The Operation of Power in Assessments Under the (England and Wales) Mental Health Act 1983

In this paper I will present an overview of my completed PhD research, which considered the use and operation of power within assessments under the England and Wales Mental Health Act 1983 (MHA). The thesis used both narrative analysis and discourse analysis to understand the research interviews I undertook. These were with 23 people who participated in 5 community MHA assessments across two local authorities in England, enabling me to explore multiple perspectives of the same event across these 5 assessments. The legislation requires key individuals to be involved in a MHA assessment alongside the person who is to be assessed and my research involved these and others. Participants included the person who had been assessed, their family members, care co-ordinators, doctors and Approved Mental Health Professionals (AMHPs). Participants were asked to describe their experience of the assessment process. The PhD drew on the concepts of epistemic injustice and used Burnham’s Social GRRAAACCEEESSS (a systemic framework for considering power and identity characteristics), to show how power operates within MHA assessments. Power was considered as it relates to the construction of knowledge(s), social control, social identity and as relational. Within this paper I present some of the key findings around the experiences of power, including the professionals who have the legal power to make medical recommendations or make an application for someone’s detention under the MHA and the people made subject to those powers. I then draw some conclusions about what this might mean in the context of contemporary UK mental health services.