Non-medical approved clinicians: Results of a first national survey in England and Wales

Abstract

The 2007 amendments to the Mental Health Act, 1983 in England and Wales enabled non-medics to take on the role of legally 'responsible clinician' for the overall care and treatment of service users detained under the Act, where previously this was the sole domain of the psychiatrist as Responsible Medical Officer. Following state sanction as an 'Approved Clinician', certain psychologists, nurses, social workers or occupational therapists may be allocated as a Responsible Clinician for specific service users. Between 2007 and 2017 only 56 non-medics had become Approved Clinicians. This study reports on a first national survey of 39 non-medical Approved Clinicians. Descriptive statistics and thematic analysis of free text answers are presented here. The survey results show the limited uptake of the role, save for in the North Eastern region of England. Non-medical Approved Clinicians were motivated by a combination of altruistic intents (namely a belief that they could offer more psychologically-informed, recovery-oriented care) and desire for professional development in a role fitting their expertise and experience. Barriers and facilitators to wider uptake of the role appear to be: organisational support, attitudes of psychiatrist colleagues and a potentially lengthy and laborious approvals application process. The survey is a starting point to further research on the interpretation and implementation of the range of statutory roles and responsibilities under English and Welsh mental health law.

A qualitative study of perceptions of senior health service staff as to factors influencing the development of Advanced Clinical Practice roles in mental health services

“…Much of discussion focused on medical attitudes. There has been a history of medical objections to new roles for other professions, for example non-medical prescribing (British Medical Journal, 2005) and non-medical responsible clinician roles under mental health law (Oates et al, 2018). However, most participants noted a warmer attitude towards new advanced non-medical roles than in the past.…”

Qualitative Interviews Exploring the Views of Healthcare Professionals Working in a Mental Health Trust in England on Pharmacists as Future Approved Clinicians

“…There are also pronounced differences in the numbers of medical and non-medical ACs. According to the rst national survey conducted in England and Wales in 2017, only 56 non-medical ACs had been appointed, which is in stark contrast with over 6000 medical ACs [3]. This survey highlighted several reasons for this discrepancy, including the training route being too confusing and laborious for non-medical AC candidates.…”

“…Routes of Qualifying Non-medical professionals (as well as medical doctors who are not on the GMC Specialist Register in Psychiatry) wishing to become an AC may only qualify via the portfolio route. This is an extensive process; one that is 'grounded in a critical engagement with human rights based interpretations of the law' [3]. In order to achieve AC status, psychiatrists, however, have the opportunity to forego the portfolio route and complete a distinctly shorter medico-legal induction course (lasting for as little as two days), whilst also automatically receiving section 12 approval -an additional set of powers under the MHA [25].…”

“…Simultaneously, both of these roles were opened up to several additional non-medical professionals that were previously not considered by the Act. This meant that medical doctors, social workers, mental health and learning disability nurses, chartered psychologists and occupational therapists could all take on the role of the AMHP or the RC [1][2][3]. Since the 2007 amendment, the list of professionals permitted to qualify and lawfully exercise these powers has remained unchanged.…”

Exploring the Views of Healthcare Professionals Working in a Mental Health Trust on Pharmacists as Future Approved Clinicians

“…Simultaneously, both roles became accessible to several additional non-medical professionals that were previously not considered by the Act—because, as it was asserted at the time, “leadership … should be based primarily on competence rather than profession” [ 1 ]. This meant that henceforth medical doctors, social workers, mental health and learning disability nurses, chartered psychologists and occupational therapists could all take up the role of the AMHP or the RC [ 2 , 3 , 4 ].…”