Treading a tightrope: Professional perspectives on balancing the rights of patients and relatives under the Mental Health Act in England

Jeremy Dixon, Megan Wilkinson-Tough , Kevin Stone, Judy Laing

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
203 Downloads (Pure)


Involuntary detention is used internationally to detain and treat people who are deemed to have a mental disorder. In England and Wales, approved mental health professionals (AMHPs) co‐ordinate Mental Health Act assessments which allow for patients to be detained. AMHPs have legal duties to identify, inform and consult with a patient's nearest relative (NR), who are, in turn, given powers to initiate or challenge detention. Our study takes an original approach through examining how AMHPs interpret their duties towards nearest relatives. We adopted a two‐stage design, which involved an online questionnaire with 55 AMHPs and focus group discussions with 33 AMHPs. The research was conducted in England between 2017 and 2018. Our questionnaire found that a high proportion of AMHPs reported that they had spoken to NRs for background information when assessing patients under the Mental Health Act. However, AMHPs were less likely to ask patients about their views of involving the NR prior to assessment. Focus group findings showed that AMHPs saw the NR role as offering an important ‘safeguard’ on the basis that NRs could provide information about the patient and advocate on their behalf. AMHPs identified practical difficulties in balancing their legal obligation towards NRs and patients; particularly where issues of potential abuse were raised or where patients had identified that they did not want NR involvement. While AMHPs stated that they sought to prioritise patient wishes regarding confidentiality, their accounts identified that patient consent about information sharing was sometimes implied rather than sought explicitly. Our findings reinforce conclusions by the recent Independent Review of the MHA, which states that current NR provisions are ‘outdated, variable and insufficient’. We identify that current practice could be improved using advanced choice documents and outline implications for AMHP practice.
Original languageEnglish
Pages (from-to)300-308
Number of pages9
JournalHealth and Social Care in the Community
Issue number1
Early online date30 Sept 2019
Publication statusPublished - 1 Dec 2019

Structured keywords

  • Centre for Health, Law and Society


  • AMHP
  • carers
  • decision‐making
  • focus groups
  • mental health
  • Mental Health Act
  • social work and healthcare


Dive into the research topics of 'Treading a tightrope: Professional perspectives on balancing the rights of patients and relatives under the Mental Health Act in England'. Together they form a unique fingerprint.

Cite this