AMHPs are often described as custodians of the Mental Health Act. For Rebecca Staff, that increasingly means protecting its principles in a system that does not always make them easy to uphold.
That phrase, “custodians of the Mental Health Act” sounds formal, almost ceremonial. Rebecca Staff’s version of the job is rather less tidy.
As AMHP Lead at Knowsley Council it can mean entering the home of someone with a history of serious violence because engagement remains preferable to a more restrictive intervention. It can also mean seeing someone who has badly harmed themselves, then moving straight on to another assessment, or persuading a magistrate in court that entering somebody’s home is legally justified. “You grapple with it daily, every assessment,” she shared.
Staff has worked as an AMHP for around 12 years, taking on an AMHP Lead role earlier this year. What comes through most strongly in our conversation with her is the tension at the heart of the role: AMHPs exercise significant statutory powers, but they are also there to protect people from those powers being used unnecessarily.
Sometimes that means resisting pressure to use mental health legislation simply because someone is difficult for the wider system to support.
“Sometimes they’re just people with trauma, or they’re choosing to live their life in a particular way,” she added. “And the mental health label or diagnosis is put onto them to try and manage them, to get them out of the community and into hospital out of the way.”
The difficulty is that resisting detention doesn’t guarantee a good alternative exists.
“You want to advocate, you want to support that person, but often there is not a great range of services for them out there,” she says. “You think we could do better and we could help them live more safely, more harmoniously, more peacefully in the community, but those services aren’t there at the level they need to be.”
When least restriction meets reality
That gap between what the Mental Health Act asks of professionals and what the system allows runs through Staff’s experience, and she’s sceptical that reform alone can close it.
“I think the Act is generally kind of good enough,” she commented. “It can always be tweaked, but that’s not the problem. It’s resources.”
Her scepticism extends to how the Act’s existing provisions are already being stretched. One example: the 14-day window an AMHP has to decide whether someone should be detained has, she says, effectively been repurposed by Mental Health Trusts as a deadline for finding a bed. “That wasn’t the purpose of it,” she said. “That was for us to make a decision, not for other people. And that’s been sort of taken from us, really, and misused.”
Additionally, inpatient beds are one pressure and community mental health care is another. Staff, who has worked as both a care coordinator and an AMHP, recalled the frustration of proving that work had been done rather than doing it.
“It’s always like, have you done your risk assessment, have you done your care plan?” she commented. “That seems to be prioritised above spending time with people, building up relationships and trust.”
She has also seen what stable teams, with psychiatrists properly embedded, can do when there’s capacity to work together rather than just react.
“When we’ve had a stable staff team and everybody’s working together, they put in that extra bit,” she explained. “When you’ve got vacancies, sickness, it feels just like a lot of firefighting.”
Knowing what the person on the other side is dealing with
The AMHP role sits between organisations — mental health services, police, local authorities — each often managing its own pressures.
Her experience with Merseyside Police shows what good collaboration looks like: regular contact, and candid conversations when they disagree. That matters when somebody needs detaining, but no bed is available. Police may be legally required to stay with the person while under pressure to deploy elsewhere, but taking them to A&E, though it looks like a solution, can be traumatic for them.
“It’s learning how other organisations work,” Staff added.
While good collaboration doesn’t remove those constraints, it can mean understanding why counterparts push back, without losing sight of the individual caught between them.
Decisions are only as good as the information behind them
Another frustration Staff returns to repeatedly is information. AMHPs make decisions about risk, detention and liberty, yet can still struggle to access relevant clinical information held elsewhere.
For Staff, that became clear during one incident involving a woman taking an overdose inside her home while Staff waited outside. Access to existing clinical information helped her understand the woman’s circumstances. “Some of that would have gone differently if I didn’t know this information,” she reflected.
Staff has spent around five years pushing for easier access to the systems containing that information. The barriers have included technology, governance, organisational ownership and, perhaps most frustratingly, the issue simply not being prioritised. “It shouldn’t have taken that long,” she said, “as it’s doable.”
“Without that, you can’t be making the best-informed decisions,” she added. It’s a deceptively simple point: giving professionals power over someone’s liberty means ensuring they can see the information needed to use it.
Exhaust every other option
The same principle, Staff believes, should apply before an AMHP is even involved. She’s contributing to discussions on what should happen before an assessment is requested, concerned it will become the next step before other options are genuinely exhausted.
“We need to consider, and we can only consider once you’ve given us the full information,” she said. “And actually, you’ve tried everything you can.”
She would like to see more assertive engagement in community mental health care: someone seriously unwell may not answer calls or appointments, and describing them as unwilling to engage can miss the point.
Sometimes Staff and a colleague decide, before seeking a warrant or progressing an assessment, to go and try again. Not recklessly — just another attempt to reach them. “You can engage those people, and that’s not tried enough.”
It’s perhaps here that the AMHP-as-custodian idea makes most sense. Reform can emphasise least restriction, choice, autonomy and treating people as individuals, but legislation can’t do the work needed to make those principles real.
Sometimes that means finding another service or getting different organisations talking. Sometimes it means making sure the professional has the information they need or protecting the powers the Act gives them from being used for something else. And sometimes it means going to somebody’s front door one more time before concluding there is no alternative. Least restrictive does not mean least effort.
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