The changing role of social workers in developing contexts for mental health professionals
One of the main consequences of the creation of AMHPs in England and Wales may be that the former relative independence of the assessment role itself will be in danger of being eroded. Opening up the assessment role to other professionals, who are likely to have similar professional backgrounds to the medical profession, may, by default, blur former boundaries based on professional independence, resulting in collusion; but there is little evidence to conclude whether such erosion has so far taken place. Instead, the Code of Practice 2008, which accompanies the Mental Health Act 2007, provides seemingly full backing to retaining independence as key, arguing that: ‘although AMHPs act on behalf of a Local Social Service Authority (LSSA) they cannot be told by the LSSA or anyone else whether or not to make an application for compulsory admission. They must exercise their own judgment, based on social and medical evidence, when deciding whether to apply for a patient to be detained under the Act’ (Department of Health 2008: 36). Herein is an emerging challenge. AMHPs are still to be approved by local authorities in England and Wales, but they do not now need to be employed by them as formerly they were required to be. This may result in a lessening of allegiance and, in turn, a decreasing motivation for local authorities to carry out the formal approval process in a robust manner. This potential trend, however, has not yet been identified and so far seems not to be established. The 1983 Mental Health Act in England and Wales was considered at the time of its inception to be a major step forward in recognizing an
individual’s right to an independent mental health assessment (Jones 1993). Independence in this context applies primarily to the central decisionmaking function about compulsory detention as being free from medical influence. Independence is seen as the underpinning principle of compulsory mental health assessments and is one of the main arguments made by BASW and the Approved Social Worker Interest Group to the expert committees in England, Wales, Scotland, and now in Northern Ireland, in favour of retaining compulsory mental health assessments as an exclusively social work function. For the Scottish committee this was central, arguing ‘it would not be appropriate for the independent role of the Mental Health Officer to be performed by someone employed within the health services’ (Scottish Executive 2001: 89). For the English committee, while they agreed that independence is key, they did not agree that this should be ‘exclusive’ to ASWs (Department of Health 1999: 48). Independence in decision making does, however, remain a central tenet in what is currently the new role of the AMHP in England and Wales. Guidance contained in the AMHP regulations introduced in 2008 describes matters which should be taken into account to determine competence of AMHPs, including being able to make ‘properly informed independent decisions’ (National Institute for Mental Health in England 2008: 5). But will this guidance be enough? The crux of this challenge would seem to centre on training, as suggested in the phrase ‘trained with equivalent rigour’ (Department of Health 1999: 48). ‘Relevant training’ needs to allow all those wishing to undertake the AMHP role to achieve the standard of competence which the former training for ASWs based on social work approaches and methods afforded, and which has been recognized by the expert committee and subsequent guidance as being of a high standard (Department of Health 1999; National Institute for Mental Health in England 2008). Any professional outside of social work will need to understand and be assessed against key competences, on a par with those which were formerly used to approve ASWs, and which, over many years, have been considered effective. Initial indications are that AMHP training in England and Wales is intentionally being grounded in the social work model. For example, in the guidance developed for the selection and training of potential AMHP applicants is included the statement, that ‘all candidates need to work to demonstrate what are in effect, social work values and practice’ (National Institute for Mental Health in England 2008: 30). This is probably a cause for celebration, as it appears to be a clear acceptance of what social work can contribute. Moreover, regulation of new AMHP training is to remain within the remit of the GSCC, the regulatory body for all social work training pre-and post-qualification. Appropriate, rigorous training in all competences will be crucial to the success of the AMHP and hopefully should allay fears which have been expressed by some, that the Approved Professional making the final decision to apply for compulsory hospital admission may be examining the case for detention through ‘non-social
work eyes’ (Rapaport* 2006: 38). The need to be approved as social work competent in the role enriches compulsory mental health social work and provides an excellent opportunity for social work’s particular contribution to achieve appropriate recognition.