Through the Lens of Assessment Under the Mental Health Act 1983: Narratives and Discourses of Power

: (Alternative Format Thesis)

Abstract

This thesis considers the use of power within assessments under the Mental Health Act 1983. It does so through the use of a narrative analysis and a discourse analysis of research interviews with 23 people who participated in 5 Mental Health Act assessments across two local authorities in England, exploring multiple perspectives of the same event. It draws on the concepts of epistemic injustice and the Social GRRAAACCEEESSS, to show how power operates within Mental Health Act assessments. Power is considered as it relates to the construction of knowledge(s), social control, social identity and as relational.

The research data is situated within a consideration of the existing literature on Mental Health Act assessments and its wider context. This includes people’s roles and responsibilities under the Mental Health Act and a consideration of recovery, risk and crisis as cornerstones of Mental Health Act assessments. It also includes an exploration of the historical trajectory of the Mental Health Act, including contemporary developments in the form of the Independent Review of the Mental Health Act and the Mental Health Bill 2022. It considers relevant literature related both to power in mental health services and to MHA assessment practice as well as my own relationship to professional power and AMHP practice.

The thesis analyses the same data using both narrative analysis and discourse analysis. The narrative analysis explores Mental Health Act assessment processes as they were storied by each of the participants within the 5 assessments. These processes are: 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 explores the construction and use of various discursive concepts within the same 5 assessments, these being: psychosis; aggression; authority; vulnerability and expertise. Seemingly minor aspects of process are shown to be unexpectedly significant. Discursive concepts that shape Mental Health Act assessments are shown to be constructed differently dependent on people’s positioning in relation to the assessment.

The key findings of the thesis 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 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 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.

Date of Award	15 Nov 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	Jeremy Dixon (Supervisor) & Sarah Moore (Supervisor)