally AMHPs have to go to County Courts to displace Nearest Relatives who exercise unreasonable objections to MHA decisions. So when AMHPs get going on social media with their nightmarish situations involving a patient with one parent they never see and who cannot be traced plus six siblings, some of whom live abroad, and some of which are step-siblings and half-siblings and where the patients non-intimate flat-mate is providing some level of ‘care’ to the person … you’ll need popcorn, quite honestly. So if you want to a distraction from increasingly poor quality television, go and read section 26 of the Mental Health Act which outlines how to determine who the NR is, work out your own and those for your immediate family and your best friend and then ask yourself: who is Harry Potter’s Nearest Relative?!
Many AMHPs are working in LA or NHS organisations which have fewer than half the AMHPs they actually need, attrition is high and pressure immense on a group of people who are invariably spinning plates all the time they’re at work. Some areas have fewer than half the full-time equivalent AMHPs they need to cover 24/7 – their system is wobbling, to say the least and they really aren’t just there filling in forms for the Doctors: they are the key legal officer in our mental health system and I, for one, am immensely impressed by anyone who is both willing and able to do the job they do.
Look after the AMHPs you meet – even if you do find the odd one here or there who is wearing sandals.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – http://www.legislation.gov.uk