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We interview three practitioners working in adult mental health and discover the familiar challenges they face and what continues to motivate them.

What is involved in working as an AMHP?

Essentially, it involves making certain legal decisions and applications under the Mental Health Act 1983 (MHA). AMHPs are responsible for MHA assessments and it is our duty, once medical recommendations have been made, to decide whether or not to make an application for the detention of the person who has been assessed.

I’ve seen a lot of changes since qualifying as an Approved Social Worker (ASW) in 2004. Up until ten years ago, it was purely ASWs who made such decisions under the MHA. But in 2007, amendments to the law allowed other mental health professionals to undertake this role. Although the majority of AMHPs are social workers, psychiatric nurses, occupational therapists and psychologists can train to become one.

What is the most rewarding aspect of the role?

Mental health affects such a large percentage of the population. Helping somebody along the path from crisis to recovery makes it a very rewarding job; seeing them progress through illness to become independent or giving them the support to progress in their lives.
How do you remain personally detached? 

You need to be very balanced in the way you work. It’s not easy, but professionally, most AMHPs are trained to empathise with the patient without getting emotionally involved. This ensures we are best positioned to help the person in crisis. 

What are the main challenges of supporting those who have experienced their first episode of psychosis (FEP)?

Determining what has been going on in the person’s life prior to becoming unwell. Sometimes what the person communicates to you can be bizarre, but there are ‘truths’. Despite someone being paranoid, building an initial good relationship is very important. How you relate and not being judgmental is essential.

‘Illegal Highs’, skunk and crack cocaine are major challenges. Working within a hospital setting, I know just how difficult it can be to manage illicit drug taking within hospitals. The misuse of substances can hugely impact the effectiveness of anti-psychotic medication. The quicker you get the person to access appropriate medication, the better. Medication doesn’t always work though. It’s also important to listen and check whether the person is concordant. Some people believe that the illegal substances can help when it may have been ‘masking symptoms’.

The number of people turning up at A&E to be ‘processed and assessed’ is very challenging.

It’s important to give clear information about what is happening to the carer; the services on offer to them, their rights to an assessment and information on how to cope, together with emergency contacts. Information needs to be supplied in various formats; verbal, written, and in the appropriate language.

What support do you offer carers?

People caring for adults with FEP can spend an average of 6-9 hours per day providing care. Caring can be a strongly positive experience, but it is often associated with burdens that are subjective (perceived) and objective; for example, contributing directly to ill health and financial problems or in displacing other daily routines. Yet, the ability of a carer to cope can have an impact on the recovery of the patient.

Reassuring them that they are able to cope, is crucial. Often, they’ll telephone many times a day asking for advice until they learn to cope. From my experience, I believe carer-focused interventions should be considered as part of integrated services for people with severe mental health problems. This improves the experience of caring, quality of life and reduces the psychological distress of the carer. 

Things get lost in communication. Nurses may not know the full background of the person they are assessing or have the time or the opportunity to speak with other colleagues or access the complete records held.

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