Growing numbers of people are being detained under the Mental Health Act after being assessed by approved mental health professionals (AMHPs). But what is the experience of being assessed like for service users and how would they like to see it improved?
Patricia Chambers, a service user and trainer who is a member of the Shaping our Lives national user network, shared her experience of the mental health system at the annual conference of The College of Social Work’s AMHP leads network.
Here are some of the key points I took away on how social workers can improve their Mental Health Act assessments based on my notes from Patricia’s presentation:
1. Assert control and don’t let the police takeover
AMHPs should be first at the door when doing a Mental Health Act assessment. Let the patient know you are there for them and don’t let the police take over. Stay calm (Patricia said “usually you do”) and talk as much as possible.
2. It’s good to talk (and to listen)
Why talk as much as possible? Well you might think someone isn’t taking in what you are saying but talk can be reassuring. Let the person know you are there to help. If you have to take them away do it peacefully and gently.
Remember that service users are often the silent participants in assessments.
“They say talk is cheap but it can do a lot of damage or a lot of good,” Patricia said. “If people are going to say things it’s better that they are positive.”
3. Keep explaining the process
Let service users know you are there to help. Explain to them what is going to happen if they are deemed to lack capacity. If things are explained, the process feels a lot less hostile, said Patricia.
4. Recognise how frightening an assessment is…
Assessments can feel disempowering. Service users can feel like the passive recipient. It feels like they don’t make the decisions or lead on them. It is something that can be a frightening experience.
5. …and the impact your own fear can have
It’s not just service users that find assessments frightening. When professionals are scared they can behave in a punitive manner, Patricia said. “It means we get scared, they get more scared and it’s a circle of fear,” she added.
Patricia pointed to this 2002 review by the Centre for Mental Health as further reading on the “circles of fear” that can exist in assessments.
6. Make service user safety a priority
Whatever happens in an assessment, service users need to know “without a shadow of a doubt that they will be safe,” Patricia told delegates. But safety is too rarely discussed by AMHPs. That needs to made a priority during assessments, Patricia said.
People may have had bad experiences of hospital that make them very scared of going back, such as being attacked on a ward or having belongings stolen.
7. Don’t enter with presumptions
Patricia pointed out the inherent conflict in assessments. The professional has a job to do but sometimes it is the opposite of what a service user wants.
“The idea of being taken away is not appealing to anyone,” Patricia said. “If you have relapsed you’re in no position to negotiate. The thought of being away from family, friends and pets can be frightening.”
Patricia feels that one way to find some kind of resolution is not to enter with presumptions. Don’t presume service users “are mad”. Don’t presume that hospital is the best place for them. Consider alternatives to hospital such as care in the community or crisis houses, she said.
8. Consider the assessment environment
If you’re conducting a Mental Health Act assessment at the office, have a nice warm room set up. Don’t conduct assessments in an intimidating environment – such as desk and two chairs with the service user on one side and professionals the other. Consider a more welcoming set up such as a circle.
9. Consider cultural differences
Patricia mentioned a case where a woman from London’s African Caribbean community was detained after a social worker sent to assess her saw the woman carefully picking out black rice grains from rice.
The social worker viewed the woman’s actions as a sign of odd behaviour. But Patricia explained that picking out black grains is part of the traditional way rice is prepared in certain communities. Apparently the woman protested “but the social worker wouldn’t listen”.
10. Realise that change starts with you
Patricia’s tips are practical. She didn’t just call for long-term systemic change (although she raised important points about definitions of mental illness and the disproportionate impact of detentions on BME communities) but she also offered plenty of suggestions for how social workers can reflect on elements of their practice immediately.
As she told delegates: "Don’t be afraid to take control. The organisation is only as good as you are. You are frontline staff and an important cog in the machine. Change starts with you."