Listen and learn

Service users are rarely asked about their experiences of Mental Health Act assessments. Graham Hopkins reports on an innovative scheme in Milton Keynes that is changing that

An assessment under the Mental Health Act 1983 can be the stuff of nightmares for service users. Having reached a crisis point other people doubt your ability to remain in the community.

Two doctors and an approved social worker (ASW) turn up to assess your mental state. You could end up being taken forcibly away to a secure hospital and treated against your will for up to six months.

Given the power professionals have in this situation the whole process can be very stressful for them too. And yet it seems that little, if any, evaluation of the service user experience takes place that can guide front-line staff. However, a scheme in Milton Keynes aims to put that right.

“The idea was for me to look at the practice of our 19 ASWs and try to develop a better sense of awareness of how their service impacted on service users,” says ASW senior practitioner David Glover-Wright. “Service users had never really had the chance to talk about their feelings or their perception of assessment and from that to learn about what happened to them. Often assessments happen at critical situations, with a lot of crisis, emotion and feeling, but never a chance to reconsider it in the cold light of day.”

The idea was linked to research that suggested there ought to be some restoring of the balance. “Service users needed time where they could piece together what had happened and learn from that situation and gain insight,” says Glover-Wright.

A Mental Health Act assessment is a formal assessment undertaken under the 1983 Act, which can be requested by the person’s nearest relative, their GP, a mental health professional or the police.

The assessment team will include two doctors (one of whom must be a consultant or duty psychiatrist) and an ASW. A decision is then made whether treatment or further assessment is required and where that should take place.

“These assessments can be extremely traumatising and that has been borne out what service users have said to us since we started this scheme,” adds Glover-Wright, who joined forces with Sarah Dewey, service user development worker with People’s Voices – a Buckinghamshire advocacy project. “We felt the scheme would be even more realistic with a service user representative working alongside us.”

Dewey also brought the crucial credibility of having herself been detained several times under the Act. She came to realise she had never fully understood her legal status during those times.
She co-devised the detail of the scheme, which takes place in the local psychiatric hospital every other Wednesday morning, where two hours are set aside for up to three volunteer service users.

The questions asked are open-ended: what were your perceptions of the assessment? How did it feel? What did you feel about those involved? It was also felt that Dewey should ask the questions. “There is a greater empathy,” explains Glover-Wright. “And a better exchange of information and ideas, and makes it more relaxed. I take notes and interject if needed.”

The notes are typed up and then shared with the service user, and with their agreement are anonymised and fed-back to professionals involved in that assessment, or as part of training.
“During training, ASWs have received service users’ comments positively,” says Glover-Wright. “I’m sure they have thought about these things, but to be confronted by stark and emotional first-person comments about what it is like, possibly from a person they were involved with, has been very powerful.” Doctors, too, have used the feedback to evaluate their practice.

Dewey believes it is crucial the feedback is being used constructively. “We as service users often comment at the time about what has happened to us as in-patients and it can be well received, but you wonder what happened to it,” she says. “Now there’s a clear way for going back to service users to say this is what happened and this is what we have learned together. Here, listening to service users is moving from a tick-box exercise towards recognition that our experiences are valid – and they need to be heard.”

Lessons learned

  • The scheme links into the recovery model: users can look at how they can avoid a Mental Health Act assessment through appreciating why the assessment occurred in the first place and why it had been treated in such a way.
  • Hospital staff felt the scheme fitted in with new government guidance on the Essence of Care. It helps them review their caring regime and places service users at the centre of the in-patient experience.
  • Plan with senior nurses about how to incorporate the interviews into the in-patient environment as units have set routines and conventions.
  • Make sure there is a room available to have the privacy, time and space to talk with a service user.


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