Where an Approved Mental Health Professional has completed a Mental Health Act assessment and decided to ‘section’ a patient, it’s not uncommon to encounter difficulty identifying an available psychiatric bed. This is an understatement, to be fair – in my more recent experience, it’s rare to find a bed is available in less than “several hours” and things often become very difficult. In that situation, our intrepid AMHP is unable to make an application because we wouldn’t yet know to which hospital the application would be made, so they are often left juggling risk and uncertainty until such time as the NHS bed managers identify a bed.
And I’d be letting down all those AMHPs I know and love if I didn’t remind you here: it’s NOT the AMHP’s job to find the bed!
This responsibility sits with the lead doctor in the MHA assessment and in practice, that responsibility is delegated to an NHS bed manager who can be a relatively junior mental health nurse whose job is to juggle four plates for a living, using only three sticks. I know bed managers who’ve ended up in Coroner’s courts having to explain bed situations along with why they often spin plates with fewer sticks than necessary and wondered why the doctor wasn’t there explaining it – it remains their legal responsibility, after all!
Meanwhile, back in AMHP-land we could reach a point where the AMHP needs to go home – some bed searches take days. Dare I say it? – some bed searches take weeks and the person remains in the community or in the care of organisations like the police or an Emergency Department until one is found, with everyone fretting about the risk going un-managed and / or the expiration of legal powers to hold people and keep them safe. I heard this morning about a response team starting duty at 0700hrs and they inherited an expiring s136 detention which would run out at 1000hrs with no sign of a bed anywhere in the United Kingdom and what we expected the police to do at 1000hrs remained unclear. Eventually, the promise of a bed started to flicker and we were all attracted by the light in the darkness. One officer said, “We’d best contact an AMHP to sign the paperwork” and off they went to make a phone call.
AMHPs EVERYWHERE
Now, here’s the rub: unless you happen to ring the AMHP office and chance upon the very same human who AMHP’d the first Mental Health Act assessment, you may find a new AMHP being allocated to the case and what is rarely remembered, they will have to undertake a new assessment of the patient if they are to put their warrant card and signature against a legal application to seek someone’s admission under the Mental Health Act. It may not take too long and will probably not involve reconvening doctors because the medical recommendations for admission made during the original assessment will last for fourteen days after they are mdae.
But the new AMHP will need to see the person – this is actually a legal requirement. Section 11(5) MHA states –
“None of the applications mentioned in subsection (1) above shall be made by any person in respect of a patient unless that person has personally seen the patient within the period of 14 days ending with the date of the application.” [My emphasis.]
During the COVID pandemic, where the world suddenly had to get very practical very quickly around proximity requirements, there was a spate of local authorities suggesting that MHA assessments could occur via videolink and it eventually led to a legal case. It can’t – the requirement to have “personally seen” means people in the same room as each other, not using Zoom.
So when the bed is found and an AMHP re-engaged, it needs to be borne in mind it’s not just a case of whipping out somebody else’s partially completed paperwork and sticking your signature where theirs would have gone. Police officers shouldn’t be surprised to find this is the case, because there are parallels with this in their work. So our second AMHP must travel to wherever the patient is and satisfy themselves the application remains justified and necessary. Apart from anything else, this is because things may have changed in the time since the original MHA assessment. It may have been the original AMHPs view that a patient remaining at home for mental health care by a community team was not a responsible way forward – hence the desire to make an application. Two days later, when things at home have gone better than expected and the patient seems somewhat improved, our second AMHP may legitimately think the application is no longer required and either decline to make it or to delay making it. There’s nothing “wrong” with this – it’s perfectly defendable practice, done appropriately.
The punchline here: don’t think that when beds are eventually identified after a problematic search, that we just need some unthinking AMHP to sign something – that’s not how this works. They must – by law – have personally seen the person and satisfied themselves of the need to still do what their colleague thought necessary earlier on.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 