Approved Mental Health Professionals’ experiences of moral distress: ‘Who are we for’?

Abstract

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 is 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.