Reconnecting with best practice in the AMHP role through Appreciative Inquiry

A contested role

My PhD research concerned an area of practice little mentioned, performed by staff occupying a contested role under UK legislation. Approved Mental Health Professionals (AMHPs) tread the tightrope of simultaneously trying to prevent detaining people under the Mental Health Act (MHA) 1983, while at the same time being the applicant for detention where they consider this is necessary. The legal framework has little to offer the AMHP to guide their decision-making, the AMHP being set the lofty task of considering “all the circumstances” (MHA 1983, s 13(2)).

Following a review of the literature in relation to AMHP detention decisions I concluded these decisions are essentially moral, and as such they touch us on a personal level (Simpson 2020). With such high stakes for the service user subject to the decision, and the AMHP making it, it is no wonder AMHPs sometimes struggle to talk about their decision-making. This at least is my own experience having been an AMHP since 2007.

A methodology to inspire

Given the contested nature of AMHP decision-making, I approached this research using a strengths-based and collaborative methodology. Appreciative Inquiry seeks to learn from those in practice, starting with their own definition of their best, dreaming of how to extend these qualities even further, then designing and implementing structures and practices that stretch the best and create a new future ideal.

This methodology proved to be inspirational, and the AMHPs involved in the study embraced positivity and used this to shape their future aligned with their own ideals. Working in the public sector it was liberating to shape practice around our own definition of what we were trying to achieve rather than feel constrained by organisational structures and policies. We shaped these structures to enable our best practice, a truly generative endeavour.

The workshop series

Nine AMHPs in one Local Authority AMHP service participated in this study, working together in a workshop format over 4 days. On completion of my PhD, I was keen to learn the extent to which this one group of AMHP’s practice ideal was shared by other AMHPs. As such I organised some one-day workshops to showcase the original study and then begin the Appreciative Inquiry discovery and dream phases to establish any new insights into practice. The first two of these workshops included AMHPs from four Local Authorities, and I have further workshops planned that similarly seek to bring AMHPs from different Local Authorities together.

I have shared my research with AMHPs in different forums, including conferences and smaller team meetings. The workshops were my first opportunity to attempt this, and my experience in that setting and all subsequent settings has been that AMHPs have naturally connected with the ideas presented. The central themes of my research revolved around a desire to slow down the trajectory towards detention to enable a greater connection with the person referred and a more holistic, transparent, and collaborative decision.

It is unsurprising that this approach would be met with enthusiasm from AMHPs who remain mostly social workers or socially oriented allied professionals (Skills for Care 2022). AMHPs work within systems that are under significant pressure, not least from increased detentions (CQC 2018) and reduced staffing (Skills for Care 2022). Problems and barriers can dominate our perspectives in AMHP practice (Bonnet and Moran 2020) yet starting from defining best practice evokes a narrative of hope and a reconnection with our own personal moral imperatives. In describing my research AMHP participants have begun by connecting with the best practice described, then they have become increasingly aware that they have their own examples of best practice that resonate with the research. They then watch those barriers and problems fall away, recognising the constraints on their practice are illusory.

Social constructionism underpins Appreciative Inquiry, the creation of reality through conversation (Berger and Luckman 1966), and the workshops created a space where reality was redefined for participants. The exercises to explore best practice and future dreaming were replete with examples that validated the original study, and participants reflected how the permission to practise at their best was such a liberating experience, lifting them from the constraints imposed by service structures and multi-agency pressures.

Next steps

The next few months will see me engage with more AMHPs through further workshops and events. These early workshop experiences have given me a measure of confidence that the practice reality defined in my study represents a shared reality for many AMHPs, and together with gaining momentum nationally for an emphasis on the AMHP role in preventing detention, I see a future of AMHP practice that is both inspirational and aspirational. In a declining service context, this feels like a paradigm shift in mental health coercion, one that AMHPs will lead the way on.

References

• Berger, P. L. and Luckman, T., 1966. The social construction of reality. Harmondsworth: Penguin Books.
• Bonnet, M. and Moran, N., 2020. Why do Approved Mental Health Professionals think detentions under the Mental Health Act are rising and what do they think should be done about it? British Journal of Social Work, 50 (2), 616-633.
• Care Quality Commission (CQC), 2018. Mental Health Act. The rise in the use of the MHA to detain people in England. Newcastle upon Tyne: CQC. Available from: https://www.cqc.org.uk/publications/themed-work/mental-health-act-rise-mha-detain-england [Accessed 18 December 2019].
• Simpson, M., 2020. A structured narrative literature review of approved mental health professional detention decisions: An infusion of morality. Practice, 32(4), 285-300.
• Simpson, M. 2023. An Appreciative Inquiry into Approved Mental Health Professional decision-making at the point of referral for a Mental Health Act assessment. Thesis (PhD). Bournemouth University.
• Skills for Care, 2022. The Approved Mental Health Professional workforce in the adult social care sector. Leeds: Skills for Care. Available from: https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/documents/AMHPs-Briefing.pdf [Accessed 9 November 2022].