’m sure some of you are familiarwith this question: “Is anyoneavailable to be mentor for anapproved mental healthprofessional (AMHP) trainee?”

What is less familiar, however, is when thequestion is followed by, “oh, and by the way,the trainee is a qualified occupational therapist(OT) … and, oh, did I tell you that she is also avery experienced team lead in her discipline?”

I have acted as mentor for approved socialworker trainees several times before, under the1983 Mental Health Act, but on this occasion Iwas curious to have an occupational therapistcome to our small but active team here inCornwall. This change was facilitated throughthe 2007 (November 2008) Mental HealthAmendment Act which allowed for otherdisciplines to train and be approved to work asco-ordinators and key decision makers withinmental health act assessments.

The previous candidates I have been a

mentor to have been fully qualified andexperienced social workers from communitymental health teams and carried considerableexperience of working with (and within) themedical model of psychiatry.

I have noticed that for some workers, thetransition from the medical model to one ofrights and safety based work, with a focus onthe Human Rights Act and the practicechanges since the Bournewood ruling, resultedin a degree of initial hesitancy. They haveflourished, however, once they have graspedthe concept of rights and liberty, and inparticular the role the AMHP can play in thedevelopment of the least restrictive, if not theleast convenient, practice.

So I was very interested to see how my firstcandidate without this background would farein the ever changing world of community care,faced with the twin challenges of dealing withreduced hospital provision within the NHSand of identifying abuse by staff in hospitals of

those patients who are formally detained as aresult of their mental impairment.

The placement itself was to be a part of thedeprivation of liberties team here in Cornwall.The team covers the whole of Cornwall andresponds to all Mental Health Act andDeprivation of Liberty Safeguard referrals forthe people of Cornwall who are outside thecommunity mental health team contract; thatis to say, those who are over retirement age,children up until the age of 16-years andpatients of all ages with learning disabilitydiagnoses.

There are seven full-time posts and one half-time post in this team. All are approvedmental health professionals and all are alsobest interests assessors. The team meetsperiodically for discussion and reflect on newcase law. We have access to out of countyadvice from the trainers of Mental Health Actcourses and our team is supported by twoadministrative staff and one manager.

I

Mike du Feu discusses an eye-opening experience of mentoring an occupationaltherapist within a social work team, discovering in the process the skills other

professionals can bring to an area of practice traditionally dominated by social work

What did the OT sayto the AMHP ...

14Professional Social Work • June 2012

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state control and the potential for overlookingan individual client’s right to self-determination. Several of the cases she has haddirect experience of have involved helping tosupport vulnerable people in complex and highrisk scenarios, including ‘absconding’ duringan assessment, threats of harm to staff andalso sudden changes to established assessmentarrangements.

Val has an especially keen perception on howothers might respond emotionally to the stateremoving the client, or how the family may be

distressed in these circumstances. She is alsovery sensitive to the client’s need for objectiveand supportive safeguards, such as the role ofnearest relative, noting that as a client’sjourney in life unfolds, circumstances mayemerge where the official nearest relative couldbe unable to represent them fairly andobjectively.

Val managed to engage with the distressedclient, and considers her duties important tofollow through. She offered sufficient respectand time to allow clients the opportunity toadjust to the interview styles. She has alsoallowed clients to dwell on certain factors,without trying to rush the patient and thusavoid an impulsive decision.

It will be no surprise to the reader that Ihave not previously been a mentor to aqualified and experienced occupationaltherapist. This has been a learning experiencefor me too. Val has been able to assessdomestic risk skilfully and, in one particularcase, I believe her previous learning and skilfuljudgement helped at least one patient to avoidcompulsory removal to registered residentialcare. I was confident at the time that the risksof harm were great; indeed I was alarmed bythe apparent risk of the client burning herselfon her own cooker while making us all a hotmilky drink. I will confess that I hadconsidered turning off the gas at the mains butVal used the time to observe and analyse theclient’s domestic skill retention level, and howrecent brain changes may have reduced herown safety and hazard awareness.

On reflection, I was able to realign myconcerns and the formal application forguardianship was avoided. Val was also quickto identify workable ‘alternatives to hospital’and was able to distinguish between those

cases where a patient would need detention onsafety grounds, and those that could besupported in the community.

I was impressed by her ability to recognise aperson’s posture and gait, and how they couldbe at risk of falling if they were prescribedsedative medication. This is a valuable asset inher work, particularly given the developingsocial trend to assist older people to remain inthe community as long as possible. It is usefulin encouraging other professionals to acceptrisk through building risk management careplanning which, in my experience, has formany years been the more conventionalresponse of the medical model.

Val worked hard in this placement to designand produce effective statutory reports. Thiswas initially quite a challenge for her as shebelieved she knew so little at the beginning ofher placement that others, includingmagistrates, would already know much morethan her. An afternoon at the magistratescourt, presenting evidence for ‘Search andRemove’ authority soon reassured her that notall public officers have a greater understandingof law and, as an AMHP trainee, Val wasalready more knowledgeable than many in themental health network.

It has come as a surprise to Val that manyother MH and generic professionals kneweither very little about the Mental Health Actor that their knowledge was so narrowlyfocussed on their own roles and tasks that theyappeared to know little about the correlationbetween the Human Rights Act, the MentalHealth Act and the Capacity Act.

During her placement in our team, Val haslearned how AMHPs refer to the MHA andCode of Practice in the R. Jones Mental HealthManual, and how to draw on her knowledge toensure that when an official reads her reportsnow, they are comprehensive, explanatory andinformative. The reader can identify thethemes of that case and the report leads thereader to an informed conclusion. Val has donewell to achieve this as she been more used toan economic style less suited to a tribunal or acourts of law hearing.

The experience has shown that anoccupational therapist can show the necessaryconcern for welfare, liberty and a flair fordecision making. Val has completed hertraining as an AMHP but this has not madeher a social worker. She is very much an OTand, now, an Approved Mental HealthProfessional. I wish her well as a futurepractitioner.

Mike De Feu became an approved socialworker in 1991. He has worked in learning disability teams, adult mental health teams andnow spends most of his professional time working in the Deprivation of Liberty Team.

15working with an OT June 2012 • Professional Social Work

This team is very busy. We have nocaseloads as such, but we accept referrals forboth Deprivation of Liberties Safeguards(DoLS) and MHA assessments throughouteach working day, Monday through to Friday.Any work outside this period falls to the HomeTreatment Service, commissioned throughCornwall Council but delivered by NHSlocated AMHPs.

Our work is varied, and our assessmentsinclude admissions to hospital for assessmentor treatment, place of safety orders and

community treatment orders (CTOs). Someof the changes in the MH Act are alsoemerging in our work, with an increase inreferrals for guardianship due to the new‘power to convey’. We also receive requests forDoLS authorisations in hospitals andresidential care homes locally.

It was against this backdrop that I embarkedon working with Val, an occupational therapistwith a difference. It became a very interestingyear, not least because the courses available forAMHP trainees in the south west do not yetincorporate other disciplines. We are in the farsouth west, and the nearest university that canaccommodate Val is in Kent! She had to traveland become resident in Kent for the taughtelement. Fortunately, Val had alreadycompleted the Best Interest Assessors Coursein Bristol, (for DoLS) so had some very clearunderstandings of liberty and how importantthis is both constitutionally and to individuals– especially to ensure that state agenciescomply with the Human Rights Act.

It soon became apparent that the firsthurdle was that people did not know whattitle to allocate Val. In the wider communitythe cultural expectation is that an AMHP willbe a social worker, not an OT. Theadministrative documents are also formattedfor a social work signatory.

Val had several opportunities to engage indirect observation and practice, with myselfand other AMHPs within our team. Sheactively participated with referrals in ruralareas of Cornwall, in town centres and also insome hospital situations.

My impression is that the Deprivation ofLiberty Safeguards training she had alreadysuccessfully completed helped Val to grasp therisk of unwarranted and unjustified potential

I WAS IMPRESSED BY HER ABILITY TORECOGNISE A PERSON’S POSTURE ANDGAIT, AND THE RISKS OF THEM FALLING IFPRESCRIBED SEDATIVE MEDICATION

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