‘Role Over’ or Roll Over? Dirty Work, Shift and Mental Health Act Assessments

Abstract

The rise in numbers of applications for people being formally detained in hospital is one of the reasons given for the independent review of the Mental Health Act in England and Wales. These figures have led to concerns that the legislation might be flawed, including in relation to the process of Mental Health Act Assessments. Discussed in this article are two of the roles involved: the doctor who is responsible for conducting a medical assessment and the Approved Mental Health Professional (AMHP) who is responsible for assessing the social circumstances and in addition making the application. Using data from a study into AMHPs and the lens of the sociological theory ‘dirty work’, we discuss shift, an aspect of dirty work not yet applied in this context. We focus on AMHPs’ perceptions of the behaviour of doctors as encapsulated in the verbatim phrase ‘role over’. We argue that AMHPs, including social workers, justify or, to play on the words of the verbatim quote, roll over. This finding adds to the understanding of behaviour as it is understood within psychiatric occupations, including social work, during Mental Health Act Assessments.

What motivates and discourages social workers from working as Approved Mental Health Professionals? Evidence about job resources and demands of the Approved Mental Health Professional role

“…We searched five databases: Social Care Online; ProQuest Social Science Premium Collection (includes Applied Social Sciences Index & Abstracts; Sociological Abstracts); PsycINFO; Medline; and Ingenta Connect. On advice from experts in the field, we 'hand searched' the contents pages of four journals (see Table 1), including all editions since 2008 and the bibliographies of four PhD theses (Hall, 2014;Morriss, 2014;Stone, 2018;Vicary, 2017); and included other references suggested by contacts. The different methods of searching generated 409 references, including duplicates, see Table 1.…”

“…There is some evidence that social workers believe that the AMHP role is a good fit with social work values and that they feel well qualified to undertake the kinds of emotional labour required (Gregor, 2010;Morriss, 2014;Vicary, 2017). Gregor (2010) defined emotional labour as 'the often undocumented aspects of a job that agencies require of their workforce such as being polite, approachable and even-tempered at all times, even in the face of unwarranted provocation from customers of the agency' (Gregor, 2010, p. 432).…”

“…While this needs some modification for social work, Gregor (2010, p. 441) recommended that support for AMHPs, from employers and through peer groups, needs to address the risks of occupational stress. Later interviews with social worker AMHPs reveal a feeling of being very well placed to ensure that decisions to detain are taken respectfully, keeping the person at the centre (Morriss, 2014;Vicary, 2017) rather than seeing them as the source of 'provocation' which may be because AMHPs generally take appropriate account of the social context (Watson, 2016).…”

“…One participant in Morriss's (2014) study emphasised the 'pressures of being the only 'real' social worker in the team' (ibid., p. 139). As noted above, the time-sensitive nature of decision-making and the need to juggle competing pressures could be an additional pressure (Vicary, 2017). These elements add to the difficulty of working in professional or personal isolation: this was identified by a participant in Gregor's (2010) research as interfering with her ability to undertake a 'decent' assessment interview: …the pressure to get things going I always find winds me up enormously and I find it very difficult to actually relax enough to do a decent interview.…”

Treading a tightrope: Professional perspectives on balancing the rights of patient's and relative's under the Mental Health Act in England

“…While recent research has focussed on AMHPs’ understanding of their role (Buckland, ; Fistein, Clare, Redley, & Holland, ; Morris, ; Vicary, Young, & Hicks, ), there are no studies which address AMHP interactions with NRs. Much of the available research is limited in scope, with a recent rapid systematic review concluding that, “the topic of the NR provisions of the MHA 1983 is complex, of significant importance to individuals detained under the MHA 1983 and insufficiently studied to date” (Shaw, Nunns, Briscoe, Anderson, & Thompson Coon, , p. 47).…”