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Getting the best from your Approved Social Worker
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This booklet can also be viewed as a non-printable pdf file but is no longer available in printed format due to limited demand. You are therefore welcome to print the text below for personal or professional use.
What is an approved social worker (ASW)?
Where do ASWs work?
What does an ASW do?
What is the role of an ASW in admitting a person to hospital?
What are the grounds for making an application under the MHA?
How independent is an ASW?
How do I know the social worker is an ASW?
What happens during the MHA assessment?
What should I say to the ASW?
What happens if the ASW decides to detain me in hospital?
What if the ASW decides not to make an application to detain me?
Does the ASW consult my relatives?
What help can an ASW give to my NR?
What aftercare am I entitled to?
What else does the ASW do?
What if I am dissatisfied?
References
Useful organisations
Further reading
The ASW has a pivotal role in the assessment of a person who it may be necessary to detain under the MHA. Parliament clearly intended that the ASW s opinion was important, both in providing a safeguard for the rights of the individual and in deciding what arrangements would be most appropriate.
This booklet gives you the information you need to know when an approved social worker becomes involved with assessing you, or someone you know, to see whether you need to be admitted to hospital under the Mental Health Act 1983 (MHA).
What is an approved social worker (ASW)?
An ASW is a social worker with responsibility for assessing someone s needs, care and treatment under the Mental Health Act 1983 (MHA). He or she will have undertaken specialist postgraduate training, which includes mental health law, and will also have a detailed knowledge of the local mental health services. This means you can expect a high standard of knowledge and experience if an ASW is involved. Because they have an official role under the MHA, you don t have the right to choose or reject the ASW who carries out your assessment.
This booklet frequently refers to your ASW because during the time you are being assessed under the MHA, he or she is your ASW and their prime focus is your needs. But once your assessment is completed, you may find you have no further contact with him or her.
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Where do ASWs work?
ASWs must be appointed by the local authority. Every local authority in England and Wales is under a duty to ensure it has sufficient numbers of ASWs for the area. ASWs may work in the community or in a hospital setting in:
- community mental health teams
- hospital social work departments
- medium secure units
- child and adolescence therapy services
- learning disability teams
- substance abuse teams
- local authority emergency duty teams
- locality community teams
- services for older people with mental ill health.
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What does an ASW do?
The ASWs plays a key role in deciding whether someone with mental health problems can be cared for in the community, or whether they should be admitted to hospital. Inevitably, this may involve taking decisions that may be contrary to a service-users own views of what they may need. Your ASW will strive to balance your civil liberties with the needs of your family or informal carers and the wider public.
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What is the role of an ASW in admitting a person to hospital?
ASWs become involved, together with your GP and a hospital doctor (usually a consultant psychiatrist), if it seems likely that you need to be admitted to hospital because of the severity of your mental health problems. Sometimes, as a last resort, an individual will have to be admitted and detained in hospital under a section of the MHA. This is sometimes referred to as being sectioned .
If this is the case, you will first have a comprehensive mental health assessment of your circumstances. The ASW will then coordinate an application to the hospital for your admission. This means that all the professionals involved will complete statutory forms setting out the reasons for your detention. Your ASW should ensure that patient confidentiality is maintained at all stages of the assessment and, if you are detained, throughout the admission process as well.
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What are the grounds for making an application under the MHA?
Your ASW and the doctors involved in your assessment must comply with what the law says about compulsory admission. If there is no other way of caring for you, the MHA sets out the circumstances that must be met before you can be detained in hospital. In summary, you must be suffering from:
- a mental disorder as defined in the MHA; and
- the mental disorder must be of a nature or degree that warrants compulsory admission to hospital for assessment or treatment; and
- admission must be in the interests of your health or safety, or for the protection of other people.
Your ASW will have had special training and gained experience in addressing all these criteria. (For more information about the MHA, see Mind s booklet, The Mental Health Act 1983: an outline guide)
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How independent is an ASW?
You have the right to expect that any ASW involved in your care will use their own judgement and not act at the direction of their employers, medical practitioners or anybody else who may be concerned with your care and treatment. The decision about whether or not to arrange a hospital admission under the MHA is theirs alone, and is arrived at totally independently. They can t be instructed by the doctors, nurses, relatives or the police to detain you. In essence, the ASW performs one of the fundamental checks and balances in the MHA, ensuring that your civil rights are upheld, wherever possible.
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How do I know the social worker is an ASW?
All ASWs should carry an official identity card (ID) issued by the local authority social services department. This will clearly identify the ASW by means of a photograph, and will also provide written proof of their authorisation to practice as an ASW. The current Director of Social Services must have signed the ID card, and it should be dated from within the last five years.
If you or your carer has any doubts about the person s identity, you may check on it by contacting your local social services authority (listed in the phone book under the name of your local council).
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What happens during the MHA assessment?
An assessment by an ASW is important, because the outcome could mean you will be admitted to hospital, either informally (meaning you go in of your own accord) or under the MHA. Assessments may be carried out in your home, in a police station if the police have become involved, or in hospital if you are already a patient.
You may want to have someone with you of your own choosing, for example a friend or advocate. This may be a distressing time for you, your family and friends, and it is vital that you are made aware of what is happening, as far as possible, and that you are supported, if that is your wish. A number of mental health facilities in hospital now have access to a local advocacy service. Your ASW or hospital staff will tell you how to contact the advocacy service. (See The Mind guide to advocacy)
At the start of a mental health act assessment, your ASW should introduce him- or herself to you, your family, friends or any other professional visitor present. He or she will clearly explain their role and the purpose of the visit, taking into account whether your first language is not English or whether you have any other communication needs. If so, he or she will arrange for the assistance of a trained interpreter (language or signing). Your ASW should interview you in a sensitive manner and, ordinarily, should give you the opportunity to speak to him or her in private. He or she will inform you of your legal rights under the MHA.
Your ASW will consider and, where possible, take the appropriate alternatives to compulsory admission, and will comply with the legal requirements of the Act. He or she will make an overall risk assessment that takes into account the degree of urgency, and which looks at any risk to you, your family or others involved in your care. He or she should offer your family and any other carers support, reassurance and appropriate information about the assessment.
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What should I say to the ASW?
Taking into account your mental health at the time of your assessment, you should try and be as open as possible with your ASW (and the doctors). You should let the ASW know your wishes and perception of your own needs, including what support you would find helpful in the community and, whether you are willing to be admitted into hospital, if necessary.
Tell him or her if you have made an Advance Directive, setting out your needs and preferences ahead of time. (See Mind rights guide 3: consent to medical treatment, for more information.) Explain your social and family circumstances, and tell him or her whether there is anyone else, apart from your Nearest Relative (NR) who you would like to be informed of the outcome of the assessment. (See below for information about your NR.)
If hospital admission seems likely, tell the ASW whether you need help with practical problems, for example, child-care arrangements, pet care or ensuring that your home and other property is safely secured.
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What happens if the ASW decides to detain me in hospital?
The ASW will arrange for an ambulance to get you safely to the hospital. He or she will meet you there, on the admission ward, and deliver the detention (section) papers to the nurse-in-charge, explaining the circumstances leading to your admission.
The ASW will make a record of the expiry date of your period of detention under the MHA and should provide the hospital with a report on your home circumstances. At the end of the process, he or she will spend a short time with you before leaving the ward.
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What if the ASW decides not to make an application to detain me?
Your ASW will liaise with the doctors who have been involved in your assessment, and should jointly agree an appropriate post-assessment care package. This package should consider alternative strategies to support you and your relatives or informal carers. They will also jointly document the reasons for allowing you to remain at home.
Your ASW will then complete a written report for the local social services authority (LSSA) outlining the reasons why it was not necessary to detain you under the MHA. The report should include the details of any support you may need in order to manage in the community. The ASW will then arrange any care or support to help you cope at home, and should offer practical assistance, such as transport home and advice about suitable alternative accommodation.
After completing the assessment, he or she will complete a Local Mental Health Act Monitoring Form. This helps the social services department to monitor the use of the MHA.
Informal admission
You can ask to be admitted to hospital as an informal patient, in other words not detained under the MHA. However, the ASW will decide whether this is an appropriate course of action, having taken into account all the circumstances. (See Mind rights guide 1: civil admission to hospital, for more information.)
Contact with the ASW after an assessment
Where appropriate, your ASW may keep in contact with you after admission, and liaise with the multi-disciplinary care team over aftercare. Alternatively, you may be allocated another mental health social worker, from the community mental health team responsible for the area where you live.
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Does the ASW consult my relatives?
Your ASW has a legal duty to inform and consult with your Nearest Relative (NR) before deciding whether to make an application for your admission to hospital. This must take place regardless of whether you want your NR to be aware of your current circumstances. The term NR relates to a specific role and powers under the MHA. You are not allowed to choose who that relative should be. The MHA sets out a list of people who may be considered as your nearest relative, and the person who is highest on the list is your NR. Usually, but not always, that person is also your next-of-kin. (The next-of-kin, or NOK, has two legal meanings: the nearest blood relation according to the law of consanguinity; and someone entitled, in law, to inherit, if a person dies without making a will.)
If your ASW cannot locate the NR, or there is no one to act in this capacity, the LSSA can apply to the county court to appoint someone to act as your NR. This may take place if a family member or social worker is concerned about the lack of one.
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What help can an ASW give to my NR?
The ASW can support and reassure the NR, giving them appropriate information about the assessment, and information about their powers and rights under the MHA. Your NR is allowed to authorise another person (in writing) to perform their functions, if they would prefer. Your ASW can advise them on how to delegate these functions, if asked to do so. A copy of the letter may be sent to the hospital managers or LSSA. The ASW can also offer advice about finding a solicitor who specialises in mental health law.
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What aftercare am I entitled to?
The MHA (section 117) places a duty on an LSSA and local health authority, together with voluntary organisations, to establish proper aftercare arrangements and to assess the particular needs of each person who has been detained under sections 3, 37, 47 or 48. Your aftercare plan should be in place before you are discharged from hospital. Your ASW should be able to clarify how this works, in practice.
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What else does the ASW do?
In addition to the above, ASWs can act as a broker between you (the service-user) and service-providers to ensure you get the help you are entitled to. They also have the authority to ask a police officer to make a forcible entry into your house, flat or room in order to assess you. This only occurs in extreme circumstances; for example, where there is concern for your safety and wellbeing, or that of others. An ASW can enter and inspect certain premises, for example, a mental nursing home, if they are concerned that you are not being looked after properly. They can be asked to provide a social circumstances report for your Hospital Managers Review or Mental Health Review Tribunal, if you appeal against your detention.
The social circumstances report should cover all your aftercare needs, so that the hospital managers or a Mental Health Review Tribunal is aware of the care and support that will be provided if you are discharged from detention. The ASW, together with hospital staff, can help you to identify a solicitor of your choice to represent you at a Mental Health Review Tribunal and Managers Review. (See Mind rights guide 4: discharge from hospital.)
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What if I am dissatisfied?
If you are unhappy about any aspect of the ASW service, you should discuss this with the ASW or social services department. If the matter can t be resolved informally, to your satisfaction, ask for a copy of the local authority s complaints procedure.
All assessments should be free from any discrimination. The MHA Code requires every local social services department and NHS Trust to keep records of the ethnicity of all patients assessed under the MHA. The Mental Health Act Commission monitors whether the MHA and MHA Code of Practice are being followed.
ASWs play an important role in making sure that the individual being assessed is considered in their wider social context and as a citizen. They prevent the agenda from being restricted to narrower, medically dominated issues.
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References
Mental Health Act manual (6th ed.) R. Jones (Sweet and Maxwell)
Mental Health Act Code of Practice 1983 (HMSO)
Mental Health Review Tribunals: law and practice A. Eldergill (Sweet and Maxwell)
Mental Health Act Commission biennial report (1997-1999) (HMSO)
Openmind 1999, 24
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Useful organisations
British Association of Social Workers Mental Health Special Interest Group
16 Kent Street, Birmingham B5 6RD
tel: 0121 622 3911
web: www.basw.co.uk
Aims to achieve better services and
anti-discriminatory practice
The Law Society
Ipsley Court, Redditch, Worcestershire B98 0TD
tel: 0870 606 6575
web: www.lawsociety.org.uk
Lists solicitors who specialise in mental health law
Mental Health Act Commission
Maid Marion House, 56 Hounds Gate, Nottingham NG1 6BG
tel: 0115 943 7100
web: www.mhac.trent.nhs.uk
Ensures patients are detained under the MHA properly
Revolving Doors
Units 28-29, 63 Clerkenwell Road, London EC1M 5NP
tel: 020 7253 4038
web: www.revolving-doors.co.uk
For people in contact with the criminal justice system
UK Advocacy Network (UKAN)
Volserve House, 14-18 West Bar Green, Sheffield S1 2DA
tel: 0114 272 8171
email: office@u-kan.co.uk Can assist you to locate a local advocacy service
Useful websites
www.markwalton.net For information on mental health law
www.scmh.org.uk For the Sainsbury Centre for Mental Health
www.imhl.com For information about mental health law
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Further reading
From psychiatric patient to citizen: overcoming discrimination and social exclusion L. Sayce (Macmillan 2000)
How to cope as a carer (Mind 2003)
How to cope with hospital admission (Mind 2004)
How to rebuild your life after breakdown (Mind 2004)
How to recognise the early signs of mental distress (Mind 2004)
Legal rights and mental health: the Mind manual (Mind 2004)
Making sense of antidepressants (Mind 2004)
Making sense of antipsychotics (major tranquillisers) (Mind 2003)
Making sense of electroconvulsive therapy (ECT) (Mind 2003)
Making sense of lithium (Mind 2004)
Making sense of minor tranquillisers (Mind 2003)
The Mental Health Act 1983: an outline guide (Mind 2003)
The Mind guide to advocacy (Mind 2004)
Mind rights guide 1: civil admission to hospital (Mind 2004)
Mind rights guide 2: mental health and the police (Mind 2004)
Mind rights guide 3: consent to medical treatment (Mind 2004)
Mind rights guide 4: discharge from hospital (Mind 2003)
Mind rights guide 5: mental health and the courts (Mind 2004)
Mind rights guide 7: managing your finances (Mind 2004)
Pure madness: how fear drives the mental health system J. Laurance (Routledge 2002)
Understanding mental illness: recent advances in understanding mental illness and psychotic experiences (British Psychological
Society 2000)
Understanding psychotic experiences (Mind 2004)
Users and abusers of psychiatry: a critical look at psychiatric practice (2nd ed.) L. Johnstone (Routledge 2000)
For a catalogue of publications from Mind, send an A4 SAE to:
Mind Publications
15 19 Broadway
London E15 4BQ
tel. 0844 448 4448
fax: 020 8534 6399
email: publications@mind.org.uk
Visit the online shop to see details of all the publications stocked.
This booklet was written by Christopher Curran and Catherine Grimshaw
First published by Mind 2001. Revised edition © Mind 2004
ISBN 1-903567-09-2
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