FATHER TOM MONTGOMERY AKA MONTY

Peter: Normal circumstances requires the signature of two medical practitioners, both in agreement of the necessity for compulsory detention. One of them must be certified as having particular experience in assessment or treatment of mental illness. The specific documents used expresses these as medical RECOMMENDATIONS, and provide the BASIS on which an APPROVED Mental Health professional then has to make a judgement as to the necessity for compulsory detention, and ONLY IF SATISFIED, signs the legal authority for the detention. It is the EMERGENCY detention/sectioning which provides most controversy.
In an emergency where safety for the patient or others is a major consideration (Not simply the need for treatment), the signature/recommendation of one doctor can suffice, together with the AMH professional’s signed authority. It is also expected that the doctor should have previous knowledge of the patient.
You specifically ask about the role of Social Services, and from your Liverpool name tag, I assume you seek info relating to England. I have given a very simple outline above, but to more fully answer your query about Social Services:
The Approved Mental Health Professional is normally an experienced social services/local authority social worker who has passed specific designated training in mental illness. The role is not to provide additional diagnosis, but to consider in the widest sense the effects of compulsory detention on the individual patient and his/her family, and whether the use of compulsion is STRICTLY NECESSARY, bearing in mind the legal implications on the patient’s status. This can include such drastic effects as invalidating a will or any recently signed legal documents such as house sale for example. This area can be a minefield for relatives.
My own mental health training, (at Liverpool University you’ll be pleased to know!) preceded the 1983 Act, and related to the previous 1959 Mental Health Act. As a manager not at that time involved in direct work with clients, I did not take the full 1983 Act training, but managing staff who did, I was required to take a ‘short course’ training of its implications where it was again emphasised that the UK Parliament, in passing both Acts, recognised the need for a non medical external moderating influence against the medical profession’s sometimes over eagerness to treat illness, sometime even against the patient’s wishes.So the LEGAL AUTHORITY for detention rests with the Approved MH worker, usually a Social Services social worker, but could in certain circumstances where they have undertaken the required training, be a MH nurse or psychologist.
SS workers have always had it emphasised to them that their key role was to safeguard the interests of the patient.
I very well appreciated that role, for on several occasions when in practice, I refused to sign emergency orders to section patients under the 1959 Act, based on just one medical recommendation from a GP. It was not unknown for GPs under family pressure to seek to section “nuisance” patients, and I had many a battle with GPs in that respect. Even worse, one local hospital based psychiatrist did a patient home visit on a Saturday en route to his golf club, signed an emergency section recommendation, left it in an envelope with a neighbour of the patient, then rung Social Services emergency duty team to request a social worker to attend, complete the emergency requirements and convey the patient to hospital. I was the weekend duty social services manager at that time and fully supported the dissenting social worker both then, and at the subsequent investigation which criticised the psychiatrist. We were all pleased when he then “retired” shortly after for he was well known locally for his erratic behaviour.
I hope this helps you appreciate the various roles involved.
MMM

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