Approved Mental Health Professionals' Experiences of Moral Distress: 'Who Are we For'?

In England and Wales, approved mental health professionals (AMHPs) undertake interviews with service users as part of wider Mental Health Act assessments. AMHPs act as the ultimate decision-maker in relation to statutory detentions. They have legal duties to consider the least restrictive outcomes for service users, including alternatives to hospital. Yet they are increasingly unable to act on this, resulting in conflicting pressures. This article draws on a qualitative research study incorporating ethnographic research and interviews with AMHPs. Evidence suggests that service restructures are creating different approaches to practice with contradictory priorities, for example, whether the work is values-driven and relational or whether approbation is attached to a 'need for speed'. AMHPs are increasingly deliberating about what makes 'proper' or 'good' AMHP practice, asking 'who are we for?' and referring to their work as 'political activity'. AMHPs' sense-making and language are indicative of moral distress. Organisational politics may lead to the work being seen as a technical-rational endeavour, not a moral one, leading to dissonance. More broadly, AMHPs and service users are, together, bearing the brunt of austerity measures and there are increasing unmet needs. Overall, there is a need to establish an ideological, theoretical and political base for practice. In England and Wales, approved mental health professionals (AMHPs) undertake interviews with service users in Mental Health Act assessments where decisions are made about detaining service users without their consent. Based on two medical recommendations, AMHPs make the final decisions about whether to detain. They are required to seek less restrictive alternatives to detention or hospital admission but they are, increasingly, unable to do this, leading to a high level of stress and AMHPs leaving the job, understood here as moral distress. This article is based on a qualitative research study incorporating ethnographic research and interviews with AMHPs. Findings suggest that there are increasingly different approaches to AMHP practice, leading to debates about what makes a 'proper AMHP' and whether the work should prioritise relationships with service users. AMHPs asked 'who are we for'? They described their work as 'political activity' and this is discussed here, both in terms of the politics of austerity limiting alternatives to hospital and the organisational politics influencing approaches to practice. The article concludes by suggesting that an evidence base for practice could increasingly be useful to support AMHPs' reflection on their practice.