The New Admission Criteria and the Role of the Approved Mental Health Professional

1. The New Admission Criteria and the Role of the Approved Mental Health Professional Sylvia Manson

2. 1983 Act 1. Must be suffering from mental disorder (specified category) 2. Must be of a nature or degree to warrant detention 3. Must be no other viable alternatives 4. Must be in the interests of the patients health, safety or protection of others 5. Mental impairment & psychopathic disorder must be ‘treatable’ The 2007 Amendments 1. Must be suffering from a mental disorder 2. Must be of a nature or degree to warrant detention 3. Must be no other viable alternatives 4. Must be in the interests of the patients health, safety or protection of others 5. For patients on longer term sections, appropriate treatment must be available for all detained patients Who should the law apply to?Criteria for admission – what’s changed?

3. ‘Treatment’ must have the purpose of alleviating or preventing a deterioration in the mental disorder or it’s symptoms Must be clinical purpose to detention Can only detain if medical treatment appropriate to the nature or degree of mental disorder –and all other circumstances of their case, is available Will include - physical health - culture & ethnicity - age - gender, sexual orientation - Location - implications for social relationships - work/education - implications of not receiving treatment Under 18’s must be treated in an environment suitable to their needs (formal and informal patients) Social Criteria for Detention - treatment Bio Psycho

4. Purpose principle – minimise undesirable effects of mental disorder and maximise safety and well being Least restrictive principle Respect – recognise and respect diverse needs, values & circumstances Effectiveness, efficient and equitable use of resources Participation –patient involvement as far as possible + Involvement of carers, family and others should be encouraged and views taken seriously Code of Practice Principles– Act says this must inform decisions

5. How is this assessed? Assessment by two Doctors – one Doctor must be ‘section 12’ approved Does the person suffer from a mental disorder? Is it of a nature or degree to warrant detention? Is it necessary in the interests of their health or safety or the protection of others? Is there appropriate treatment available? Make a recommendation to detain the person AMHP must consider ‘all circumstances of the case’ whether there are any less restrictive alternatives. decide whether to detain the person

6. Role of the AMHP • The AMHP brings a social perspective to the assessment including recognising the role of oppression and discrimination in mental health • They provide a balance to the medical perspective, viewing the person within their environment and wider community • The AMHP must evaluate all the circumstances, balancing the rights of the individual to self determine their affairs, with the need to provide compulsory care where no alternatives are viable.

7. Assessing ‘all circumstances of the case’ Person’s own views - ‘interview in an appropriate manner’ Strengths & coping strategies culture history Legal considerations Appropriate treatment? What stressors? What solutions? Spirituality Family & friends Discrimination & oppression Wider Social factors & perspectives employment RISK ASSESSMENT

8. Risk Assessment What are the risks in relation to: The patient’s health? Their safety? Protection of others? Likelihood + impact = risk Need to assess risks associated with all options including risks arising from detaining the person

9. AMHP - Assessment How can the risk be reduced? What alternative care can be put in place? Does the risk justify over riding the person’s civilliberties? Level of risk What is the nature or degree?

10. Tasks of the AMHP Coordinating the assessment Assessment & making an application where appropriate Ensuring compliance with MHACt & Code of Practice & other legislation e.g. Children Act & MCA Conveying to hospital Ensuring the rights of the patient and Nearest Relative are met Ensuring the care of dependent children and adults Protecting the patient’s property

11. AMHP – The Regulations • Must be a qualified nurse, social worker, OT or psychologist • Must under go a period of approved training • Must be authorised by the LSSA but can be employed by another agency • Must comply with Conflict Regulations

12. Financial – cannot benefit financially Business – assessors cannot be involved in the same business venture Professional – cannot be line managed by another assessor or all assessors work within the same team (unless urgent necessity) or be the assessor for a patient from your team Principle of ensuring objectivity and independence in all other circumstances Conflict Regulations

13. AMHP Training Working in complex situations Knowledge & application of law Values based practice Making informed decisions Working collaboratively & using networks 600hrs at post grad level Practice and academic assessment Authorised for 5yrs Minimum of 18hrs annual refresher training

14. The Act is permissive rather than prescriptive Recognises modernised service delivery Utilises the skills of other practitioners Allows the best person for the assessment at hand How do we ensure independence is maintained? Maintain a focus on social perspectives of mental health & the patient as a citizen. Moving Towards AMHP Opportunities Challenges

15. The AMHP is a key role within the Mental Health Act - an important investment for mental health services!