The role of Local Authorities in the mental health act
A couple of days ago on Twitter I saw a tweet from @Andy_Bell_ (Andy is the Deputy Chief Executive at Centre for Mental Health) We have never actually met in the real world but have exchanged tweets here & there.
Andy’s tweet was in response to a tweet from @ClaireCNWL (Claire is a national director in the NHS & again we have never actually met in the real world but are connected by twitter – I know, check me out ;-))
Anyway Claire’s tweet was about the NHS England Mental Health Plan & Andy wanted to know if there were some key questions that @MH_Challenge local authority member champions should be ask of their clinical commissioning groups and mental health trusts in relation to implementing the plan.
I am afraid at that point I couldn’t resist the opportunity & jumped into the conversation with both size 10s – banging on about the use of out of area beds in Private for Profit Provision (P4PP) & about the conveying arrangements for people following on from a Mental Health Act Assessment (MHAA) and suggesting that that member champions should visit their Approved Mental Health Practitioners (AMHPs). Job done and this disruptive innovator wandered of into the twittersphere . But no Andy called my bluff & here I am writing another blog about crisis mental health “pathways”.
There are only so many ways even a grumpy and pesky AMHP can say the same thing – but here goes.
When you think about crisis “pathways” what do you actually think?
I suspect like most people you think about the NHS and about doctors and nurses and I fear that many of you somehow envisage the girls and boys in blue being part of the equation.
Now you are sort of right about the doctors and nurses and I fear that because of “deflected demand” (I will come back to that term another time) that the police are overly involved in the pathway. But I doubt any of you actually thought about the Approved Mental Health Professional (AMHP)? Or thought about Pink Forms or thought about CCG commissioning arrangements for conveying patients to hospital.
You might have thought about the Mental Health Act & about people being “sectioned”. But I doubt you thought about the Code of Practice or have given much thought to how the state actually goes about “sectioning” someone.
I suspect you hope/imagine that somehow those tasked with this job simply crack on and that the infrastructure and resources they require to do the task are available to them and that multi agency working is a real thing because it looks good on a process map.
Well here is a wakeup call: they are not and each agency is prioritising increasingly scarce resources & too often stuck in the middle of that mess (sorry care pathway) are the AMHPs.
The NHS is responsible for the commissioning and delivery of mental health services. Most of us who have mental health issues are seen & managed by our GPs and if we need more we are referred on to secondary services e.g. Community Mental Health Teams (CMHTs).
If primary and secondary care don’t work out and we become so unwell or distressed that we require a Mental Health Act Assessment (MHAA) the AMHP is requested to step in.
But AMHPs don’t actually work for the NHS; they tend to be almost exclusively Local Government workers. That’s right, these Local Government pen pushers are the vital component in MHAAs. AMHPs are tasked with coordinating MHAAs and the state has invested in them the duty and powers requited to deprive a person of their liberty, if they meet the legal criteria for detention. It is a huge responsibility. Unfortunately the state has also mostly neglected to give these AMHPs the resources or means to do the job expected of them.
If you are a mental health champion for a local authority and you want to really understand this, then go and spend some time with your AMHPs.
Imagine being in someone’s house uninvited and telling them that you are going to detain them under the provisions of the MHA. But hang on a minute, the NHS doesn’t actually have a bed, so would you be good enough to hang around please? And when there is a bed would you be good enough to let us back in please? And now there is a bed would you be good enough to wait around a few hours until the ambulance turns up to convey you please? Oh, and by the way that bed is 100 miles away….welcome to the world of the AMHP & spare a thought for those on the receiving end of all this.
The use of out of area beds was best described recently by Dr Mike Hunter (@DrMikePsych) as “deporting” people. Quite simply it is a rotten idea on lots of levels. Yet it is an everyday practice. This needs to be challenged by you. You need to be asking your local CCGs why they are transporting/deporting your constituents, sometimes 100s of miles away. You need to ask the CCG if they support the families of these adults and children to visit when they are placed out of area.
We all need to campaign to ensure that this practice stops and request that the £s being spend on out of area placements be better invested in local NHS provision and alternatives to hospital e.g. crisis houses or cafes.
The police in general and @MentalHealthcop in particular deserve great credit for driving the NHS to improve the interface between the NHS and the criminal justice system. But what have local authorities done? I happen to know that most Deputy PCCs are local councillors and that many local councillors sit on various NHS boards – so you are in the rooms and can ask the questions and influence the decision making.
There has been an awful lot of rhetoric about mental health in recent years. There have been lots of plans and lots of campaigns. But the reality does not mirror the rhetoric and there is loads that needs to be done.
My challenge to you is a simple enough one. Go visit your AMHPs. Listen to them and understand the issues and then go and challenge your local NHS to step up – please.