We need to assess the shortfall of AMHP knowledge on substance misuse and its impact on people who are being assessed under the Mental Health Act, writes Daisy Bogg.

As an approved mental health professional (AMHP) I have regularly seen, and continue to see, people with drug and alcohol issues, often after police have brought someone in under section 136 of the Mental Health Act.

What determines whether a person is detained or not should always be an objective assessment of risk and need.

Yet, in my experience, when it comes to assessing people with drug and alcohol issues it is too often the perceptions and attitudes of the AMHP and the assessing doctors that dictate matters.

A notoriously hard group to support

People with substance misuse issues are a notoriously difficult group to support – we know this. Disengagement, non-compliance and risk are common.

Most of us also have views about the use of drugs and alcohol, whether addiction is an illness. Some of these may be real, others based on stigma and stereotyping.

When we consider dual diagnosis of substance misuse and mental health, a lot of AMHPs and doctors will base their assessment depending on what they believe the ‘primary issue’ is. If drink or drugs is seen as causing the mental distress, they may deem the person as not needing mental health treatment.

The morality of drug use is irrelevant



But to my mind that is a false debate within the context of the Mental Health Act. If the person is presenting as suffering from mental disorder (as defined by the MHA) and meets the relevant criteria, then as an AMHP I need to look at what needs to happen to support their needs now.

To be frank, my views on what therapy a person may need and the morality of drug use are not relevant and shouldn’t inform my decision making.

Shortfalls in professional knowledge?

Appropriate use of knowledge and evidence is one of the AMHP competencies. Yet no one has thought to ask what AMHPs actually need to know about the risks and needs of people with mental health and substance misuse issues in order to undertake the role. 

It may be that the lack of information and personal attitudes, combined with the prevalent view within our services that co-morbid clients are somebody’s else’s responsibility, has an impact on practice.

As part of my PhD project at York University’s social policy and social work department, supervised by Martin Webber, I want to examine these issues through research.

I’m attempting to consider how all of these factors (attitudes, stigma etc.) impact on AMHP practice? What is the impact of current attitudes and capabilities on the access to treatment and assessment outcomes for people with substance misuse problems?

Ultimately I hope that the research will have a positive impact not just on professional practice, but more importantly on the experience of people we assess under the Act.

Daisy Bogg is an AMHP and a member of the AMHP leads network, hosted by The College of Social Work.

Image: Canadian Press/Rex Features