Approved Mental Health Professionals (AMHPs) and the compulsory detention of Black service-users under the Mental Health Act - An institutional Ethnography

People from Black ethnic groups in England are disproportionally detained under the Mental Health Act 1983 (as amended 2007) [MHA] compared to other ethnic groups. Several national policy initiatives and legislative reviews have been established to address this issue with no desired outcomes. Ninety-four percent of the approved mental health professional (AMHP) workforce comprises social workers. Central to the AMHP's statutory role is making decisions regarding the compulsory detention of individuals to hospital, a process that contributes to the overrepresentation of Black ethnic groups in detentions. There has been limited research into how these processes impact AMHP decision-making. This inquiry seeks to address this gap in knowledge, guided by the methodological and theoretical framework offered by Dorothy Smith’s Institutional Ethnography.

This research adopted the standpoint of social worker AMHPs to develop contextualised understandings of the social and ruling relations that influence AMHP practice. Ethnographic fieldwork spanning 12 months across two local authorities in England involved interviewing 31 social worker AMHPs, focusing on their experiences with Black service-users during different phases of MHA assessments. The study explored the role of multi-disciplinary collaboration and textually mediated work within AMHP practice.

This inquiry is guided by two key research questions: 1. To what extent do the accounts of social worker AMHPs' experiences of coordinating MHA assessments with Black service-users reflect the "ideological" work of AMHPs? 2. When applying the least restrictive option and considering the social perspective in their decision-making, what factors influence AMHPs' consideration of whether to detain an individual under the MHA? This study’s findings underscore the pivotal role of the social perspective in AMHP decision-making. However, challenges arise in translating the social perspective into practice. Firstly, because the MHA Code of Practice lacks explicit guidance on how it should be enacted. Secondly, due to the structural and systemic disadvantages faced by Black people in Britain. This is marked by disparities in socio-economic mobility via pathways that include access to social capital - a key factor in AMHP detention decision-making. Findings delineate the role of pervasive systemic racism, which operates through structures that support or restrict access to the socio-economic determinants of mental health.

To address entrenched disadvantages, policies need to fundamentally reorient to acknowledge the intricate link between mental health and socio-economic mobility. This includes factors such as social capital, sustainable livelihoods, social cohesion, community belonging, educational attainment, and freedom from discrimination. For social work and AMHP practice, this means adopting more holistic, rights-based, and preventative approaches tailored to racialised communities, addressing the social, economic, and cultural determinants of mental health.