Assessments under the Mental Health Act 1983: Uses of power
Research type
Research Study
Full title
Through the lens of assessment under the Mental Health Act 1983: discourses and narratives of power
IRAS ID
213143
Contact name
Rosie Buckland
Contact email
Duration of Study in the UK
3 years, 11 months, 3 days
Research summary
Research Summary
This qualitative study explore the experiences of assessment under the Mental Health Act 1983 (MHA) in the community, to better understand how power functions within assessment processes. MHA assessments consider whether or not someone will be detained under a section of the MHA; a process often known as 'sectioning'. Several people are involved in the assessment process and this research will interview all the people involved in a small number of assessments that took place during the same time period within the same NHS Mental Health Trust. It will also analyse the documents produced at the time of the assessment which record the decision-making process around requesting and undertaking an assessment.
The research builds on existing research into MHA assessments, which is both qualitative and quantitative. Existing research has focussed on detention trends, such as the current rise in the numbers of people being detained, and structural inequalities in terms of the types of people most likely to be assessed and detained. Research has also looked at how assessment decisions are made and the experiences of people who have been detained. No previous studies have specifically explored power in the way that this study aims to.
This study fits within a tradition of systemic research and will understand each individual MHA assessment as a unique system. It will assume that the people involved in the assessment will negotiate power in ways that depend on a range of factors. These factors will however, be connected to broader organising systems, such as psychiatric diagnosis and medical treatment I will be using both discourse analysis and narrative analysis to understand the data collected during the study.
Summary of Results
I am grateful to everyone who participated in the study 'Assessment under the Mental Health Act 1983: narratives and discourses of power'. It was conducted by me, Rosie Buckland as part of a PhD project funded by a studentship at the University of Bath. I interviewed 23 people who had participated in 5 Mental Health Act assessments across 2 Local Authority areas in England. Interviews took place between December 2018 and November 2020. People who has been assessed under the Mental Health Act within the last 6 months but were no longer in hospital responded to an open call out for participants and were then interviewed. Other people, including doctors, Approved Mental Health Professionals, Care Co-ordinators and friends and family who had also been involved in the assessment process were then approached for interviews. Participants were asked to talk about their experience of that same assessment, as well as about their experience of Mental Health Act assessments more broadly. The study was seeking to understand more about the operation of power in Mental Health Act assessments.
The PhD thesis then analysed the same data using narrative analysis and discourse analysis methods. The narrative analysis explored Mental Health Act assessment processes as they were storied by each of the participants within the 5 assessments. The processes that were explored in the analysis were: the Mental Health Act assessment interview; gaining and executing a S135 (1) warrant; being taken to a place of safety under a S135 (1) warrant; making the decision to convene a Mental Health Act assessment and being taken to hospital in a private ambulance. The discourse analysis explored the construction and use of various discursive concepts within the same 5 assessments. These were: psychosis; aggression; authority; vulnerability and expertise. Seemingly minor aspects of process were shown to be unexpectedly significant for participants. Discursive concepts that shape Mental Health Act assessments were shown to be constructed differently dependent on people’s positioning in relation to the assessment.
The key findings of the study are that epistemic injustice is a routine outcome of Mental Health Act assessments; that harms may occur before, during and after a Mental Health Act assessment takes place; that there are significant distinctions between professional and non-professional knowledge and that people ‘fill in the gaps’ about their experience of assessment; that personal and social identities are significant in shaping the course of Mental Health Act assessments and that the social network of the person assessed under the Mental Health Act may be excluded from assessment processes with detrimental effects.
Recommendations are made within the thesis for policy and practice informed by these insights and with a view to a greater redistribution of power in Mental Health Act assessments. The recommendations made are: that people should have greater control over their use of hospital and community services based on their perception of their needs; that iatrogenic harm should be given more consideration and people supported following a Mental Health Act assessment; that information about Mental Health Act assessment processes should be provided differently; that advance planning around Mental Health Act assessment preferences should become a routine part of mental health services and that greater consideration should be given to people’s social context, including the use of carer’s assessments. Further research is indicated to explore the effects of such changes as well as to consider the Mental Health Act assessment experiences of particular marginalised groups. I plan to continue to write journal articles using data from the study, so that it can contribute to developing understandings about how people assessed under the Mental Health Act, their family, friends and carers and professionals experience Mental Health Act assessment processes. This knowledge is particularly relevant as the Mental Health Bill progresses and is likely to make changes to how Mental Health Act assessments are conducted.
REC name
Wales REC 4
REC reference
18/WA/0250
Date of REC Opinion
13 Aug 2018
REC opinion
Further Information Favourable Opinion