DMH 415 Unison
Draft Mental Health Bill
Approved Mental Health Professionals (AMHPs)
Prepared by
UNISON
January 2005
Introduction
This document is an addendum
to UNISON's submission to the Joint Committee on the Draft Mental
Health Bill. This piece of evidence has been delayed as UNISON
wanted to consult with members who are expert in the field of
mental health social work. We are now pleased to be in a position
to submit this paper which covers the role of the approved social
worker (ASW) within the ambit of mental health. We would like
to offer our apologies that this evidence could not be included
in the original submission. However, we do hope that the Committee
will find our conclusions to be of value.
The Role of Approved Mental
Health Professionals (AMHP)
Under current legislation
two doctors, one of whom must be a consultant psychiatrist, and
an approved social worker (ASW) must agree that a patient should
be compulsorily detained.
This procedure has worked
well in the past, allowing decision making to arise from agreement
between a high level medical perspective as well as an independent,
social-work orientated perspective.
UNISON is concerned that
the Draft Bill seeks to dilute this provision. Section 2.12 of
the consultation document states: "Two doctors and an approved
mental health professional will consider whether a person meets
the conditions for initial use of compulsory powers."
The basic definitions
of the Bill confirm "a person is an approved mental health
professional if he falls within a description specified by the
appropriate Minister in regulations". UNISON is concerned
about the implications of widening this definition. At present
the basic training for ASWs consists of a specialist postgraduate
training course - including both academic and practical work.
This is completed before the formal process of appointment to
work as an ASW can be considered by any local authority. There
is no indication in the consultation document of the sort of non-medical
training which an approved mental health professional would be
expected to have.
UNISON's position is that
ASWs work within a framework which avoids institutional pressures
and which allows the ASW to retain an independent status for decision
making. Without this element, the exercise of compulsory powers
would be a wholly medical decision and would lack the checks and
balance of the non-medical perspective, brought by the approved
social worker. The input of personnel who are distinct from the
admitting care team, and who embody a social context perspective,
is key.
Therefore UNISON believes
that there should be no change to the current arrangements, requiring
agreement from an ASW, unless the new AMHP role can be demonstrated
to embody the key features of the ASW role. UNISON is not yet
convinced that the Draft Bill strikes the right balance in the
provisions which set out the requirements for the AMHP role. In
UNISON's view the key features of the role currently undertaken
by the ASW are:
In deciding whether the
mental condition of the patient requires compulsory admission,
it essential to ensure a balanced judgement about the medical
and social factors which contribute to the patient's situation.
To provide this, the ASW undergoes training which ensures that
they have a wide understanding of the range of social factors
which underlie mental illness.
It is not yet clear that
this training and background will be required of those taking
on the AMHP role. There is a concern amongst current ASWs
that, if the AMHP is from a nursing background, they may -
because of the training route they take to qualification - tend
to take a similar view of the situation to the medical professionals
involved, thereby depriving the patient of the balancing role
currently played by the ASW. We acknowledge that nursing training
is evolving fast but only clear requirements (mirroring
the current ASW training) would be acceptable for the AMHP role.
Our members are also concerned
that, if the AMHP is part of the same organisation as the psychiatrist
who is the first signatory of the admission order, it may be more
difficult for them to express a dissenting opinion. There are
occasions, albeit rare, on which the ASW feels obliged to
disagree with the doctor(s) about whether compulsory admission
is necessary. In the current situation, the fact that the
ASW is employed not within the NHS but within the local authority
(and with a responsibility to the Home Office) provides a crucial
measure of independence. We can see no recognition of this factor
in the arrangements suggested for the AMHP in the new Draft Bill
and, without some measure of organisational autonomy for the AMHP,
we would again have to argue that the civil rights of the
patient, under the proposed changes, cannot be fully protected.
Conclusion
In summary, UNISON acknowledges that
reform of the Act is necessary. However, there are key issues
around the compulsory hospitalisation of individuals which, if
implemented, could weaken the current procedures. UNISON also
has concerns that some of the changes could adversely affect the
civil liberties of patients by extending powers of compulsion
and extending the definition of "mental disorder".
UNISON hopes that this consultation
process will result in firm assurances that the key features of
the ASW role will be preserved and that there will be trained
and qualified staff able to provide an independent assessment
prior to the use of compulsion. We urge the Government to consider
this issue very carefully. Failure to do so could bring the issue
of compulsion fully into the medical sphere, removing the important
social care dimension from the decision making process.
For further information please contact:
Gail Adams Owen Davies
Head of Nursing, Health Group National Officer, Local Government
Group
UNISON UNISON
1 Mabledon Place 1 Mabledon Place
London London
WC1H 9AJ WC1H 9AJ
Tel: 020 7551 1317 Tel: 020 7551
1347
Fax: 020 7551 1354 Fax: 020 7551 1195
e: g.adams@unison.co.uk e: o.davies@unison.co.uk
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