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Tom Burns, Jorun Rugkåsa (AMEND Manager), Jennifer Burgess

Project Outline

The AMEND study seeks to explore how changes in the definition of mental disorder and the detention criteria of the 2007 MHA impact on clinical practice, user experience and service availability.

AMEND explores whether the new Act has led to a change in the numbers, proportion, diagnostic status and ethnic background of individuals being detained by mental health services. It will compare the characteristic of patients assessed under the Mental Health Act over a four month period (July- October) in the years 2008, 2009 and 2010.  Data will be collected in three mental health trusts across England: Birmingham & Solihull Mental Health Trust, West London Mental Health Trust and Oxfordshire and Buckinghamshire Mental Health Foundation Trust. The service level, socio-economic and ethnic heterogeneity of the catchment population across these sites (total 4.2 million) will ensure that the findings of the project are generalisable to a national level.

The 2008 cohort will have been assessed under the 1983 Act, the 2009 cohort soon after the introduction of the 2007 Act, and the 2010 after clinical experience of the new Act been established. Further data collection in 2011 will enable a more long-term assessment of whether potential changes remain over time. AMEND will thus give us an understanding of how the new Act is being applied, how its conditions are being interpreted (ie introducing a single definition of mental disorder and introducing a new “appropriate medical treatment” test), how it is being experienced by service users, carers and clinicians, and whether services are changing to ensure delivery of appropriate medical treatment for disorders previously considered ‘untreatable’.

A MHA assessment will be defined as “a clinical encounter where an Approved Social Worker (ASW) has been involved or invited, or where at least one medical recommendation has been completed, regardless of the outcome of the assessment (detention, voluntary admission or no admission)”.  For each such assessment information will be recorded on:

  1. The setting of the assessment: (venue, day, time), individuals      involved in the assessment, carer/family presence
  2. Clinician variables: Basic sociodemographics, professional role,      years of clinical experience, average proportion of detention to      assessment
  3. Patient characteristics: Basic sociodemographic, level of community      and social support; and clinical variables
  4. Service characteristics: Local bed availability, availability of      alternatives to detention, provision of specialist outreach services
  5. Factors determining outcome: A range of possible alternatives which      might have prevented detention had these been available

The study is lead by Birmingham & Solihull Mental Health Trust. The Principal Investigator is Professor Swaran Singh, and in Oxford Health NHS Foundation Trust it is led by Prof Tom Burns. The study is funded by the Department of Health under their MHA policy research programme.