The lost social perspective: relocating the social perspective in approved mental health practice and the Mental Health Act 1983

ABSTRACT

The ‘social perspective’ was inserted into the Mental Health Act 1983 Code of Practice (2008a) to ensure that skills and perspectives associated with the Approved Social Worker (ASW) were adequately transferred to the broadened role of Approved Mental Health Professional (AMHP). Nonetheless, there is a lack of clear guidance on how the ‘social perspective’ should be enacted in AMHP practice which causes several misalignments with how AMHPs balance other obligations in their decision making. Aspects of the Least Restrictive Option and Human Rights Legislations (such as the European Convention on Human Rights) are inconsistent with the objectives of the ‘social perspective’ and have replaced the ‘social perspective’ as a dominant feature of AMHP practice. Consequently, the ‘social perspective’ has avoided a clear definition, and meaningful guidance on how it should translate into practice. The ‘social perspective’ is often neglected in law reforms and policy decisions limiting both commissioning advancing the ‘social perspective’ and reducing its safeguarding function to the service user.

KEYWORDS:

• Social perspective
• Approved Mental Health Professional (AMHP)
• Mental Health Act 1983
• least restrictive option
• European Convention on Human Rights

Acknowledgments

I am grateful to Kirsty Keywood and Dr. Sarah Devaney for their insightful comments on earlier drafts. I would like to thank the anonymous reviewer for their thoughtful and constructive comments and suggestions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. The Secretary of State is authorised to issue a code of practice under section 118 of the Mental Health Act 2007.

2. AMHP responsibilities include reception of individuals into guardianship, consultation over granting community treatment orders, admission under s.135 following a warrant from the magistrates and entering private premises in discharge of their duties. They also have power under the DoLs framework to contribute to the assessment of patient needs regarding potential deprivation of liberty under the MCA. What tends to tie these various responsibilities together is the difficult question when to make decisions on behalf of an individual that is contrary to their own choices.

3. Robert McLean, who was the chair of the Approved Social Worker Interest Group states. ‘You’re going to have community psychiatric nurses and OTs who are from the medical model and who will find it hard to take a non-medical view,’ (cited in Leason 2004).

4. As Johnstone (1993) noted, even the most ardent promoters of psychosocial interventions persisted with the notion of medication compliance (cited in Leff and Vaugh).

5. This is an oversimplification, as the medical model may also be referred to as ‘the disease model’ (Gould 2010, p. 16), from multiple theoretical standpoints, from a purely biological envisioning of mental distress to attempts to conceptualise mental distress in terms to empirically evidenced categorises and diagnostic criteria (Rogers and Pilgrim 2010, p. 2).

6. These detentions were seen as flagrant violations of Article 5, which holds that ‘[n]o one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by law: (e) the lawful detention of persons for the prevention of the spreading of infectious diseases, of persons of unsound mind, alcoholics or drug addicts or vagrants;”, or more generally the conditions that determine the lawfulness of deprivation of liberty on the basis of social or medical reasons.

7. The Care Quality Commission reports ‘limited or no improvement in the key concerns that it has raised in previous years. In particular, no improvement in evidence of: (a) patient involvement being recorded in care plans; (b) patients’ views about their care being recorded; (c) whether clinicians have considered the least restrictive option for care.’ (CQC 2019).

8. The reforms propose to determine whether the ‘current setting represents the least restrictive option’ and give more powers to the tribunal to ‘grant leave, transfers and community services’ (DoHSC 2021, p. 32). The reforms propose to align the criteria of use of Community Treatment Orders with the new s. 3 criteria, specifically the requirement to evidence the risk and likelihood of ‘significant harm’ (p. 57). The Care and Treatment Plan is a living document for all those subject to compulsory powers, and whilst the document ought to record a number of factors, it introduces an obligation to record what treatment options are available to service users, how care can be delivered in the least restrictive way, that treatment options are explained and justified to service users, and that the expressed wishes and interests of the service user are recorded (p. 40).

9. In 2001 an unprecedented number of cases regarding the unnecessary compulsion of persons with mental health disorders or intellectual disabilities came to court including: Keenan v UK 27229/95 [2001] ECHR 242, R (C) v MHRT London South and South West Region 2001 EWCA Civ 1110, R (H) v MHRT North and East London Region 2001 EWCA Civ 415, R (K) v Camden and Islington Health Authority 2001 EWCA Civ 240, R (N) v Ashworth Special Hospital Authority 2001 EWHC Admin 339 and R (Secretary of State for the Home Department) v Mental Health Review Tribunal, PH as interested party 2002 EWHC 1128 (Admin);[2002] MHLR 241.

10. In Kersting et al’s study on the use of psychical and chemical restraints on psychiatric patients, 67 cases resulted in serious harm or death (2019).

11. For a fuller exploration on the limitations of ‘rights language’ as an agent to provide substantive reform refer to Rose, N., 1985. Unreasonable Rights: Mental Illness and the Limits of Law. Journal of Law and Society, 12 (2), 199–218.