How do Approved Mental Health Professionals Make Decisions During Mental Health Act Assessments? An Observational Study of Practice

This project is a qualitative research study exploring how Approved Mental Health Professionals make decisions within the framework of an assessment under the statute of the Mental Health Act (MHA 1983). AMHP’s work within a clear statutory framework, with accompanying Code of Practice, and operate within both local and national policies which detail how, and in what circumstances assessments ought to be undertaken. These decisions are clearly framed within statute, and amendments in 2007 led to the implementation of a set of ‘Guiding Principles’ which should underpin all decision making under the Act. Alongside legislative changes to the role of the AMHP, research and reports highlight the pressures placed on these practitioners via increased workload, resource issues and a reducing workforce. The Care Quality Commission report a year on year increase in use of the MHA. This research explores how AMHPs’ make decisions within this current context and if and how contextual factors effect these judgements. It is a case study design using observations of practice during ‘real time’ assessments of the mental health needs of individuals, combined with interviews with AMHPs and a Key Informant who was assessed under the MHA. There is a scarcity of research that explores what occurs during practice in this area and so this project contributes to furthering an understanding of this. The methods also shed light on the ethical implications of accessing a ‘hard to reach’ area of practice. The findings develop research knowledge around professional discretion, the impact of emotion on decision making, and values-based practice. They contribute to a conceptual understanding of the ways in which AMHPs set the scene for effective decision making, exploring virtue ethics and relationship-based practice. The contextual barriers that create challenges to AMHP practice are outlined and recommendations made to support the AMHP workforce in delivering human rights-based practice.