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‘Shifting sands and thinking on your feet’: a day in the life of an AMHP

August 4, 2020 | Written by Frances Folkard

This is a guest blog by Frances Folkard, an Approved Mental Health Professional (AMHP).

Our days are mostly about arranging and conducting Mental Health Act Assessments. Any AMHP will tell you “a day” is never the same as any other.

Conducting a Mental Health Act Assessment is like setting off on an expedition. The AMHP thinks: “I am trained for this, I have some tools, I am as prepared as I can be. I have gathered the troops and 2 doctors, I have a destination sorted, the bed and the possibility of assistance, with an ambulance if needed” and off you set.

Conducting a Mental Health Act Assessment is like setting off on an expedition.

But what you don’t know is: “how is this going to end, or when?” – so many dilemmas & variables ahead, ‘shifting sands’, thinking on your feet; unanticipated things presenting.

And you hope for some good luck, because you’ll need it!

Let me tell you about a situation I was recently involved in.  We received a referral for a 28-year-old woman who lives alone – we will call her Kiri. She has a diagnosis of bi-polar disorder, has cardiac problems and has a mild Learning Disability.

Kiri started becoming unwell a few weeks ago and is now beyond treatment in the community. The referral tells me she “is paranoid, suspicious & aggressive – believes food is poisoned and has stopped eating”. Kiri rings her Mother constantly throughout the day.

Was there need for a Mental Health Act Assessment? Yes. I emailed doctors, none were available that day.

Thursday. One Psychiatrist could do 5pm. I finally found another who could do that time too.

I met one Psychiatrist outside the woman’s home. We waited. I texted the other, she was delayed getting PPE.  I rang and asked if she could get some for us and the patient – a kind woman, she already had. She arrived. The patient’s mother said she has a key and could let us in. I reserved that as a fallback preferring to knock and see if Kiri would let us in herself.

We could hear loud talking. We knocked and knocked, called through the letter box, telephoned. No reply.

I rang the patient’s mother, she came, opened the door with her key and disappeared again. We entered the hall and said hello, heading towards the stairs thinking she was upstairs. But no, Kiri was in a room to the left back of house, sitting on sofa with cat on her lap. She jumped up, slammed the door, and shouted at us to get out. We explained why we were there and wanted to talk to her – “No, get out. You’re Nurses, you’ve lied to me, go away”.


Dr A has a soft kind voice and told Kiri she was a doctor. She became aggressive in manner, shouted at us to leave and said she knew us very well – we had not met her before. She told us to go or she would call the Police. We said to call the Police and tell them we are here. She rang 999. We could hear her giving her address. We ask: “Please tell them Dr A is here”.

I went outside and rang 101; I told Police that Kiri was on a 999 call to them and that we were in attendance for a Mental Health Act Assessment. I asked them to link both calls on their system. We told her we were leaving and left.

The Psychiatrists felt they had enough to write a joint medication recommendation. We sat in Dr A’s car. We then heard Kiri’s voice shouting on the street saying that her father had raped her. Dr A approached the patient’s gate smiling and said: “I am Dr A, we have not met before, I am very pleased to meet you”. Kiri shouted back: “you are my father”. Dr A, from Nigeria, said: “look at the colour of my skin, do you really think I am your father?” Kiri replied: “you are a cross dresser, you are a fake, you are my father” and went inside.

The exchange confirmed our assessment. Back to the car to continue. A Police car then arrived. It was a PC responding to Kiri’s call to Police. He knocked on the door, but she did not reply. I asked for his mobile number as I might need his help when the ambulance arrived – Kiri’s mother told me she put up a lot of resistance last time.

lots of people in the terraced houses on both sides of the street came out and clapped for the NHS, but Kiri did not emerge.

He gave me his number. Papers were completed at 19:15. I rang SWAS (South Western Ambulance Service) and requested an ambulance. They said they would try to attend within the hour. The Psychiatrists left.

The Police officer stayed on the street. At 20:00 lots of people in the terraced houses on both sides of the street came out and clapped for the NHS, but Kiri did not emerge. I rang the ambulance for an ETA – it had not yet been allocated. I was told that one was on its way to us at 19:50, but it had been diverted to a cardiac patient.

At 20:10 a triage doctor from SWAS rang me and asked if a PTV (patient transport vehicle) would suffice. I explained that Kiri has a cardiac condition and I wanted a paramedic crew in attendance in case anything happened on the way, short journey as it was.

From the moment I signed the AMHP application form the patient was in my custody.

I stood there thinking not only: “what if she doesn’t answer the door and let us in?”, but: “what if she locks the door from the inside so her mother’s key won’t be able to open it from outside?”.

Would we have to go to court & get a S135(2) warrant? Oh no.

The PC and I shared concerns and all kinds of anticipated problems.

At 20:45 the ambulance arrived. A 2-person crew. A woman driving & a tall dark-haired young man to approach the patient. He geared up. We agreed the PC would go in first, me behind him. I was going to tell Kiri that the doctors and I are concerned she is not well and that we think she needs a period of assessment on X Ward etc. I would not tell her she was detained, for fear of increasing her stress or affecting her cardiac condition.

The PC and I shared concerns and all kinds of anticipated problems.

We knocked on the door. No response. The PC talked through door, all quiet. I rang the patient’s mother – she had been parked nearby; she came and gave me her key, then she ran off again (fortunately she owned the house).

Phew! Kiri had not locked the door from the inside and left the key in the lock. We got in.

Kiri was standing on the second from bottom step on the stairs. She looked cross. I explained what was going on and ended saying: “so Elliott has come with an ambulance to take you there”.

She took one look at Elliott, the male paramedic, and her face broke into a wide beam. She trotted towards him in bare feet, not interested in finding slippers or shoes. She boarded the ambulance without difficulty.

At that point she looked like a young girl, a hint of her learning difficulty becoming apparent.

And that was the luck. Had it been Elliott driving and his female colleague approaching the patient – it could have been a completely different set of circumstances.


Kiri was admitted to hospital safely.

Share your social work story at stories@socialworkawards.com telling us your name, job, contact details and social care number (just so we know you’re a social worker, we will keep it private).

A Plumber’s bag and ten extra minutes

July 30, 2020 | Written by Gary Spencer-Humprey

I will always remember my consultant social worker comparing social workers to plumbers. ‘Just like a plumber can’t do their job without their plumber’s bag, said Jo, ‘a social worker can’t do their job without their social work toolkit’.

Armed with knowledge and skill, they also need various tools… to get the job done.

A plumber needs a range of tools and equipment to successfully change that pipework, install your new sink or unblock your washing machine. Armed with knowledge and skill, they also need various tools such as a pipe wrench, faucet key and plumber’s tape to get the job done.

Just like our social work training equips us with the theoretical knowledge and skill to work as social care professionals, social workers too need their own toolkit bags. Taking a few moments to reflect that I was indeed working in a social work team and not a building site, it all clicked into place when I started to build my own social work tool bag. No one can tell you what to put in your tool bag, it’s your bag. Some may have support plans, a pen and a consent form. I had colouring pens, an A1 size flip chart pad and Sharpies. 

I was privileged to work in a new, social work-led mental health, forensic and substance misuse team for my first year as a qualified social worker. In this team we worked with people and change; we would work with resistance, distress and ambivalence.

We ran social work and peer-led groups sessions weekly and linked with our local community to offer opportunities to adults living with mental illness. We also supported people with enduring mental illness into voluntary work and some into paid employment – it was the best year a newly qualified social worker could ask for.

An alternative approach

In this team, I was introduced to an alternative (or creative) approach to social work under the tutorage of my assessed and support year in employment (ASYE) practice educator Lawrence Taylor. 

He always helped me try and see and feel what it would be like to be in the shoes of the people I work with. How would I want to be treated or assessed?

I recall once time working with Sam, a 18-year-old adult with autism, obsessive compulsive disorder and bulimia. Sam rarely spoke but when he did, it was only about philosophy or space. Sam preferred texting, emailing or drawing, but again it was mostly around his areas of interest. 

I opted one day to bring in my brand new pack of Sharpies and an A1 flipchart pad; we had a semi directed session about the future and goals and each took it in turns to ‘share and tell’ out picture with a narrative.

At the end of a 60 minute assessment, Sam has drawn what his worries were, his fears, his plans for the next six months, his five-year goal and what he wanted to achieve from his social worker.

Sam has drawn what his worries were, his fears, his plans for the next six months, his five-year goal

They were all pictures, but Sam was empowered to tell me in his narrative whilst I quickly jotted down these important points on my pad. When reflecting back to me what each picture meant to him, we were able to hold a short, but meaningful conversation about what would evenly lead to his support plan.

I was able to complete a detailed assessment of his needs, wishes and goals and we worked closely for the next few weeks towards getting Sam back to college. The A1 pad and Sharpies were now my wrench in my social work tool bag. As the months and years pass, I’ve added small figurines, toy cars, characters from the film Inside Out, MoodCards and a pair of magnets. 

Time to plan

Fast forwording four years to 2020, I had moved on from my social care mental wellbeing team into a seconded Approved Mental Health Professional (AMHP) Hub. Along with this came the more legalist approach of social work assessment in the form of Mental Health Act Assessments.

I feared my ‘Plumber’s bag’ would be out of action for some time, having to coordinate the detailed assessment undertaken with doctors under the Mental Health Act and facilitate the safe admission or home care of individuals in a mental health crisis.  

As Covid-19 restrictions came into place, the AMHP hub continued to operate 24 hours a day, seven days a week. As other friends and colleagues were working from home, reviewing individual and families remotely, AMHPs were still very much out conducting face-to-face assessment (or interviews). 

The county I serve is a mixture of rural and urban, the drives often require a scenic and traffic heavy route through the South Downs. During the Covid-19 restrictions with less traffic on the road, I found myself getting to places with extra time to spare (which in reality meant on time, as a social worker, I’ve always been working 10-15 minutes late since starting this career).

Having this extra time meant that I had opportunities to plan for my intervention a little more.

Alternatives to talking

I recall one day planning to assess Betty, who was in hospital under section 2 of the Mental Health Act 1983. Her consultant has asked for an AMHP and second doctor to assess to consider if Betty should now become subject to the provision under section 3, as she required a longer period of treatment. 

Betty was 40-years-old. I was fortunate to have assessed her the previous month, so knew a little about Betty’s history. She was assessed under the Mental Health Act and detained under section 2 following a lapse of her illness and what is being described as selective mutism. She would not talk. 

When I assessed Betty the previous month, I tried a variety of different approaches including writing, drawing and eventually using my laptop to type a variety of closed and open questions to which Betty was able to respond – this indicated to me that she was able to read and felt more comfortable responding to written questions / using alternative communication methods. 

Whilst waiting for my independent section 12 approved doctor, I was thinking about how I could be as inclusive as possible to Betty in her assessment rather than reply on my laptop. The Code of Practice for the Mental Health Act chapter 14.42 directs AMHP is to consider alternative communication methods to increase participation of the assessment and to break down barriers to maximise the person’s involvement in the assessment.

Rekindling creativity

I decided to have a look in my Plumber’s bag in the boot of my car. I found my MoodCards; I selected a variety of moods and emotions from the pack (which you can see from the picture range from positive moods/emotions such as happy, hopeful, satisfied to negative moods/emotions such as sad, worried, depressed et cetera). 

At the beginning of the assessment MoodCards were introduced to Betty along with the purpose of the cards. I made sure they were in reaching distance from Betty and I also made no further reference of drew any attention to them for the rest of the assessment (as a means of using them as a semi-directed prop). 

After approximately 30 minutes, and during a protracted period of silence, Betty reached for the blue ‘Sad’ card and said: “I feel sad,”.  She then replaced this and picked up the orange anxious card and Betty said: “I feel anxious too”.  These two cards open a meaningful, but limited dialogue with Betty talking further about the feeling of unease and worry on the ward.

An extra ten minutes

You may not see from the picture, but unease and worry were not emotions or mood that were on these cards. We had a small conversation and the doctor made some suggestions about medication which could reduce her feelings of anxiety. 

By unpicking her emotions, I was able to glean an understanding of her current thinking pattern without the need for a protracted and detailed dialogue

This intervention worked particularly well at encouraging Betty to talk about her emotions, which had been unsuccessful in previous standard assessment approaches. By unpicking her emotions, I was able to glean an understanding of her current thinking pattern without the need for a protracted and detailed dialogue, which Betty has previously found difficult. 

Whilst Covid-19 has impacted a range of services which has been awful and distressing for many, I have found having those extra ten minutes to plan for my intervention has been an opportunity for me to rekindle creative approaches to my practice as a social worker and an as AMHP.    

This is Hope: a poem by Katy Else aka The Unheard Bird

July 17, 2020 | Written by Katy Else

Katy Else aka The Unheard Bird, a social worker at Livewell Southwest and talented poet, has written ‘This is Hope’ for the people of Plymouth in response to the COVID-19 Pandemic, and to illustrate how communities have come together to support each other during lockdown.

Tell us your social work story at stories@socialworkawards.com telling us your name, job, contact details and social care number (just so we know you’re a social worker, we will keep it private).

We may be in the same storm, but we are not all in the same boat.

July 15, 2020 | Written by Jade Watson

This is a guest blog from Jade Watson, Social Worker for the Adults Social Care North East team at Shropshire Council.

Lockdown, for me, felt like a sudden shock, as though I was swimming amongst the waves representing the general conflicts both in social work and outside of social work, and then a tsunami hit me.

I had not recognised how much being in the office and talking to my colleagues meant to me; I joined the team in October 2019, and I have learnt that I am closer to my colleagues than I thought.

Although people may be in the same storm, we are not all in the same boat

In the Adults Social Care North East team, we have a buddy system, where we have been allocated one person to make an effort to contact during the working week. This has helped as, although people may be in the same storm, we are not all in the same boat. Each person has different circumstances and it is therefore helpful to talk about both work and social well-being with a colleague who is in the same line of work. We have also been having check-in meetings for council updates and to talk about team morale and adaptation.

Ensuring that we only went on essential house visits created an extra challenge. I was living on my own, so I isolated myself with my family and have been completing remote phone call assessments since lockdown. It seems so different having service users on my caseload who I have spoken to, but I have not seen in person.

I can recall going on a walk, as part of my daily exercise, around the start of lockdown, and coming across one of my encouraging primary school teachers. I explained my role and how I found it hard to not be seeing service users regularly. However, he thought that it was great that as a team we have been RAG rating (red, amber, green rating) people as part of a critical list and phoning them; adults who have been living alone have especially been appreciating this. I found this encouraging and it made me recognise that it is important to get up and think that, although working from home constantly is challenging, our work can mean a lot to those we phone, especially if they are feeling isolated.

 

Remote assessments

 

Completing phone call assessments has also allowed us as a team to reflect upon how we may be able to complete some re-assessments by phone call after lockdown if there has not been a lot of change and this can cut out commuting time.

When on duty I have also learnt that if someone requires an urgent Care Act assessment for them to have care in place immediately, a phone call assessment with the family and relevant professionals or carer can be more efficient.

For example, I experienced a service user who had no formal care in place but was being cared for by his daughter who needed to go to work. By liaising with the daughter and completing a remote mental capacity assessment, I was able to assess the service user’s care and support needs and ensure that he had a care agency supporting him as soon as possible.

Unfortunately, the service user ended up going into palliative care and dying, but the efficient response from the referral ensured that he was cared for and safe during the last few days of his life.

Remotely, I have adapted to providing well-written and robust risk assessments for when a service user’s placement was at risk due to a capital reduction in finances. I carefully listened to both her daughter’s account and the experiences of the carers within the service user’s care home, and how they had adapted to the service user’s challenging behaviours.

Well known around the care home for her assertive and feisty demeanour, the staff felt that it would be detrimental to place the service user in a different care home. Due to her dementia and her confrontational behaviours, it was observed that both her well-being and the well-being of staff and service users in a different care home would be compromised if she were to move.

Her daughter talked about how she had been previously been in a different placement but was asked to leave. However, in her current placement, her mother feels like she is at home.

Overall, I feel that lockdown has been a catalyst for re-assessing priorities and ways of working effectively.

Carers at the current placement ensure that they have one-to-one time with the service user to support her to feel calm and valued.

Originally, the care home was asking for £926 per week, but the manager said that she felt that she could not move anywhere else and the costs were brought down to £700 per week.

Overall, I feel that lockdown has been a catalyst for re-assessing priorities and ways of working effectively while best practice for those that we support are maintained, and for building upon and strengthening the resilience of the North East Adults Social Care team and Shropshire Council as a whole.

I have appreciated how colleagues, care agencies, and day services have thought creatively of how to offer extra support to those in need. For example, one of my service users has been provided with an activity box from a day service that he would not usually attend, who I liaised with.

It is positive to hear about day services reaching out of families and service users. I feel that after lockdown we will be grateful for the effectiveness of joint working throughout the local authority and that this collaborative work will continue.

Tell us your social work story at stories@socialworkawards.com telling us your name, job, contact details and social care number (just so we know you’re a social worker, we will keep it private).



Diary of a Director of Children’s Services: Part 2

July 7, 2020 | Written by Ana Popovici

Ana Popovici, Director of Children’s Services at Wandsworth Borough Council talks about clear lines of sight, the power of feeling safe and championing social justice.

During this crisis I had my first ever speed dating experience! This was with the Personal Advisers, social workers, participation and housing officers in the care leaving service. Each had a minute to put their question to me and I had a minute to reply, no more.

Our conversations and their stories highlighted for me the absolute need for a clear line of sight and connectivity between us all. This has renewed my commitment to making sure that my line of sight does not get blurred. And the outcome: we have got ourselves a commitment to a second date.

A big part of my role during this crisis has been in working with our community of schools and teachers. Our teachers and school staff have played a crucial role in supporting both their schools’ community and wider civic society in recent months.

The power of feeling safe

Many colleagues have suffered the loss of loved ones. Many have experienced heightened anxiety or even fear in the wake of this terrible disease. There is a risk of a pandemic anxiety settling in, including the fear of going outside or into public spaces which are not felt safe anymore.

Part of our recovery planning has to be to help people locally to feel safe again.

It reminds me of the transformative power of feeling safe. Part of our recovery planning has to be to help people locally to feel safe again. Then, now and in the future, our schools will continue to provide education, stability and continuity in a changed world.  

If there are positives that we can take from our experience of the pandemic they are that circumstances have forced us to work in new and innovative ways, that colleagues have worked together and communicated in a way that maybe they haven’t before, and that we have become more aware of each other’s vulnerabilities and more sensitive to the situation that we each find ourselves in.

It is hard to imagine that life will go back exactly as it was before the pandemic. In many ways, the forever optimist in me wishes that we will collectively learn from this and strengthen practices which have emerged in this crisis. I would like us to use this crisis to generate change for the greater good.

Championing social justice

As I end this blog, I want to reflect on the most recent events around the globe which have brought the whole world together aligned and focused in a call for justice.

I want to share vibes of hope at times of sadness, despair and uncertainty – feelings we have all experienced since the appalling death of George Floyd. I know that George Floyd’s story had made raw the daily lived experiences of many black colleagues, children and families across the world of how they have been treated at times.

Whilst we might all feel angered and frightened, with the pandemic of racism now being in the public mind alongside the virus pandemic and the anxiety pandemic, I know that together we can continue to champion the fight against injustice and condemn racism with those determined actions which are within our power to bring about.

Tell us your social work story at stories@socialworkawards.com telling us your name, job, contact details and social care number (just so we know you’re a social worker, we will keep it private).

Lockdown diary: ‘We have limited access to vulnerable children’

July 2, 2020 | Written by Temi Osonaike

This is a guest blog from Temi Osonaike, Senior Social Worker.

My alarm goes off at 8am prompt and I hop into the shower and shortly after, make myself a cup of green tea ready for the day ahead.

I have a table which I bravely collected from the spider web filled shed. I strategically placed this in my bedroom as this is the brightest room in the house.

I get to imagine I’m in a hot country, remote working…my imagination gets the better of me until I am rudely awakened by Microsoft Teams notifications. I am back in the comfort of my bedroom. I receive good morning messages from my team between 9am-9.15am and everyone is checked in and ready to commence their working day.

Checking in with children

“Hello Moto,” my work phone is switched on and phone calls begin to come in. Scheduled virtual visits with children and families subject to Child Protection and Children in Need Plans are under way.

For the most part parents and carers have been open to communication via WhatsApp video calls whilst others…well, the battle continues to ensure that the children are seen and heard.

 

The battle continues to ensure children are seen and heard.

Sighs of relief when I have checked in and seen that my children are safe.

In between phone calls and virtual visits I respond to emails, mainly from schools and health professionals, I share resources/tools with families and other colleagues, upload my case notes and meeting minutes and before I know it. 12:50 pm strikes. I receive an email reminder by my super team manager stating: ‘Team meeting starts in 10 mins, remember to log in to Microsoft Teams.’

Team meeting time

Whether we admit it or not, I for one look forward to connecting via MST with my team. I’ve observed a theme: one of my colleagues shares where her new location is during each meeting, on some days it has been Cuba, and other days it has been Colombia (in her dreams). Another of my colleagues doesn’t realise she is on mute and so we all gesture to her as if we are playing a game of charades that we can’t hear her, whilst another colleague logs in to the meeting in true social work style, a couple of minutes late.

My team manager quickly reigns everyone in and restores order to the video call. We discuss the feedback from the managers’ meeting and share our views on the impact this will have on our practice as social workers.

The meeting draws to an end, and everyone is reluctant to leave but true to our profession, we all quickly gain sight of the time and rush off (virtually) to our scheduled Children in Need review meetings or core group meetings.

At some point between the end of our daily team meetings and the end of the working day, I manage to top up on my cup of tea and get a snack. You’d think that working from home would mean you snack more because you have unlimited access to the kitchen. However, I have come to find that a day in my life as a social worker working from home is not quite the dream.

Heightened risk

The risk we are holding as professionals is heightened even more during this period, as we have limited face-to-face access to our most vulnerable children and families.

In turn we are having to evidence the extent to which we are going to ensure that we are managing such risk adequately from the confines of our home. We are doing all of this whilst ensuring we are in good enough health to be able to do this job during such a time as this.

Feelings of guilt, but also helplessness, consume me at times as I reflect on decisions yet to be made if and when a crisis is to come and I am asked to head out on a home visit. Is this a risk I am willing to take? Or is this a risk I should be taking?

I quickly deflect from this and imagine myself journeying to a hot country somewhere far from England, as the sun is blazing through my bedroom blinds.

The risk we are holding as professionals is heightened even more during this period.

 I imagine myself sat on an aeroplane and vividly hearing the air hostess saying, ‘If you are a parent and you have a child, ensure you place your own mask on before that of your child’.

My imagination is disrupted by an email from my team manager asking who among us is fit and healthy and willing to go on a home visit if directed by senior management.

For now, I haven’t had to make that decision yet. But, in light of Covid-19, I have promised that I will ensure my own mask is on as a social worker before venturing into visits which would require me to place the masks on children and families to safeguard them from harm.​​​​​​​

Tell us your social work story at stories@socialworkawards.com telling us your name, job, contact details and social care number (just so we know you’re a social worker, we will keep it private).

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