‘Where law, medicine and social care collide’: meet the mental health officers

Mental health officers (MHOs) – very broadly speaking the Scottish equivalent of the approved mental health professional role – are faced with making incredibly tough calls every day over whether to deprive the liberty of people in acute mental distress by detaining them under Scotland’s Mental Health Act.

I caught up with Callum Hendry and Paul Flaherty, both senior practitioners and MHOs with Edinburgh’s north mental health team, to find out more about the realities of this complex role.

The legal system in Scotland is distinct from England and Wales, so what legislation do you work with as MHOs?

Callum: There are three main bits of legislation. The Adults with Incapacity Act, the Adult Support and Protection Act and the Mental Health (Care and Treatment) Act 2003. As MHOs, we’re really creatures of those three statutes.

What are the issues facing your team at the moment?

Paul: In terms of caseloads, we have clients with learning disabilities, older people, people with acute and enduring mental illness.

In the wider picture there are massive financial restrictions happening across the country and in Edinburgh it is pretty tight. There’s also been a lot of restructuring at a local level and at a national level the Scottish government is considering the whole integration [of health and social care] agenda, which I have some concerns about.

There have been suggestions that the integration push in Scotland could see the MHO role opened up to the other professions, as happened with the old approved social worker role in England. What’s your view on following the English model?

Paul: I feel very strongly that the English model isn’t transparent enough. I think we need a check and balance of having someone from social work, who is MHO trained, who doesn’t work for the same NHS body that is doing the other side of the assessment. I think that allows for a bit of independence.

That’s not to say that everyone who works in health is automatically colluding with the idea of putting people in hospital. But in my experience, health is very hierarchical in the way it works. I think it is harder for some professionals in health to assert themselves, whereas social work has a slightly different way of working and people can be a bit more autonomous in terms of how they reach their views.

I think service users would have a lot of difficulty in seeing independence in the process that leads to possible detention if we all worked for the same body. I think that would be a fatal flaw but that’s not to say that the current system’s perfect or that people aren’t cynical about it now.

What’s the hardest part of being an MHO?

Paul: It can feel pretty relentless getting a new case every week. At its worst I have a new case on my desk but I might not have even seen the person I was allocated the previous week, because I’ve been busy going to tribunals, completing reports, doing care management social work for my other cases but I’ll have a new case on my desk on the Monday.

You juggle a lot in this job. You constantly look in your diary, you’re constantly juggling things. But I think there’s a professional satisfaction in doing the best you can for people that are in distress.

I think a lot of people looking in from the outside think ‘it must be awful being part of a sort of locking up process where you take away people’s liberty’. And, yeah, that is something you do, but only if you think there is no choice and certain criteria are met.

But you can also save somebody’s life, metaphorically and quite literally, if you give them a chance to recover their health, that wouldn’t have happened if they were not in hospital. You can feel a sense of achievement when someone’s mental state improves and you look to help out with practicalities – debts, bills, housing, getting support.

On a good day that all feels really satisfying. On a bad day, you don’t get any of that, but that’s true of most jobs to an extent.

The amount of overlap between policing and mental health issues has come up a lot recently. How do you find working with police?

Callum: The police here are remarkable. I think they’re holding the system up actually. It’s not the social workers.

The police have to face this chaos on the streets, and find people wandering about who are distraught or destructive and they have to contain it somehow. I’d be interested to know what proportion of the police’s work is criminal law and what proportion is managing chaos.

For people that don’t get the training, they’ve got something that keeps them able to face it. The fact is they are not as punitive, aggressive or angry about this as they well might be.

It is they who take people up and down to the hospital and what they are met with is a gatekeeping service. It’s described as a mental health emergency service but actually what they have to do is decide who gets in and who doesn’t. It’s a gatekeeping function and, of course, it’s defensive.

Out there in the wider world, we have the letter of the law and all this finely elaborated system. It’s all-new since the Scottish Parliament and it’s state-of-the-art stuff derived from consensus building and consultation. But out there you still sometimes have people scrambling around for their lives you know?

Would you recommend the MHO role to social workers thinking about going into mental health?

Callum: This job is where a number of different worlds collide or interact. The law, medicine, social care come together. Some very complex issues are being worked out there.

If you’ve got time to think and you’re not struggling for survival, it’s interesting. Because people don’t agree on how to frame the problem – each discourse has its own language, its own way of coming to terms with the human reality, the visceral chaos, the blood, sweat and tears.

If you can find a spot where you’re both engaged in this work and you’ve got room to breathe, it’s interesting. You don’t always get to think about it and you can become a creature of habit so you can swing between being bored to being anxious out of your mind.

But somewhere in the middle there’s a job there that’s complicated in a good way and it’s a slightly privileged position. You get to move in and out and help people think a bit because they haven’t been given the luxury, or the time, or the authority to act – they’ve just had to live with the horrible reality.

I started out in community care years ago and it’s useful to me now because I see how far the world has improved. For all its failings and complexities, community care is better than the way it was. We used to rely on institutions that grew out of benevolence but people would be horrified with that system now. It’s useful to remember now and then that things do improve.