AMHP Procedure

The table below sets out some of the factors that can lead to changes in a person's mental health. It is important that you rule these out, and take any appropriate alternative action before contacting the AMHP service.

Do not hesitate to contact the AMHP Service to discuss the case and potential avenues.

A referral into the AMHP service should only be made when there are no alternative, less restrictive solutions available. It is the expectation, at all times, that the referral information given is both accurate and reflects an up-to-date clinical picture of the person’s mental health needs. If open to a team, it would normally be expected that a visit to see the person has taken place preceding the referral however this may not always be possible. For this reason, AMHP’s will undertake a pragmatic consideration of the risks in the case when deciding the course of action.

Other options could include:

1. support from a Home Treatment or Emergency Response Team;
2. additional respite for a carer;
3. changes to a care and support service;
4. the provision of urgent care and support services;
5. reablement e.g. to support a person to learn a new medication regime.

Attempts should always be made to establish whether the person has a Consultant Psychiatrist or care co-ordinator.

If the person has a Psychiatrist or mental health professional involved, you should make every effort to contact them in order to:

1. provide information to them about the situation;
2. agree whether they will respond; and
3. take their advice about the need to contact the AMHP service.

If the person's Psychiatrist is not available, attempts should be made to speak with a Community Psychiatric Nurse (CPN).

If the Psychiatrist confirms that they will respond and arrange to visit the person, the outcome of their visit should be established before contacting the AMHP service. Responsibility to refer to the AMHP Service lies with the Responsible Clinician / Community Psychiatric Nurse rather than Adult Care, however if there are any barriers, Adult Care colleagues are encouraged to speak with the AMHP Service for further advice and guidance.

All referrals during the daytime can be made directly to the AMHP Service via their business support team on tel: 01522 550411 (8am – 8pm).

Out of hours (8pm – 8am):

All referrals should be made via the Customer Service Centre:

Tel: 01522 782333

The following information must be provided:

1. The reason that a Mental Health Act assessment may be needed;
2. What possible causes have been explored and ruled out;
3. What other solutions have been explored and why they are not appropriate;
4. Whether you have contacted the person's Consultant Psychiatrist, and the advice given;
5. What the actual or likely risks are to the person, and to others.

The triage AMHP who considered the referral will provide you with advice about alternative solutions that should be explored, which you should act upon in a timely way. A copy of the triage form and rationale for the decision will be sent to the referrer. Further contact with the AMHP Service can be made for consideration, should any new information or change in circumstances become evident.

If the decision is to accept the referral and escalate to assessment under the Mental Health Act, this will be allocated to an AMHP and you may be contacted by them to:

1. provide further information; or
2. to support in the assessment process (where there is a clear benefit).

You should co-operate with any requests made by the AMHP whenever it is possible for you to do so.

In cases of existing open involvement to a professional it may be prudent for that worker to jointly attend the assessment. This is at the discretion of the allocated AMHP who acts as assessment co-ordinator but would usually be a highly beneficial act.

The AMHP service will endeavour to provide a swift and timely response to the request; however response times could be influenced by factors such as:

• The availability of doctors;
• The need to obtain and arrange a warrant of entry (section 135 MHA);
• The need for involvement with involved professionals.

A clear record of the outcome of the referral must be made as soon as possible by the AMHP triaging the referral.

A triage form will be completed to record the work undertaken; this can be found in the documents centre on MOSAIC and a copy provided by the AMHP Service where required.

If the AMHP has arranged and carried out a Mental Health Act assessment, they will:

1. complete an AMHP report, in line with local recording requirements; and
2. provide an update to the referrer;
3. where applicable, update the allocated social worker or team, via case note alert;
4. discuss the case and outcomes with the person’s nearest relative.

If the person has been admitted to hospital under the Mental Health Act, arrangements should be made by the allocated or duty social worker to cancel or suspend any care and support services that were in place.

If the person was not admitted to hospital:

1. the AMHP should arrange any other mental health services that are needed (for example, a Psychiatry consultation or intervention by a CPN); and
2. the allocated or duty social worker should arrange to carry out any care and support functions required (for example, reassessment, urgent care and support, review).

It is the responsibility of all professionals involved in the person’s care and support to work together and consider other necessary arrangements or referrals as and when required. This may include agreeing follow up with health and other secondary mental health services.

The allocated or duty adult care worker should also arrange to carry out any care and support functions required (for example, reassessment, urgent care and support, review).

It is also important to note in certain cases, the Mental Health Act assessment may conclude with the criteria for hospital admission being met; however, there is a delay due to long waits for psychiatric inpatient beds. If this is the case the person is not under any legal authority, and it is expected that any existing or interim support actions remain in place.

If a bed has been provisioned and the paperwork duly completed, then support may need to remain in the case of excessive transport waits. If the person absconds then it will normally be the responsibility of the Police to take the person to the ward once found.

In 2023, Lincolnshire Police decided to implement the RCRP approach with the support of partners, including NHS and council colleagues. Lincolnshire Police began implementing the first stage, the 'Concern for Welfare' tool, on 18 March 2024. They have identified the 'top ten' concern for welfare demands where responses may change based on individual factors:

• Reports of people walking in the road, children cycling or drunk people;
• Reports of confused (elderly) or distressed people;
• Reports of people failing to attend appointments (including people leaving A&E with cannulas;
• Children not in school;
• Concerns for people in their homes; people fallen, lifeline calls, not answering the door, unknown if inside the address or not;
• Reports of people collapsing in public places where the circumstances are unknown;
• Reports of concerns for a person whose location is unknown;
• Door entry for EMAS;
• Self-harm/suicide attempt where injury is confirmed;
• Suicidal ideation reported by the person or a third party.

The RCRP approach does not exclude police from responding to emergencies involving someone with a mental health need. However, their involvement is determined by a threshold, which is reached when police need to investigate a crime or protect people at immediate risk of harm.

A partnership approach is required to identify and respond to these changes. Work has not yet been completed around all pathways, so we need to monitor the impact and identify any gaps or risks.

To safely and effectively implement RCRP, we need to record our experiences and outcomes of police contact. This will help us capture best practice and identify any issues or gaps. We have adapted the ‘Need to Know’ form to include a new section (S.3) to share feedback where the police have used the ‘right care right person’ approach, or there is a change to their usual response.

Examples might include:

• Police have been contacted regarding a concern for welfare;
• Police have been asked to support with a person who potentially poses a risk to themselves or others;
• Any other scenarios where you have contacted Lincolnshire Police to request their support in respect of a vulnerable person;
• Any scenarios where others have been redirected to our services by Lincolnshire Police in accordance with a ‘right care, right person’ approach.

We would like to understand where the process has had a positive outcome for the person, as well as where it needs to be improved to achieve this, and have developed this process to support us in collating this information. Please see below for process map (fig.1) and further guidance:

Guidance on completing the Adult ‘Need to know’ form is provided on page one of the form which can be found here: Adult Care “Need to Know” Process (sharepoint.com)

IMPORTANT

This process does not replace the existing “Need to Know” process. When an incident occurs that may be politically sensitive, attract media interest, or involve serious injury or death of someone known to adult services, complete the “Need to Know” form. Email it to relevant parties, including DASS, Assistant Directors, and the “Need to Know” inbox (DVD_SAR@lincolnshire.gov.uk) with the subject heading “Adult Need to Know.” If RCRP is relevant, complete section 3 of the form for review by the IMR coordinator.

If you have immediate concerns about the police response to live incidents, continue to escalate these by requesting to speak to a supervisor in the Lincolnshire Police control room. Then complete the “Need To Know” form. The LSAB escalation policy can be used to resolve ongoing matters.

For any queries or comments related to Right Care, Right Person, please contact Justin Hackney justin.hackney@lincolnshire.gov.uk or Kerry Stacey Kerry.Stacey@lincolnshire.gov.uk