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Power Sharing within Coercive environments?

Power Sharing within Coercive environments?. Charlotte Scott PhD Student ss12cas@leeds.ac.uk . Lens: PhD Student – exploring decision making during Mental Health Act assessments Approved Mental Health Professional. Privileging Knowledge? (Pawson et al, 2003) Limits of understanding

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Power Sharing within Coercive environments?

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  1. Power Sharing within Coercive environments? Charlotte Scott PhD Student ss12cas@leeds.ac.uk

  2. Lens: • PhD Student – exploring decision making during Mental Health Act assessments • Approved Mental Health Professional

  3. Privileging Knowledge? (Pawson et al, 2003) • Limits of understanding • How is the lived experience of coercion heard? (is all contact with mental health services coercive…?)

  4. Context • The Mental Health Act 2007 Assessment • Power • Coercion

  5. Power ‘ I have the state authorised power to deprive you of your liberty, against your wishes, for up to six months’

  6. The Guiding Principles: (MHA Code of Practice) Empowerment and Involvement: Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others where appropriate should be fully considered when taking decisions. Where decisions are taken that are contradictory to views expressed, professionals should explain the reasons for this

  7. But what happens in practice? • The ‘knock at the door’ • The ‘behind the scenes’ discussion • The key players involved in the decision – AMHP, psychiatrist, family members, police

  8. Coercion, capacity and the ‘dominant narrative’ • Hearing the voice of the person being assessed – meaningful participation in the decision making • The impact of human rights related legislation on decision makers? • Decision makers ‘Anchoring’ to a position during the assessment

  9. The Role of the AMHP: Early Findings from my research • A will to explore the least restrictive option • To find a ‘stillness’, to listen (see Dwyer, 2012) • To advocate for the individual being assessed but…….a sense that by the point of a referral for a MH Act assessment often other options have already been explored

  10. Mitigating Power – towards co-production? • Creating an environment that is more conducive to involving the person being assessed in the decision to be made • Ensuring the person has time to pack, has money in their pocket, time to phone people they need to • Considering the impact of ‘conveyance’ – the ambulance on the quiet cul de sac • Put yourself in someone else’s shoes?

  11. Re-imagining risk…. • Reflecting on the discourse around ‘risk’ (Glover -Thomas, 2011) • Taking a step back to look at the journey that leads up to a MH Act assessment – how might that chain of events lead to a different outcome?

  12. ‘Because I’m terrified of the Mental Health Act and I know services in my area are not sympathetic. At the very time you need help the most I have to be very careful and then maybe not get the help I need. It’s a real Catch 22’ Faulkner, JRF, 2012

  13. Ways forward? • Advance Directives –what I prefer to be called, what language I use to describe what is going on, what helps, what doesn’t, signs that tell you I am struggling, jointly agreeing on a ‘gauge’ for when intervention is necessary • Who should be the decision makers?

  14. Barriers • Time ‘to be’ with individuals, ‘to drink tea’, nurture relationships • A lack of resources to divert people from crisis e.g. inpatient bed closures, reduction in community services

  15. Concluding thoughts • Given the inherent power held by the practitioner decision makers, thinking (initially) about the small changes that can be made in practice • How can we consider creative use of support networks and sharing assessment of risk

  16. References DofH (2015) Mental Health Act Code of Practice, The Stationery Office Dwyer, S. (2012) ‘Walking The Tightrope of a Mental Health Act Assessment’ in Journal of Social Work Practice 26 (3) Faulkner, A (2012) The Right To Take Risks: Service Users’ Views Of Risk In Adult Social Care, Joseph Rowntree Foundation Glover-Thomas, N. (2011) ‘The Age of Risk: Risk Perception and Determination Following the Mental Health Act 2007’ in Medical Law Review 19 (4) Pawson, R, Boaz, A, Grayson, L. and Barnes, C. (2003) Types and Quality of Knowledge, Social Care Institute of Excellence, London Tew, J, Gould, N, Abankwa, D, Barnes, H, Beresford, P, Carr, S, Copperman, J, Ramon, S, Rose, D, Sweeney, A. and Woddward, L. (2006) Values and Methodologies for Social Research in Mental Health, Social Perspectives Network,London.

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