An Appreciative Inquiry into Approved Mental Health Professional decision- making at the point of referral for a Mental Health Act assessment.

Abstract

In England and Wales, the Mental Health Act (MHA) 1983 provides a legal framework for psychiatric detention, requiring two medical recommendations from legally defined doctors, and an application from an Approved Mental Health Professional (AMHP). Civil detentions are the result of an assessment process involving all three professionals, not always together. AMHPs make detention decisions but they also make a decision at the point of referral. This qualitative study focused on that early decision made by AMHPs. Nine AMHPs in one local authority attended four workshops exploring their experience of decision-making at the point of referral for an MHA assessment. The collaborative strengths-based methodology of appreciative inquiry encouraged participants to define the best of their practice, then build on those strengths with service design amendments. Data analysis was completed by participants within the workshops using nominal group technique. At the point of referral for an MHA assessment participants were optimistic about avoiding detention, changing gears through the analysis and deconstruction of presented risks, and buying time to meet with the person referred and work in a more collaborative, transparent, and person-centred way. Based on my review of the available literature, these qualities are more challenging to achieve in traditional assessment approaches involving three professionals. As such this study highlights how AMHPs are more likely to achieve practice consistent with their values at the point of referral for an MHA assessment. The detention decision was in essence relocated to the assessment completed at the point of referral, and participants wanted to see this early decision valued within the service, creating a triage AMHP role and AMHP s 13.1 report to legitimise interventions that seek to avoid the necessity of an assessment process involving doctors. Participants also wanted a shared pathway to assessment with doctors seeking alternatives to detention, promoting a multi-agency emphasis on less restriction. This is the first study to explore this area of practice, and the rich understanding gained validates the importance of service structures that support this decision, enabling AMHPs to practise in a way that is consistent with their purpose and values.