Further to my mentioning of a new paper on the development of the approved mental health professional (AMHP) role, and what this might mean for nurses, here now is a link to a full text open access version downloadable from ORCA.
In this article, my friend Michael Coffey and I discuss the implications of the changes made in 2007 to England and Wales’ Mental Health Act for the role of the mental health nurse. We were helped on our way by Jackie Neale, Michael’s colleague and Co-Director of the AMHP programme at Swansea University and by Dr Martin Webber, Reader in Social Work at the University of York, both of whom read and commented on an initial draft of our paper. Writing for this blog, Michael says:
Nurses for the first time can make applications for detention in hospital based upon their independent judgement and with regard to the opinions of their medical colleagues, based upon a social perspective and the principle of least restriction. This is as far as we know unprecedented in UK mental health law. In many ways this changes the provision of mental health nursing in ways that have as yet to be measured. These changes reflect similar moves internationally in mental health law. There are huge challenges here though. Nurses are creeping into the territory of other professions who are not exactly welcoming them with open arms. Specific occupational knowledge and values are claimed by social workers who have traditionally fulfilled the approved role. These may be seen as jurisdictional claims and nurses have to show that they too can ‘pass’ as workers with a social perspective who are able to be independent of doctors. This is easier said than done and nurses have a chequered history in relation to occupational biomedical dominance. Added to this nursing is chiefly a biomedical task nowadays despite all the claims to being ‘holistic’ and being as focused on the social aspects of people as on anything else. Claims by nurses to be ‘psycho-social’ oriented or even ‘bio-psycho-social’ should be treated with some scepticism as many of these nurses subscribe to ideas of genetic determinism and are overly chemotherapy-focused. So can nurses actually juggle both a primarily biomedical focus and a social one to come to independent decisions in cases where the person might lose their liberty?
The backstory to this publication includes the fact that, with Jackie Neale, Michael runs Wales’ only AMHP programme. You can find out more about this post-qualification, postgraduate, course here. Our new article also comes out of Michael’s and my shared interest in mental health work and roles, and in thinking about (and researching) what nurses and others do. Another piece of behind-the-scenes detail is that Michael and I were once part of a team which came pretty close to getting a large grant to investigate AMHPs, and the experiences of people on the receiving end of their services.
8 thoughts on “Nursing and the approved mental health professional role”
You may not remember me but we worked briefly together in Tower Hamlets (seems a lifetime ago). I was a little dismayed that inspite of the opposition to the proposals embedded within the mental health bill, the suggestion that other disciplines should occupy a role similar to that of the ASW was met with barely a wimper. Furthermore, if memory serves me correct, the Bill’s justification for this went something like ‘we see no reason why other disciplines cannot take on the role of the AMHP’ or wards to that effect. Ironic considering the drive towards evidence based practice over the last 15 years or so. The government’s evidence for extending the role to other disciplines was a little tenuous, according to that statement.
Since the bill, and the subsequent amendments to the mental health act, my message to students has pretty much echoed yours, i.e. nurses have a relationship with biomedicine which, at least potentially, compromises their ‘pure’ social care perspective. I also express a note of caution concerning the possibility of being cooerced into agreement with the medic because of the nurses’ intimate relationship with psychiatry, where the same concern doesn’t quite apply where the social worker can exercise an independent view.
My major concern is that service users may have lost their recourse to a perspective, and indeed an assessment which is non-clinical, and will consider at it’s heart the principle of community alternatives to detention. Students are asked to explore the paradox of a mental health service which promotes the principles of recovery whilst reaffirming the disease model through less inclusive and more restrictive legislation. I’m off my soap box now.
P.S. I’ve enjoyed reading your work and students are steered in its direction, particulalry where some of these contentious issues are concerned.
I remember you very well and I’m really pleased to hear from you now. Wasn’t it the Community Resettlement Team you were working in? And are you at London South Bank now?
Yes, it is interesting how relatively little discussion there’s been on the implications of the AMHP role for nurses (and perhaps on the more general changes in roles and responsibilities across the board). This idea that groups of workers are interchangeable is very problematic, in my view.
All the very best (and thanks both for commenting and pointing others this way!).
Do you ever get to the NPNR conference?
Correction to the penultimate paragraph ‘social care perspective’.
It’s great to hear back from you. Hmmm, been at LSBU for 10 years now, how time passes. You’re right, I worked at the CRT in Bow/Poplar, then moved a little down the road to Newham where I appeared in a number of guises, had one foot in education from about 1997 and then both feet since 2003 with London South Bank. Just noticed the number of typos in my original post, if only my students could see this now.
I’m afraid I don’t get to the NPNR conference but a colleague and I are working on an article which will hopefully be followed up by a study of recovery language (or lack thereof) in practice, next semester, and hopefully thereafter a response to a call for papers, maybe for the NPNR conference, though 2014 may arrive a little too early.
I had a mind to write something on the subject of the role of the AMHP and the ethical challenges to nurses, but it continues to reside in my head for the moment. As you say the notion that professionals can drift unseamlessly into other areas of practice is problematic, but in my experience very few people express concern, even service user groups.
It calls to mind my experience as a clinical nurse lead in Newham where I had a manager whose idea of holisitic care added up to one worker per case, i.e. you satisfy all the needs of the person; my own view was that being holistic was also concerned with meeting the whole needs of the person, but this could add up to a multitude of services and workers potentially. I found myself spending a lot of time advocating for nursing and social work colleageus who were having to deal with complex social care or health care needs that weren’t matched by individual skill sets owing to their limitations. Many colleagues continued to struggle on in the fear that they may be seen as weak or failing if they were to admit to limitations in their practice.
The other important concern is that service users may be denied the best service available because of the striving for the generic practitioner role. The same applies in many ways to the role of the AMHP; those in the higher political echelons have a limited understanding of the value of a multi-professional formal mental health assessment, and their advisors it seems are driven by anti-therapeutic agendas, though who the drivers are is I guess a moot point. I’ve become a bit cynical in my old age Ben, in case you hadn’t noticed.
I don’t think you sound cynical here at all. There is a sense in which the roles of nurses, social workers and others are not fixed, but move around (and always have done, to some degree). But the AMHP role for nurses was not here one day, and then (via legislation) *was* here the next. And that’s tricky, because it represents a very sudden jolt to the system and to interprofessional role relations. And there are definite questions on how far AMHP work can be incorporated alongside other kinds of work that nurses do, and on the knowledge that is needed.
Hey, get along to the NPNR conference!
All the best
Thanks for the reply, and the validation, there’s a fine line between being critical and cynical and I’m careful not to cross it; it’s important to practice what I preach to students. You are right, to a degree nurses and social workers are adaptable enough to deal with health or social care issues that are not too complex, and I guess from a service users’ perspective it makes things less complicated if there are less workers involved.
I’m guessing that the AMHP role qualifies as complex, and that the implications for the promotion of a social care perspective stretch some way beyond the knowledge base of the practitioner, a point which law makers appear to have overlooked (directly or otherwise).
Anyway, the NPNR conference is appealing, and it would be good to contribute to the event someday.