A case study of the factors and processes involved in the use of compulsory powers when carrying out Mental Health Act 1983 (amended 2007) community assessments, from the perspectives of Approved Mental Health Professionals in one local authority in the North of England – A Critical Realist Perspective

In England and Wales, the Mental Health Act 1983 (amended 2007) is the primary piece of legislation for the assessment, treatment, and detention of those deemed to be mentally disordered. The task of considering and coordinating assessments and making the application for detention rests with the Approved Mental Health Professional (AMHP).

The aim of this research was to explore the various factors that impact upon and influence the decision-making of AMHPs. The research was a qualitative exploration of the decision-making of AMHPs using semi structured interviews followed up with a focus group. 18 Semi-structured interviews with AMHPs were undertaken using a fictitious vignette of a community-based assessment. The focus group with seven AMHPs further explored their beliefs about the purpose of mental health legislation.

The study found that AMHPs applied their own frameworks of understanding to the process of assessment which incorporated a range of variables that they recognised as risk indicators. Risk was the primary reason for undertaking Mental Health Act 1983 (amended 2007) assessments and the primary consideration with regards to detention in a psychiatric hospital. The assessment of risk closely reflected the principles of the Act and criteria under the legislation regarding the person’s health, safety or with a view to the protection of others. The focus group revealed how the AMHPs identify as a distinct professional group who have a critical view of the legislation and medical approaches to mental illness. The medicalisation of mental distress, lack of viable alternatives to in-patient admission and the risk/blame culture were identified as negative factors that could lead to the decision to detain. This included conflicts about particular groups of service users who were perceived to be driving their own admission or detention in opposition to the view of the AMHP.

The conclusion of the research is that the decision making of AMHPs is multi–factorial and involves situational interpretation using individual frameworks which incorporate professional values, practice wisdom and pragmatism. The AMHP can therefore be said to function as a critical realist in that he/she is crafting contemporary mental health practice through a reflective lens coloured through the constructivist concepts of discourse, language and identity and, which is grounded in social realities. The AMHP strongly values his/her right to make independent decisions, a role that is paradoxically enshrined within the legislation and also limited by it.