Proposals to open up the approved social worker role to other
professionals should not come at the expense of non-medical opinion
when deciding whether to detain a person, according to the Mental
Health Act Commission.
In a report published this week, the commission, which monitors use
of the 1983 legislation, states that social workers “provide a
safeguard against unnecessary use of compulsory powers”. They offer
a non-medical view of the patient’s best interest and emphasise the
least restrictive care option.
It adds that confidence in professionals’ objectivity is essential,
and that decisions on whether to detain a person should continue to
be taken by a multi-disciplinary group.
“There is real danger that teams consisting of nursing staff and
doctors will be perceived as operating in collusion or from a
particular viewpoint without appropriate checks and balances,” it
It adds that social workers approved under section 114 of the act
undergo “what is probably the most thorough training on the
provisions of that act currently available to any mental health
Consequently, if the ASW role is widened, it should be accompanied
by rigorous training requirements, the report says. It criticises
the government’s lack of action on solving the difficulties
encountered by NHS trusts wanting to employ ASWs. Under the act, an
ASW has to be an “officer” of the local authority’s social services
In 1999 the commission asked the Department of Health to look at
the issue and suggested that either the law be amended or that
guidance be issued to social services, but neither has happened. As
far as the commission is aware, it remains the case that only
social services employees can be approved as ASWs.
Other concerns raised by the report include the lack of access to
fresh air for patients. In some units, patients had not been
outside for more than a week, with staffing pressures cited as a
In addition, 43 per cent of patients who had been detained for more
than a month had not seen their responsible medical officer for
more than a week, and the number of children and adolescents being
admitted to adult wards in England and Wales rose from 138 in
2001-2 to 213 in 2002-3.
– Placed Amongst Strangers from www.mhac.trent.nhs.uk