Alternatives to hospital admission: People assessed under the Mental Health Act 1983 (amended 2007)

I have been working on looking at alternatives to hospital admission for people assessed under the MHA 1983 (amended 2007) for the last five years and I am interested in other professionals and service user views on this subject.  Below is a brief outline of the work I have been considering. 

 

The 1983 Mental Health Act ( the act ) has for two decades provided support to people with chronic mental health problems by offering hospital admission both informally and compulsory. However, the thinking about welfare policies, including the establishment of new mobile mental health teams (Crisis Resolution and Home Treatment)  has change the landscape since the introduction of the Act. 

 

 These teams (CRHT) pose both opportunities and threats for the practice and education of mental health act assessors.  The Approved Social Worker (ASW)  under the Act (changed to AMHP in 2009) is the lead assessor and it is the work of this group of practitioner’s, which this study wishes, investigate.  In addition, professionals working in the new mobile mental health teams, who have previously seen their work as essentially rooted in local hospital services, are having to review their practice when considering the Act. The establishment of Crisis Resolution and Home Treatment (CRHT) teams to provide an alternative to hospital admission gives ASW’s opportunities to consider new working practices. Although the aims for both CRHT teams and ASW’s seem  similar, to provide the least restrictive alternative resource for people with chronic mental health problems, they have not been seen as natural partners.  This research investigates ASW’s practice in the light of these new teams.

 

 

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Hi Peter,

While it is not strictly about alternative provision, the paper I presented at the Asylum conference recently does concern the use of coercion. It is available at http://bob-thegreatgiginthesky.blogspot.com/2011/09/challenging-coe...

Bob

Dear Bob

Sorry for taking such a long time to reply and thank you for your paper.  As an AMHP and ASW for over 20 years I also have reflected on the amount of 'power' is invested in the role.  I also believe that we need to look at the issue of 'mental disorder' in terms of considering alternative approaches, but this involves being clear about what the role of the AMHP is and how they apply their power. 

While the work of Szasz can be seen as a radical voice from the past, what he stood for then and which is still applicable is the arguement  for people with mental health problems to have their 'rights' protected and this being reflected in legislation. 

Thank you again for your paper and you have any objection to me quoting your paper in the research I am under taking.

all the best

Peter

Hi Peter

I'd be delighted to be quoted. I've also just finished another paper which you may find interesting. I hope this will be published in the European Journal of Social Work.

Bob

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Hi Peter

This sounds most interesting. I currently teach mental health studies on a MSc Social work course. In my practice life i worked as an AMHP often alongside CRHT and Assertive outreach teams. I also worked in forensic social work services in the community. Anecdotally, AMHP practice has changed in light of these new teams. There has been many discussions around thresholds and how they have been impacted by the presence of a CRHT. In practice i found exploring a mental health act assessment with the CRHT as helpful. Often the CRHT would have already seen a service user prior to the MHAA being requested. There are a number of boundary issues that i found arose from the presence of the CRHT. One such issue is the presence of medical staff on the team and how this might impact the way in which referrals for MHAA were taken forward. In terms of alternatives to admission, my own experience is there is an ongoing need to explore all possible alternatives despite the presence of the CRHT as a resource for alternative admission. AMHP I would be interested in your findings and have similar interests to explore (research) how AMHP practice is changing.

Look forward to hearing more.

Stefan

Dear Stefan

Sorry for taking such a long time to reply and thank you for your comments.

I also teach, on the BA social work and MA Mental Health courses at UCS, the MA Mental Health course  includes the GSCC (not for long) AMHP training and I also work as an AMHP on a local authortiy EDS rota.

  I was interested in your comments about the joint working with CRHT teams and was thinking whether  you were able to pin point what the 'boundary issues' are and what the influence  medical staff have on the interface between AMHP work and CRHT teams. Is it possible to identify the range of boundary issues, whether there is a common language when negotiating with the CRHT team, what are the 'rules of the game'  to get the service you want for the service user. I work with two CRHT teams as an AMHP and they operate very differently, one being flexible with the rules the other seeing the 'risk threshold' which AMHP's work within as being beyond their remit.

all the best

Peter

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