AMHP Procedure

1. Using this Procedure

This procedure should be used by:

  1. Practitioners and managers working in Adult Care and Support teams and services; and
  2. Approved Mental Health Professionals (AMHP'S).

2. Introduction to the AMHP Service

The Approved Mental Health Professional service (AMHP service) responds to requests for Mental Health Act assessments to be carried out. They:

  1. Decide whether or not to carry out an assessment; and
  2. If so, make all necessary arrangements for the assessment to be carried out.

The service consists of:

  1. An AMHP Manager; and
  2. A team of virtual AMHPs, based in several locations across the borough.
The AMHP service works on a rota basis and social work practitioners not on duty fulfil a range of social work functions under the Care Act in whichever team they are ordinarily based.

3. When a Mental Health Act Assessment may be Required

A person may need to have a Mental Health Act assessment when:

  1. There is an acute and critical deterioration in their mental health; or
  2. There is a gradual decline over time that has reached a critical point; and
  3. The person or those people around them are at significant risk of harm as a result of their current mental health.

The following are just some of the things that could indicate a person's mental health has deteriorated:

  1. Increases in challenging behaviour towards others;
  2. Increases in actual, or threats of self harm;
  3. High risk self neglect, for example refusing food or drink;
  4. A point of carer breakdown is reached or imminent.

4. Before Contacting the AMHP Service

The following steps should, wherever possible all be taken before contacting the AMHP service:

  1. Identify possible causes;
  2. Explore other solutions; and
  3. Consult the Consultant Psychiatrist.

Identify possible causes

The table below sets out some of the factors that can lead to changes in a person's mental health. It is important that you rule these out, and take any appropriate alternative action before contacting the AMHP service.

Step to Consider Example Advice
Could there be a medical reason? An infection (e.g. a UTI), an injury, an illness If there is, or may be a medical reason the urgent advice and support of the person's GP should be sought.
Have there been changes in mental health medication? New medication, increases or decreases in dose If there may be issues with medication, the urgent advice and support of the person's Consultant Psychiatrist or CPN should be sought.
Have there been changes in circumstances? A new home, living with different people, relationship issues, bereavement, diagnosis of a serious health condition (e.g. Cancer). Other support, such as Psychology services may be more appropriate to support the person to manage the change in circumstances.

Explore other solutions

The AMHP service should only be contacted when it is clear that there is no alternative, less restrictive solution.

These could include:

  1. Support from a Home Treatment or Emergency Response Team;
  2. Additional respite for a carer;
  3. Changes to a care and support service;
  4. The provision of urgent care and support services;
  5. Reablement e.g. to support a person to learn a new medication regime.

Consult the Consultant Psychiatrist

Attempts should always be made to establish whether the person has a Consultant Psychiatrist.

If the person has a Psychiatrist you should make every effort to contact them in order to:

  1. Provide information to them about the situation;
  2. Agree whether they will respond; and
  3. Take their advice about the need to contact the AMHP service.

If the person's Psychiatrist is not available attempts should be made to speak with a Community Psychiatric Nurse (CPN).

If the Psychiatrist confirms that they will respond and arrange to visit the person, the outcome of their visit should be established before contacting the AMHP service.

5. How to Contact the Service

Contact details

If it is decided that accessing the AMHP service is the most appropriate and proportionate course of action you should follow local guidance to make the arrangements.

If you are unsure you should always consult with the AMHP Manager before requesting an assessment.

Wherever possible contact should be made in the morning, as this will allow any AMHP that is appointed to gather information effectively from other practitioners, and consult with those involved in the person's normal care or treatment.

Information that must be provided

The following information must be provided to the AMHP Manager;

  1. The reason that a Mental Health Act assessment may be needed;
  2. What possible causes have been explored and ruled out;
  3. What other solutions have been explored and why they are not appropriate;
  4. Whether you have contacted the person's Consultant Psychiatrist, and the advice given;
  5. What the actual or likely risks are to the person, and to others.
Need to Know
Risks should be evidence based, taking into account what has actually happened, or is likely to happen using existing information about previous incidences of mental health deterioration.

The AMHP Manager will determine whether an AMHP needs to be appointed based on the information that you provide.

If an AMHP is not appointed

If the AMHP Manager declines to appoint an AMHP they will provide you with advice about alternative solutions that should be explored, which you should act upon in a timely way. If these do not prove effective further contact with the AMHP Manager can be made.

If an AMHP is appointed

If the AMHP Manager appoints an AMHP to consider the need for a Mental Health Act assessment you may be contacted by the AMHP to:

  1. Provide further information; or
  2. To support in the assessment process (where there is a clear benefit).

You should co-operate with any requests made by the AMHP whenever it is possible for you to do so.

Making a record

A clear record of the outcome of any contact with the AMHP Manager must be made as soon as possible.

6. Practice Guidance for AMHP's

When appointed by the AMHP Manager to decide whether a Mental Health Act assessment is the most appropriate and proportionate course of action all AMHP's must:

  1. Apply the 5 overarching principles of the Mental Health Act;
  2. Have full regard to the Mental Health Act Code of Practice.
Principle Definition in Code
Least restrictive option and maximising independence Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery whenever possible.
Empowerment and involvement Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this.
Respect and dignity Patients, their families and carers should be treated with respect and dignity and listened to by professionals.
Purpose and effectiveness Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines.
Efficiency and equity Providers, commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. All relevant services should work together to facilitate timely, safe and supportive discharge from detention.

See the Mental Health Act Code of Practice.

If there is a possibility that the person with mental health needs may lack capacity the AMHP must also have full regard for the principles of the Mental Capacity Act.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, which explains the principles of the Act and how to implement them.

If a decision is made not to detain a person under the Mental Health Act the impact of any other action taken upon the person's liberty must be considered, and appropriate authorisation sought where any deprivation of liberty is likely to be unlawful.

See: Recognising and Responding to Deprivations of Liberty, which explains how to recognise a deprivation of liberty and the action that should be taken.

7. Following the AMHP Intervention

If a Mental Health Act assessment has been carried out

If the AMHP has arranged and carried out a Mental Health Act assessment they should:

  1. Complete an AMHP report, in line with local recording requirements; and
  2. Write a summary case observation; and
  3. Alert the allocated social worker or team.

If the person has been admitted to hospital under the Mental Health Act arrangements should be made by the allocated or duty social worker to cancel or suspend any care and support services that were in place.

If the person was not admitted to hospital:

  1. The AMHP should arrange any other mental health services that are needed (for example a Psychiatry consultation or intervention by a CPN); and
  2. The allocated or duty social worker should arrange to carry out any care and support functions required (for example, reassessment, urgent care and support, review).

If an assessment was not completed

If the AMHP decided that a Mental Health Act assessment was not appropriate or proportionate they should;

  1. Write a summary case observation setting out a clear rational for their decision;
  2. Alert the allocated social worker or team; and
  3. Arrange any other mental health services that are needed (for example a Psychiatry consultation or intervention by a CPN).
The allocated or duty social worker should arrange to carry out any care and support functions required (for example, reassessment, urgent care and support, review).