Alex RKMaking Decisions in Compulsory Mental Health Work (edited by Jill Hemmington and Sarah Vicary, Policy Press, 2023, 203 pages, c £24.99)
To get the bad news out of the way first, this book does not quite live up to its title, insofar as that title suggests that it will cover all aspects of decision-making in the fraught zone of mental health compulsion. Rather, its true focus is rather narrower, with many of the chapters focusing on different aspects of the role of the Approved Mental Health Professional in decision-making under the Mental Health Act 1983. Examples include the chapter on occupational therapy in AMHP by Rachel Bloodworth-Strong and a chapter by Sarah Vicary on Nurses as AMHPs, as well as thoughtful chapters on reflective supervision by Gill Robinson and reflective practice by Kevin Stone. I anticipate, in consequence, that it will – rightly – find its way rapidly onto reading lists for AMHP training, especially as those chapters which range more widely use the example of the AMHP as decision-maker.
But all this does not mean that the book is only for AMHPs: anyone involved in the exercise of or interested in the place of coercion in the mental health context will find riches within its pages. Particularly stimulating are the opening chapters on lived experience and the boundaries between professionals and others (by Neil Caton and Jen Kilyon, who have different lived experiences) and frames and the boundaries of race and ethnicity in Mental Health Act Assessments by Hári Sewell. The latter, in particular, brings matters very concretely home by focusing on five decision-making points for an AMHP, namely (1) personal development to engage critically with race and ethnicity; (2) MHA referral; (3) toxic interaction theory; (4) risks and the racialised patient; and (5) recording.
The central linking device of the book, outlined at the start, and synthesised again at the conclusion, is that “[d]ecision-making on compulsion and coercion is beyond legalistic; perception is a prism, and an understanding of frames and boundaries is fundamental to critical reflection” (page 11). As a lawyer, it is interesting to note the use here of the term ‘legalistic,’ as opposed to ‘legal,’ and again in the editors’ five dimensions of assessment and decision-making which influence coercion and compulsion, alongside practical and processual; relational and interpersonal; moral and ethical; and professional (page 4). Unlike the other – neutral – terms used in this framework, ‘legalistic’ might be thought to carry with it a negative connotation.[1] The editors may well be using the term as a synonym for ‘legal,’[2] but they may well also consciously or subconsciously be reflecting their framing of the law. If and to the extent that the editors are challenging an attitude which focuses on the question of whether something is legal to the exclusion of whether in some broader sense it is ‘right,’ then I would entirely agree with them. Matthew Graham in his chapter on framing mental capacity and mental health legislation in decision making undoubtedly starts to develop such ideas. But I would hope in a second edition of the book the editors would have space to bring out in an express fashion their framing of the law (alongside the consideration of children and young people which was planned but was not ultimately possible due to changes in personal circumstances). In the meantime, though, the first edition will I hope sell like hot cakes to those critically concerned with the difficult areas that it covers.
[1] The Cambridge Dictionary definition of ‘legalistic,’ for instance, is “giving too much attention to legal rules and details.”
[2] This is suggested by the fact that they note at page 3 that “a lot of education and practice materials focus on the legalistic aspect of the role,” when what I anticipate they really mean is the “legal” aspect of the role.
