I work for West Sussex County Council’s Out of Hours Emergency Service as an Approved Mental Health Professional (AMHP). I initially trained in the role in 1989/90 and have been reapproved to act in the role at five yearly intervals, most recently in November 2019. I am a social worker by professional background, and I am registered with Social Work England.
I was on-call on a recent bank holiday. My shift was from 9.00am-5.00pm, although there is always the possibility it will overrun as each piece of work needs to be fully completed and written up. It can sometimes be the case that there are no pieces of work to do. I like to have a fallback activity for such occasions.
On this one, I had been provided with a copy of David Emery’s ‘Full Metal Cardigan’ to read. This, I was told, was an interesting memoir about working as an AMHP. I wanted to read it and compare it with my own experiences. However, no sooner had the shift got underway, I was asked by the Lead AMHP coordinating the shift’s activities that day to set up a Mental Health Act Assessment at a local mental health hospital. This was to assess a 23-year old female for a Section 3 (S.3) admission under the Act.
A S.3 is a compulsory admission for treatment, meaning nursing care and observation, medication, and psychological therapy (where possible and available). It also includes work to rebuild a person’s strengths and capabilities to be able to live independently with their mental health issues outside of hospital.
You have to have a really serious mental health issue to get into and stay in a mental health hospital in the first place. Most people with mental health issues are supported by their GP practice or through wellbeing services in the community.
The woman I went to assess is a quadriplegic as a result of cerebral palsy (without any associated learning disability), and not because she had survived trying to kill herself by jumping off the top floor of a multi-story car park. However, she had recently tried to kill herself on the ward by choking on anti-bacterial wet wipes that she had stuffed into her mouth.
She had been ‘hearing voices’ in her head instructing her to kill herself. She didn’t want to be in hospital any longer (she had in fact been there for several weeks already), but she was not well enough to be allowed outside of hospital at the moment, as the staff at the proposed placement for her could not guarantee her safety.
I arranged to interview her, accompanied by two psychiatrists, both female. The outcome was that I made an application for her compulsory detention in the hospital, accompanied by two written statutory medical recommendations.
There is an increasing expectation of a ‘business as usual’ service and not an ‘emergency’ service on bank holidays. On this particular day, I was one of only three AMHPs available across the county during the daytime. There were seven referrals requiring attention.
My next job was to complete a Section 2 statutory application for a 32-year old man to be admitted under the Mental Health Act to a mental health hospital in a neighbouring county about 40 miles away. I did not know the person, but he had been assessed under the Mental Health Act the previous day by one of my AMHP colleagues and two doctors.
They had concluded he needed to be in a mental health hospital for more specialist assessment because the risks to his own health in the community were so high that he would likely try and kill himself. The assessment team had also concluded that he needed to be detained under the Act because he was reluctant to go there.
Work under the Mental Health Act can be quite challenging at the best of times, but the important thing is to always be person-centred and person-focused.
I was asked to go to a town centre address where I was met by a community support worker from the local mental health crisis resolution and home treatment team and by a secure ambulance with three crew. I collected the previously completed statutory medical recommendations from the local mental health place of safety assessment suite (where they had been in the safe overnight) and I wrote out my statutory application in readiness.
I knew I would still need to check the person’s situation for myself and be satisfied having interviewed him, however briefly, that an application needed to be made.
He wasn’t at home. But we tracked him down at a house six miles away where he was laying a patio in a back garden in return for some cash to tide him over. When we got there, we had a slightly strained conversation in front of one of the houses where he explained that he was ‘rather busy’ with the patio-building and could he ‘go to the mental health hospital another day?'. I suggested he show us the work he had been doing that morning. He agreed and we followed him around to the relevant and more private back garden.
The ambulance was brought to the rear of the house as well. It was there that he decided that he would go to hospital after all. We agreed to wait until he could be paid off for the work done that morning (his mate had gone in search of a cash machine, so we had to wait until his return) and then he stepped into the back of the secure ambulance (an unmarked minibus with child-proof locks operated from the driver’s seat) and off they went.
Before the ambulance left, I gave the crew the completed statutory paperwork; the man thanked us all for our patience and support.
I then went home to work on my laptop and write up my Mental Health Act Assessment reports confirming what I had done that day. I also updated the council’s electronic records. I made sure that the duty manager knew that I was home safe. I finished my work at 7.30pm.