Mental health social work during the COVID-19 crisis: an AMHP's perspective

Professional Social Work magazine - 19 May, 2020. Share your COVID-19 experiences here.

The challenges of the pandemic for people with enduring mental illness have been numerous. Many have been cut off from face-to-face services that have supported them over the years. During this time, I have noted an increase in the levels of people experiencing paranoia with apocalyptic narratives.

This is extremely difficult to confront when the assessing team is interviewing in full PPE which can feed into a person's psychosis. I can only imagine how terrifying this must be for someone who is in mental distress and this is something that I have had to reflect on as it is contrary to one of the principles of the Mental Health Act of empowering the service user.

Furthermore, it is also very hard to appear discreet and promote dignity when wearing bright blue gloves and a face mask makes you stand out in the community.

My experiences when completing Mental Health Act assessments has been that non-verbal communication is extremely difficult to establish. Rapport is stifled by the face mask that is literally masking my facial expressions. The wearing of PPE is a barrier - that is what it physically is designed to do.

Communication and rapport are crucial in times of crisis to de-escalate and provide assurance to service users and family. The mask is a barrier to effective communication; during one assessment the psychiatrist was talking but the service user was responding to me, I felt like a ventriloquist’s dummy.

I have also lost track of the amount of people who have said 'I cannot tell if you are smiling or not'. I guess there is a limit to how expressive one’s eyes can be.

As an AMHP one of the key components of maintaining someone’s mental health is social networks and exploring the person’s social safety net. For the most part these have been removed or severely curtailed during the pandemic.

At the moment least restrictive options, which are the cornerstone of Mental Health Act assessments and AMHP practice, are increasingly more difficult to implement as protective factors are notably absent. 'Stay at home, isolate and avoid other people' are the very antithesis of successful interventions for someone with enduring mental ill health.

There are many people involved in a Mental Health Act assessment and co-ordinating it all has become somewhat more challenging. Each agency - police, paramedics, doctors, GPs, social services - are following slightly different processes during the pandemic. It can lead to a fragmented approach, which as an AMHP I try to bring more together for the assessment.

Despite these challenges I am in admiration of colleagues that statutory services are still running, and that people are able to access a Mental Health Act assessment during this pandemic when in crisis.

We are all learning and reflecting during these times on what has worked and what could work better. The important thing for me as an AMHP is that assessments have continued and that service users and carers have been able to access support when needed.

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