AMHP Procedure
This procedure should be used by:
- Practitioners and managers working in Adult Care and Support teams and services; and
- Approved Mental Health Professionals (AMHP'S).
The Approved Mental Health Professional service (AMHP service) responds to requests for Mental Health Act assessments to be carried out. They:
- Decide whether or not to carry out an assessment; and
- If so, make all necessary arrangements for the assessment to be carried out.
A person may need to have a Mental Health Act assessment when:
- There is an acute and critical deterioration in their mental health; or
- There is a gradual decline over time that has reached a critical point; and
- 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:
- Increases in challenging behaviour towards others;
- Increases in actual, or threats of self harm;
- High risk self neglect, for example refusing food or drink;
- A point of carer breakdown is reached or imminent.
The following steps should, wherever possible all be taken before contacting the AMHP service:
- Identify possible causes;
- Explore other solutions; and
- Consult the Consultant Psychiatrist (where their details are known).
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. |
The AMHP service should only be contacted when it is clear that there is no alternative, less restrictive solution.
These could include:
- Support from a Home Treatment or Emergency Response Team;
- Additional respite for a carer;
- Changes to a care and support service;
- The provision of urgent care and support services;
- Reablement e.g. to support a person to learn a new medication regime.
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:
- Provide information to them about the situation;
- Agree whether they will respond; and
- 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.
If it is decided that requesting a Mental Health Act assessment is the most appropriate and proportionate course of action you should do so using the following guidance:
- Process for Requesting MHA Assessments;
- One Page Practitioner Guide to the Requesting an MHA Assessment Process.
Both can be found in the Local Resources area.
If the AMHP declines to complete an assessment 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 can be made.
If the AMHP decides that a Mental Health Act assessment may be necessary you may be contacted by them to:
- Provide further information; or
- 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.
A clear record of the outcome of any contact with the AMHP must be made as soon as possible.
When determining whether a Mental Health Act assessment is the most appropriate and proportionate course of action all AMHP's must:
- Apply the 5 overarching principles of the Mental Health Act;
- 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.
The following locally developed resources and guidance can be found in the Local Resources area:
- Joint Policy for Police Assistance to Mental Health Act Assessments;
- AMHP use of Private Ambulance Conveyance following a Mental Health Act Assessment;
- Procedure for Remote Application Section 135 1 MHA 83 Teeside Magistrates;
- Mental Health Act Leaflet.
If the AMHP has arranged and carried out a Mental Health Act assessment they should:
- Complete an AMHP report, in line with local recording requirements; and
- Write a summary case observation; and
- 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:
- The AMHP should arrange any other mental health services that are needed (for example a Psychiatry consultation or intervention by a CPN); and
- 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 the AMHP decided that a Mental Health Act assessment was not appropriate or proportionate they should;
- Write a summary case observation setting out a clear rational for their decision;
- Alert the allocated social worker or team; and
- 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).
Last Updated: January 3, 2023
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