How conversations can empower and involve: Building the evidence for Approved Mental Health Professionals’ communicative practices

Abstract

Approved Mental Health Professionals (AMHPs) undertake Mental Health Act (MHA) interviews and they make the ultimate decision, based on doctors’ medical recommendations, to detain an individual in hospital without their consent. AMHPs are required to embed the statutory guiding principle of Empowerment and Involvement as well as to maximise service users’ self-determination and this is part of a broader policy orientation toward principles of participation, involvement, shared decision-making and supported decision-making. Yet there is very little research in this area and AMHP practice takes place in the absence of guidelines or clear evidence base. Consequently, more needs to be understood about effective techniques for communication and involvement. This study was conducted with AMHPs from an AMHP service in England. A qualitative methodology was employed to gather indepth information about AMHPs’ communicative practices. MHA assessments were observed and audio-recorded to enable Conversation Analysis to be used to analyse the content and style of communication within interactions. Findings suggest that at a micro, conversational level, AMHPs worked to address obstacles to communication as well as to maintain, or restore, affiliation and alignment in their relationships with service users. Evidence suggests that communicative techniques form part of AMHPs’ broader coordinating and empowering role. The study concludes that there is a need for a more deliberate and deliberative approach to re-engineer how AMHPs and service users work together, providing original evidence for AMHP practice and supporting future training.