I ‘section’ people under the MHA

[Narwhalelife]

I am an Approved Mental Health Professional (AMHP). It is only AMHP’s that can section people.
Little is known about us and our role but lots of people know what ‘sectioned’ means - Ask me anything 😊

@antelopevalley

Yes that’s exactly what I am talking about.

I have been thinking about this more and I was joking before when I said they should have mental health professionals undercover. But the more I have been thinking I actually think it should be compulsory training to spend a month in a section undercover for all mental health professionals.

It’s one of the only jobs I can think of where people working in it will likely never actually use the service and experience it from the other side IYSWIM. Ie. Shop owners use shops, general medicine people use healthcare, restauranteurs use restaurants, architects live in houses etc.

Waves at Op. my partner is an AMHP and I'm a RMN. What do you think about the changes to the MHA particularly NR.

Hi OP,

How much training did you have within your training around people with a learning disability being made subject to the MHA?

Thanks

I'll just add to my post... I mean being subject to the MHA due to a mental health condition comorbid to their LD... before someone corrects me

Why would a young suicidal man be released by A&E after 5 hours with the crisis number and 'CPN will be in touch with you within 3 weeks'
Do they hope the distressed person will succeed to get thm off the books?
cynical mother of suicidal man here

Drug & alcohol issues are excluded as criteria for detention under the mental health act. Although we would consider someone who had these issues and a mental illness.

The individuals you are taking about are probably likely to have personality disorder diagnosis (and there are many different types). Admitting these patients to an inpatient unit is complex because the treatment they require is long time psychotherapy and this is not available in most hospitals. However, we definitely do detain people with this diagnosis. Additionally, once in hospital people can struggle with the environment and we often see an escalation in risk, further attempts to self harm, aggression and violence towards staff and other patients, so sometimes this makes the situation worse.

some people can get long term psychological treatment in treatment hospitals but il be honest these can cost in excess of £300k a year to the NHS and there are so few of these types of beds where patients usually stay for up to 2 years, so the NHS has to ration these resources. And they have a very low success rate. In my career I have only known 2 people to go through this whole system including a treatment bed for nearly 3 years and come out much more well and is now back at work etc.

I’m sorry about your experiences. The NICE guidelines of treatment for EUPD includes long term psychotherapy or group therapy (which everyone hates usually) but the lists are so long that people often get little support in between, I havnt worked in a mental health team for a few years but in the AMHP service we will try and make the best decisions for people in the moment we see them considering their history and community plan.

A bit but I expected this to a point, hence the post, as it’s such a niche job people know very little about.

plus we work with police a lot and these frustrations are not just on this thread but in real life too.

Sorry to hear about your daughter. The only things I would recommend is keep sharing your concerns with anyone that will listen. Remember that her nearest relative (which will be her dad currently if she is living with him) can request a mental health act assessment from the local AMHP service. Research treatment units and suggest these as there is sometimes scope to use services outside of the ones the NHS regularly use.

There is no set ‘limit’ on what it takes to have someone detained under the mental health act in a case of ED we do have scope to move in before things become terrible.

also take her to A&E if you are concerned for her physical health, all hospitals with an A&E department will also have a floating psychiatric team who will assess her (you might have to mention this to them!)

We cannot section people for physical health needs, it’s an exclusion in the mental health act, but if she has a diagnosis such as this and her mental health causing a risk to her health (which is sounds like it is) then yes, we could use it potentially. Get back in touch with the local mental health team, share your concerns and mention her history and the physical health risks

Great question.

I think it’s an unnecessary stress on probation services and I see ‘hot potato’ clients in this area.

Mental Health Orders in my experience have little teeth. They are an alternative to hospital orders and sectioning which the court may have at its disposal at the time although hospital orders can only be imposed for schedule 14 offences - not all offences. But there is nothing to enforce them because, if a person refuses to attend and then defaults on the treatment order then the courts are very unlikely to recall to custody because of the mental health element in my experience.

Mental health nurses can use section 5(4), nurses holding power. It only lasts for 6 hours though.

Hi!

ermm, I think for some people the changes to NR will be beneficial but will also cause nightmares for AMHPs and patients a like.

The fact treatment will have to have ‘therapeutic benefit’ will also be interesting to justify in practice. I mean, Clozapine for example - great if it works but the side effects and restriction on liberty to retitrate etc - thinking for non concordant CTO recall patients ? Will be difficult to justify depends who the treatment has to be therapeutic for - I imagine the person but what about protection of others - the mind boggles lol but I’m sure it will be worked out

BUT, I’m all for better community resources (let’s hope we actually get them!!) and for people having more say in their treatment.

As social workers first, we have to demonstrate a minimum of 2 years hands on experience with all spectrum of mental illness, including autism and LD before embarking on the AMHP training although many AMHPs have much more experience than this.

We then have to have mandatory training in these areas every year.

When a person with LD is being assessed under the mental health act we have to have a psychiatrist with LD experience present also so we have their expertise.

the mental health act criteria is also slightly different for people with LD to avoid these people being put in hospital for long periods inappropriately.

Sadly, I’m not sure. If an AMHP had assessed and made this decision we are duty bound to provide a plan (which one would hope is better than a call in 3 weeks) and this should be communicated to family.

In short, if there are viable community options available people will unlikely be detained under the mental health act. In my area anyone in this position has a follow up within 72 hours so we start with that and then layer up the plan from there.

If your background is social work did you also have to undergo mental health training for this job role?

Yes I’m a social worker first - we have to retain this registration to practice as an AMHP -you have to have a minimum of 2 years frontline mental health experience (but many have more than that) and it’s then it’s a postgraduate diploma at university a year of law, legal training and a 5 month hands on placement in an AMHP service.

Delicate question

Would you 'section' someone who had made plans to take their own lives and the lives of their children.

Without all the detail - this would seem a police ,children services and indeed an AMHP matter. Depending on the circumstances I would expect all of these services to be involved

Hi OP, great thread!

Do you have any general advice on how to deal with someone who needs to be detained /is having some kind of crisis?
E.g. Any phrases to use/avoid, is eye contact a good thing etc.

I used to be a mental health nurse, I haven't been one for a number of years though now are Amhp ,s still mainly social workers ?
Back in the day it was approved social worker ,s that sectioned people but then the training was opened up so other mental health professionals could do the training ,but ime admittedly a few years ago it was still mainly social workers who were Amhp s

How bad does someone have to be to get sectioned? I was in A&E with a family member yesterday after being referred there by the GP after an emergency appointment. The family member was having a huge mental breakdown, threatening to commit suicide and and practically begging to be kept in as did not feel safe going home yet all we got were helpline numbers, they are much beyond this and need real intervention. Is there anything I can do to get them some proper help asap? Thank you

Hi! Sorry for the delay I didn’t receive the notification for this unfortunately.

Try and keep your relationship as normal as possible, encourage them to do the things they would have done (if it’s safe). Support them as best you can as if someone was about to go into a physical health hospital for an operation. Find out visiting times, reassure them you can visit and if they need anything, soft lounge wear to wear on the ward is always a good option for them to pack & their favourite snacks.

normal eye contact etc

yes still mostly social workers. In our team we had one nurse but they left a couple of weeks ago and we have 2 occupational therapists.

i have never met or heard of a psychologist becoming an AMHP.