A colleague is in a complexity where they have several EUPD patients on the female ward, who for various reasons are requiring a MHA assessment. There has been instances where the AMHPs have spoken to the patients on the phone and concluded that a MHAA isn’t required, despite the ward RC providing a medical recommendation and is requesting one. I’m not sure if it’s resources, or other reasons. I understand it’s not a statutory requirement to complete the assessment, but wondered around appropriateness of telephone assessment, and if that is sufficient to ‘‘consider the case’’. How to proceed if the AMHP team have not provided a documented, reasoned response as to why the MHA assessment wasn’t required; but the RC is still of the view that a detention is required as the risks are simply not manageable in the community. I would like to highlight, these are often patients from out of areas; thus not familiar to the treating team, and often these discussions do not involve their local MH teams.
I wondered if there were case laws around this?
Keen to hear other’s views, and other themes of consideration.
An AMHP is not able to conduct an ‘interview’ as part of a MH Act assessment over the phone.
But if an AMHP has made a decision, as part of their duty under section 13(1) of the MH Act, that a phone call discussion would be useful to gather information to enable a decision about whether in all the circumstances a MH Act assessment is proportionate and/or necessary it is their decision and therefore not unlawful. They should have communicated their decision to the referrer and been very clear about the reasons for their decision so I am assuming the reasons were communicated? There may have been a report with the rational for the AMHPs decision clearly outlined which if you were not the referrer you may not be aware of as you mention you are a colleague.
I think this may relate to the current thinking amongst AMHPs about the s.13(1) consideration and how best this is achieved. Traditionally there would be a bias towards conducting a face-to-face assessment with at least one doctor and in cases like this often with a previous medical recommendation from another in hand; but there is a view amongst AMHPs that this approach prejudices the consideration, gives too much authority to the doctor in a process which is intended to promote equal, autonomous decision-making by all, demotes the social factor and even intrudes in various unwelcome ways upon the patient, all when we are not legally obliged to do it this way. By slowing the process down and understanding consideration much more broadly, such defects can be remedied, and a face-to-face interview, for example, might be avoided altogether. I do not know what other things were done here as part of the consideration but they may have involved other professionals away from the ward, family, helpful friends and voluntary agencies, reading in on treatment approaches, all sorts of things. There are of course some hazards with this way of doing it and as the past correspondent points out, there needs to be a recorded rationale which you might ask to inspect.
The Critical AMHP blog site has the debate on this, if you wanted to understand this approach better: the original paper from Matt Simpson, subsequent work by Robert Lewis and John Mitchell, both AMHPs, and most recently a piece by me in which I rehearse some criticisms of the approach, with a response from Nick Perry.
I have indeed gone down a rabbit hole with Matt’s article, yours and Nick’s reply. I resonate the most with your article actually, and enjoyed it - thank you!
I hear and understand everything you’re saying, but it’s also true that despite a med rec; the AMHP and a s12 doctor can assess and decide not to detain. There is also the view that with a medical recommendation and current treating clinician not in the discussion/assessment which might add pressure to the assessors and patient; bias is therefore also reduced.
I hear the part where it is felt that it gives too much authority to the doctor; but they are indeed the Responsible Clinician so not sure how that is escaped? Additionally, whilst respecting s13.1; I wondered who will assume responsibility of the risks if the RC felt a detention was required, but the process felt against it - I don’t mean to catastrophize, but a Coroner’s Inquest despite reportedly not being adversarial; it can often be looking for a someone/something to ‘blame’. (cue Dr Gibbons work on the Psychodynamics of Suicide). Also, I wondered, tying in with too much power of the RC; whilst they being an expert in both mental health and risks and knowing the patient more thoroughly following a period of 28 day assessment, how would their view not hold more weight compared to cross sectional assessors such as the AMHP and then maybe a s12 doctor if the assessment proceeds? Is there a framework how the AMHPs assess risk and thereafter decide that the case has met the threshold to be considered; especially as they’re being asked to conduct individual assessments without the benefit of a s12 Doctor’s medical opinion side by side? Psychiatrists are trained to identify counter-transference and prevent it from future clinical encounters; I wondered how did the AMHP’s maintain objectivity as more often than not, the above is usually for patients who struggle with EUPD.
I reflect that slowing down the process also increases massive bureaucracy for the AMHP, without an increase in resources, I’m not sure how can they realistically be expected to maintain such high standards, whilst request for assessments keep building up.
I completely agree with the process if someone is being assessed prior to admission to hospital, to prevent unnecessary detentions, as I’ve often found detentions to be an ‘easy’ way out when you’re assessing someone at 2am, with no past history available who is threatening a variety of risks. I’m not certain it’s completely helpful for a lot of cases (but not all) that are already in hospital.
Value your/any opinions, feedback and a healthy debate as I too am learning the perspective of AMHPs whilst caring for my patients. Thank you again Tim.