My understanding - subject to invited correction - is that an ‘application’ for admission to a hospital is more powerful than a ‘medical recommendation’. I can think that because across the land ‘medical recommendations’ (not sure what percentage) are being allowed to lapse due to bed shortages when AMHPs can’t locate a bed to complete an ‘application’.
The Nearest Relative (NR) can make an ‘application’ for a Section 4 admission but a medical doctor can only make a ‘recommendation’ and hope for the best.
I think it depends which way you think about it. Doctors can’t admit compulsory without an AMHP agreeing, but neither can an AMHP admit unless the she has recommendations from the doctors.
Arguably the most powerful person is the one who controls the resources. One reason recommendations expire is because there is no bed available to admit someone to, and the AMHP can’t make their application until they know where the person is going to be admitted to……
Of course! Which means that Trusts are more powerful than Parliament but that’s for a very different discussion.
I’m looking only at the power of the NR compared to the doctor. The former has a power to make an ‘application’ (as per text of the law) the latter (the doctor) has no powers of ‘application’. Applications are powerful because AMHPs become rate limiting with the noose of ‘no beds’ around their necks.
This means that the NR is equally powerful to AMHPs in respect of ‘applications’ under S4 and both more powerful than doctors. I’m really hoping to be put right in my ‘defective’ logic.
I am not sure I agree with your logic there Russell, or your terminology.
When a person is detained it will require more than one person and that those personss, making rational, professional (or informed) opinions will contribute to the compulsory admission. It is not about power as much as it is about agreement!
Many thanks. I’m not looking at detention. I’m looking at powers of ‘application’ and ‘recommendations’.
Application - normally in my understanding - is the final powerful step of AMHPs - because they can allow recommendations to lapse when Trust power overrides the Will of Parliament.
Doctors have no powers of ‘application’. Both the AMHP and the NR have powers of ‘application’ and both will be subject to a force more powerful than Parliament - which is ‘no beds’.
I am not sure that Drs or AMHPs consider their responsibilities as powers. The bottom line is that more than one person/agency is required to deprive a person of their liberty. That may be a nearest relative, but they have no more
“Power” in such a co text as a Dr
Irrespective of what they consider about responsibilities or power - there is an objective element to power(s).
I define and explain what power objectively means in the broadest all encompassing sense:
“The capacity to influence, shape, or control outcomes, behaviors, and circumstances through various interconnected means: institutional authority (like laws and governance), economic resources, physical force, social position, specialized knowledge, technological capabilities, cultural influence, and psychological manipulation. It operates both visibly through formal structures and invisibly through societal norms, manifesting as the ability to enable or constrain, reward or punish, include or exclude, and ultimately determine the choices and opportunities available to individuals and groups within any given context. Power exists not just in direct control, but in the subtle ability to shape narratives, set agendas, and influence how people understand their world and their place within it.”
Caution: not because the word ‘punish’ appears in the broad general definition above means that I think AMHPs, NRs or doctors are intent on delivering punishment.
What I am saying is that - whether or not anyone considers their responsibilities as powers - once they act on powers given to them by Parliament - to influence detention then the issue of comparison of powers arises.
In my evidence based comparison - so far I see the NR having more power to influence detention via ‘application’. I say (said) that because applications are in general more powerful than recommendations (the latter can be left to fizzle out to nothingness like nobody’s business).
The recommendation and the application are each necessary (and not sufficient) in order to detain.
After the recommendation has been made then in a sense it’s true that the only person with “power” is the person who can make the application, but that applies to any system with two requirements that have to be met in serial.
Maybe in practice it depends on who wants detention more, and who feels the other is frustrating that goal. If it were more often the case that AMHPs were disappointed with doctors for not providing recommendations then you might say that the doctors wielded more power. I think you are saying the opposite about power because you have experienced the opposite scenario – that doctors’ recommendation for detention regularly “fizzle out” when AMHPs don’t apply for detention.
Incidentally, despite often asking, I’ve never met anyone who has personal experience of a nearest relative making an application for detention under any section, or can hand-on-heart promise me that they know it happened.
..factually incorrect? If so may I see the evidence that makes it factually incorrect? [Note that I have avoided personal comment about you nor anyone else.]
I’m not sure what sort of evidence you have in mind. Nobody I’ve ever asked has known of a nearest relative making an application, so you might count that as evidence. You rely on an “evidence based comparison”: how often have you seen a nearest relative wielding the power to make an application for detention?
If you really are just comparing the doctor’s recommendation with the application in general (by NR or AMHP) then it’s true that not all recommendations lead to applications. But your “power” argument really only applies during the time period after a recommendation and before a potential application (as mentioned above).
I am unable to debate an individual’s experience. My submission to this forum was on based on evidence of what is stated in the law that is accessible to everyone.
If I have misquoted the law then I wish to be corrected.
Nobody is disputing that a recommendation and an application are both required before detention under section 4 begins and, in relation to that, you haven’t misquoted the law.
It might be said that a nearest relative armed with a medical recommendation is more powerful than a doctor who is willing to give a medical recommendation, but since a nearest relative can’t make an application without a recommendation it’s overly simplistic to conclude that an application is more powerful than a recommendation or that a nearest relative is more powerful than a doctor.
And doctors can’t even begin to make an application at all even with a second medical recommendation.
The application is the ‘power’. Recommendations are pretty powerless. How? They can be torn up, forgotten, rescinded - I’ve seen all of the latter happen. Applications howsoever made cannot be so treated. Do you or anyone else disagree on the latter?
You began this topic by talking about section 4 which doesn’t need a second medical recommendation. (I guess you meant “recommendation”.)
Nobody has disputed that a recommendation might not be followed by an application.
I understand your perspective quite well now. I’m just not convinced that – looking at the system overall – this means one is more powerful than the other, or that a nearest relative (who can in theory make an application) is more powerful than a doctor.
I aim to convince no one. I remind myself of a debate in previous different threads where authority prevailed over logic and facts.
As with AMHPs application is what finalise the ‘dentention’. So for S3 two med recs can sit there and be allowed to fizzle out of no AMHP application follows.
The NR has a power of application that doctors do not have.
Show me the errors in my assumptions and logic.