Shropshire Council

Derek's story (AMHP)

Derek, manager, social worker and approved mental health professional (AMHP), guides us through a single day at work:

9:00am: Great news - the day starts well. Only yesterday I was seeking a Magistrate’s Court warrant so that I could interview a woman who repeatedly refuses to see housing colleagues; she is at risk of being evicted. The police have found her. They are bringing her to a *place of safety as she urgently needs a *mental health act assessment.

9:30am: Advance warning from the *Crisis Team. An individual is not taking their anti-psychotic medication. I have to get background information from the electronic health records.

10:00am: Discussion with a Learning Disabilities specialist psychiatrist about a plan to renew another person’s *Community Treatment Order. We want to support them while they live in shared housing. This is straight forward and easy to agree. Luckily, the psychiatrist will also assess the woman in the safe place at 11am. Now I just need her GP.

11:00am: GP not available. Not uncommon (there’s 20 miles to travel), but a local semi-retired *Section 12 Approved GP is able to join the Learning Disabilities psychiatrist and myself. Our patient is said to self-neglect, have learning difficulties, depression and possibly to lack mental capacity. She may also be exploited financially by her sister. But I cannot jump to conclusions. Happily, when we meet she presents positively and is able to talk coherently. She even shares a joke with us after she’s got over her annoyance at being “picked up” by the police. The assessment is clear. There is no reason to keep her any longer and she can go home. Hopefully my report will be helpful to Safeguarding colleagues in considering her mental capacity, her relationship with her sister and her housing issues.

1:00pm: The Crisis Team are concerned about a woman who has been threatening to run in front of cars. They have requested a formal *Mental Health Act assessment. It’s difficult to find a psychiatrist for the rural area but eventually I find one who is available at 4.30pm.

1.30pm: Electronic records and reports started. Always important.

2:00pm: Advance warning from a Mental Health Social Worker who is planning to visit a resident at a local care home later today. The resident had a well-established diagnosis of schizophrenia and was recently treated under *Section 3 at the Redwoods Centre, but she may have been discharged a little soon and appears to be relapsing.

3:00pm: Psychiatrist and Social Worker have seen the care home resident and consider that re-admission under the Act is required. The resident is paranoid towards other residents and now the police are involved too. The psychiatrist is willing to stay if I can find a second doctor to assess within an hour. No GP is available from the person’s own practice but happily the Section 12 GP I used this morning is available. We agree to meet at 4pm.

4:00pm: Interviewed the patient with the GP. The psychiatrist had already seen her. We agree that because her behaviour is so variable, she ought to be admitted to hospital under Section 3 of the Mental Health Act. The psychiatrist is clear about the diagnosis and treatment required.

5:00pm: It takes time to sort arrangements. A bed is confirmed at the local hospital where the person was recently treated. She is willing to go and has been calm all afternoon. I decide with the Care Home’s manager that it would be safe to transport her the short distance by car, with the manager as escort. This isn’t easy to arrange, but with a little negotiation and the promise of a handover from the Care Home’s manager who knows the person very well, it is agreed. I give the person the news as well as explaining her rights to appeal against the Section 3 and to have an independent advocate if she wishes.

5.30pm: It’s a good handover on the ward and we leave the person happily sitting in the ward garden.

6:00pm: I return the manager to her Care Home before writing up a brief note on the outcome and checking that my colleague AMHP is safe with the 4.30pm assessment.
It’s time to head home now with a reflection on the detailed working knowledge of the *Mental Health and Mental Capacity Acts that has been required in one day.

Glossary – the key terms explained:
*place of safety – section 136 of the Mental Health Act gives the police the power to take a person from a public place to a place of safety if they think they have a mental disorder
*Mental Health Act assessment – to determine if someone has a mental health disorder requiring assessment (section 2) or treatment (section3) under the act
*Crisis Team – a 24 hour service offered to prevent hospital admission and support following discharge from hospital
*Community Treatment Order – to support someone in the community and prevent hospital admission
*Section 12 Approved GP – a doctor having specialist mental health issues knowledge
*Mental Health Act and Mental Capacity Acts – The two main acts that guide the AMHP’s practice