Assessment is an Intervention (We Just Seem to Have Forgotten That)
I don't know exactly when it happened, but somewhere over the years I've found myself wondering whether assessment has quietly become something different to what it was ever intended to be. Working in a CMHT and as an Approved Mental Health Professional, I've carried out hundreds of assessments. Some have lasted twenty minutes, some several…
The Withheld Number
Mental health services talk a lot about partnership these days. We have collaborative care planning, co-production, shared decision-making, person-centred approaches and trauma-informed practice. Entire conference programmes can be built around the idea that we should be working *with* people rather than doing things *to* them. Then we ring people from a withheld number. I've been…
When Welfare Thinking Undermines Capacity Assessment: Lessons from the Frontline
Some of the most difficult Mental Capacity Act assessments arise where risk is chronic, emotions are heightened, and professionals are carrying understandable fears about serious harm or death. These are precisely the circumstances where the analytical precision the MCA demands can begin to erode under the weight of welfare concern. I was recently asked to…
Reflections from the Classroom: On "Engagement", Safety and the Stories We Tell Ourselves
A few weeks ago I was invited to speak with a group of AMHPs in Manchester about conversations around suicide and self-harm within Mental Health Act assessments. As usual, the most useful part came out of discussions. The discussion moved quickly away from legislation and process and into the uncomfortable, complicated reality of practice. One…
When Asking Creates Risk: A Reflection on Suicide-Related Internet Use in Assessment
During a recent suicide prevention training session, a participant posed a question that has stayed with me: “If we ask people about suicide-related internet use, could we actually be introducing the idea—especially if they hadn’t thought about it before?” It is a question that sits in quiet tension with current guidance—and one that warrants careful,…
When the Therapist Becomes the Patient: Workforce Suicide Risk in Mental Health Services
I recently undertook a Mental Health Act assessment of a man presenting with self-injurious behaviour and persistent suicidal ideation. The clinical risks were significant, but not atypical of frontline mental health practice. What was striking, however, was that he was himself a therapist—an experienced member of the mental health workforce. This encounter reflects an increasingly…