AMHP Procedure
This procedure should be used by:
- All practitioners and managers working in Lincolnshire County Council services (adult care and children’s);
- Approved Mental Health Professionals (AMHPs);
- All practitioners working in Lincolnshire Partnership Foundation Trust (LPFT).
Lincolnshire County Council provides a 24/7 Approved Mental Health Professional (AMHP) Service for Lincolnshire’s residents and anyone in the area requiring assessment in line with (s.13) of the Mental Health Act. AMHPs are mental health professionals who have been approved by a local social services authority to carry out certain duties under the Mental Health Act. They are responsible for coordinating Mental Health Act assessments, considering least restrictive alternatives and where admission to hospital if a person is detained, keeping the welfare of the person as their primary concern. Social workers, mental health and learning disabilities nurses, occupational therapists, and practitioner psychologists, registered with their respective regulator, may train to become an AMHP.
The AMHP service is provided by a core team of AMHPs within LCC, supported by AMHPs who hold other substantive posts within Lincolnshire County Council and Lincolnshire Partnership NHS Foundation Trust, on a rota basis.
Any practitioners interested in gaining their qualification and undertaking AMHP duties should contact the Workforce Quality and Development Team or an AMHP Service Team manager.
A person may need to have a Mental Health Act assessment when:
- there is an acute and critical deterioration in their mental health; or
- there is a gradual decline over time that has reached a critical point; and
- there are significant concerns about the person's health or safety, or risk of harm to others in relation to their deteriorating mental health.
The following are just some of the things that could indicate a person's mental health has deteriorated:
- Significant changes in a person's functioning and/or behaviour towards themselves or others;
- Unusual behaviour, withdrawal from friends and activities, or a loss of interest in things they used to enjoy;
- Changes in mood, dramatic mood swings, depression or excessive irritability;
- Changes in sleep or appetite, significant changes in sleep or appetite, or difficulty sleeping;
- Increase in self-neglect, for example, refusing food or drink;
- Changes in perception: Heightened sensitivity to sights, sounds, smells, or touch, or a feeling of being disconnected from reality;
- The person's mental health deterioration is having a significant effect on familiar relationships including the possibility of carer breakdown.
The following steps should, wherever possible, all be taken before contacting the AMHP service:
- Identify possible causes;
- Explore other solutions; and
- Consult the Consultant Psychiatrist or care co-ordinator.
If unsure, please contact the AMHP service for discussion of the situation and we will be able to advise on the best course of action at that time.
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.
|
Step to Consider |
Example |
Advice |
|---|---|---|
|
Could there be a medical reason? |
An infection (e.g. a UTI), an injury, an illness. |
If there is, or may be, a medical reason then urgent advice and support of the person's GP should be sought. |
|
Have there been changes in mental health medication? |
New medication, increases or decreases in dose. |
If there may be issues with medication, the urgent advice and support of the person’s Consultant Psychiatrist or CPN should be sought. |
|
Have there been changes in circumstances? |
A new home, living with different people, relationship issues, bereavement, diagnosis of a serious health condition (e.g. Cancer). |
Other support, such as Psychology services may be more appropriate to support the person to manage the change in circumstances. |
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:
- support from a Home Treatment or Emergency Response Team;
- additional respite for a carer;
- changes to a care and support service;
- the provision of urgent care and support services;
- 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 care co-ordinator involved, you should make every effort to contact them in order to:
- provide information to them about the situation;
- agree whether they will respond; and
- take their advice about the need to contact the AMHP service.
If the Psychiatrist/mental health care co-ordinator 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 / mental health care co-ordinator 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.
Referrals may be received from:
- Professionals belonging to any agency;
- Nearest relatives, family or carers.
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
On contact, Business Support officers will complete the initial referral and will ask relevant information needed to do so.
The following information must be provided:
- The reason that a Mental Health Act assessment may be needed;
- What possible causes have been explored and ruled out;
- What other solutions have been explored and why they are not appropriate;
- Whether you have contacted the person's Consultant Psychiatrist/mental health care co-ordinator, and the advice given;
- What the actual or likely risks are to the person, and to others.
Risks should be evidence-based, taking into account what has actually happened, or is likely to happen, using existing information about previous incidences of mental health deterioration.
An AMHP will then triage the referral to determine whether an assessment is required under the Mental Health Act or whether lesser restrictive options remain viable based upon the information at referral and other sources as required. It is important that if you make a referral, you are available to discuss this further to ensure this can be progressed in a timely manner, as the triage AMHP may require further information or discussion to determine the correct pathway needed.
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:
- provide further information; or
- 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:
- Specific needs relating to the person themselves to enable them to participate to the best of their ability in the assessment;
- The availability of doctors;
- The need to obtain and arrange a warrant of entry (section 135 MHA);
- The need for involvement with involved professionals;
- We will keep the referrer informed should there be any delay to our response and to agree the risk management plan with you in the meantime.
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.
Where no assessment is recommended, a copy of the triage form and rationale for the decision will be sent to the referrer.
When the triage worker is undertaking work to decide whether a Mental Health Act assessment is the most appropriate and proportionate course of action, all AMHPs must:
- apply the five overarching principles of the Mental Health Act;
- have full regard to the Mental Health Act Code of Practice.
|
Principle |
Definition in Code |
|---|---|
|
Least restrictive option and maximising independence |
Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery whenever possible. |
|
Empowerment and involvement |
Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. |
|
Respect and dignity |
Patients, their families and carers should be treated with respect and dignity and listened to by professionals. |
|
Purpose and effectiveness |
Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. |
|
Efficiency and equity |
Providers, commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. |
See the Mental Health Act Code of Practice.
If there is a possibility that the person with mental health needs may lack capacity (regarding decision specific care and support needs, admission to hospital or making decisions around other aspects of care), the AMHP must have full regard for the principles of the Mental Capacity Act.
See the Mental Capacity Act 2005 Resource and Practice Toolkit, which explains the principles of the Act and how to implement them.
If a decision is made not to detain a person under the Mental Health Act, the impact of any other action taken upon the person's liberty must be considered, and appropriate authorisation sought where any deprivation of liberty is likely to be unlawful.
See: Recognising and Responding to Deprivations of Liberty, which explains how to recognise a deprivation of liberty and the action that should be taken.
If the AMHP has arranged and carried out a Mental Health Act assessment, they will:
- complete an AMHP report, in line with local recording requirements; and
- provide an update to the referrer;
- where applicable, update the involved worker or team, via case note alert;
- 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 involved worker or team's duty worker to cancel or suspend any care and support services that were in place.
If the person was not admitted to hospital:
- the AMHP should arrange any other mental health services that are needed (for example, a Psychiatry consultation or intervention by another appropriate mental health service; and
- the involved worker or team's duty 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 involved worker or team's duty 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 may be 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 and risk management actions remain in place by community services - the AMHP will discuss this with services at that time regarding responsibility and to ensure a clear plan is 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 - again, the AMHP will discuss this with services at that time regarding responsibility and to ensure a clear plan is in place. If the person absconds then it will normally be the responsibility of the Police to take the person to the ward once found.
The AMHP will consider and address any needs relating to the care of children and/or vulnerable adults relating arising from, or identified by, the assessment process. See. Safeguarding.
The AMHP will also consider any issues relating to protection of property and pets and make necessary arrangement for these. See. Protection of Property.
Feedback/Complaints
Once the AMHP's input is complete, the person, family members, and referrer will be offered the opportunity to provide feedback on their experiences of this referral and/or assessment.
If a person wishes to raise any issues of concern they should contact the customer service centre to follow this up. See: Make A Complaint.
Last Updated: February 10, 2025
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