On Becoming an AMHP
I am not currently warranted and haven’t practised as an AMHP (approved mental health professional) for over six years. But last week, someone asked me if they thought they should do the training course. I ended up talking for longer than I’d expected and it gave me the idea for this post.
I undertook the training to practise as an approved social worker (ASW) in 2006/7. I was the last ASW approved by my local authority. When I was ‘offered’ the training, our service manager told me it would be the last opportunity I would get because after the changes in the law, all the training opportunities would go to nurses so if I wanted to do it, it was my only chance (I might have been a bit gullible but I’d only been in that job for a year at that point).
I undertook the training as a block over a few months. It was the best training I’ve ever done. The focus from the start was on human rights and an understanding of the power one holds to make an independent decision about the detention and removal of liberty of another person. The course, rightly, made a lot of that and ensured we did not take our power lightly.
I came from a specialist field of mental health (older adults mental health) so the training also exposed me, in a much broader way, to the general adult mental health social work and understanding of mental health across the board. There were parts to the course about CAMHS and working with people with learning disabilities and autism because as an AMHP on a rota, one works across the board.
While I could never say that I enjoyed the work. it would be a particularly cruel and unethical person who did and I’ve not heard that from anyone, I found that having the responsibility to make a person’s interaction with the state at the most difficult part of their life, a privilege and a position which had to be treated with respect. I can’t make the badness of that occasion and action go away, if someone needs to be admitted under compulsion, but I could always try to make a difference by acting in as humane a way as possible and being as clear as I could with the person and their family about what would happen.
But one can never ‘enjoy’ it. I tried to think of it as not having the power to detain on my own — I couldn’t do that, as I could only make applications to detain if I had the two medical recommendations (or one in an emergency — although I never used section 4) but rather, I did have the power, on my own, to make a decision not to detain. And I did make that call when I had two medical recommendations in my hand, on a few occasions. That is what it is about — it’s about knowing that you have explored all alternatives and can make a decision not to detain.
The support from the other ASWs/AMHPs (the switch happened just a couple of months after I was first warranted) was unfailing. They were a good bunch and we had excellent training and support within the LA and trust. There is mandated CPD that all warranted AMHPs must complete on an annual basis so we had to have time made for us to attend, and it was always good to catch up with colleagues in other parts of the organisation. My direct line manager was an AMHP as well, which helped and I had separate clinical supervision from a senior social worker in one of the general adult CMHTs which helped me with the non-specialist work I did.
I also, and I’m almost sad to say this, definitely had a different response to some other MH professionals (er.. medics mostly) when they knew I was an AMHP — they did treat my opinions with more weight than they had before the training — or maybe it was because I’d developed more confidence and understanding of the area.
There wasn’t a Mental Health Act assessment I attended without my stomach making knots and feeling my familiar anxiety creeping up. I often pondered the significance of the act that I was performing on behalf of the state and it was never something I took lightly. But once I met the person and started talking, it was just about being a person and being human — although ensuring that the role was carried out with the clarity and honesty that was necessary.
So would I recommend anyone does the training? Yes. I trained reluctantly. I wanted to do the practice education course and was told I had to the ASW training first as it was a service need. I was a bit scared to be honest, thinking about the power I would wield. But it changed me and it changed me in a better way for having done it. We have power. But we can use it with humanity, honesty and humility. While I can’t ever say I’m the best practitioner or the most able or the most competent or the most knowledgeable, I can be honest and clear and do my best. And then I know I can make an awful period, as much about the person who is going through it, as possible.
I got my practice education training in the end, after a few more years. And I gave up my warrant when I left my job with the LA. But having had that experience improved my practice all round. It also allowed me to take my career in directions that would not have been possible or that I would even have considered without it. So if anyone is wondering, yes, do it. Learn from it. And be the best you can be at it because it really does make a difference.