The Role of the Approved Social Worker

What is an Approved Social Worker? Approved Social Workers (ASWs) are qualified and experienced social workers who have participated in additional training and have been assessed as competent to carry out the specific duties and responsibilities set out in the Mental Health (Northern Ireland) Order 1986.

ASWs have an integral and significant role in the care and protection of people who have a mental disorder and have specific duties and responsibilities under the Mental Health (Northern Ireland) Order 1986.

The five Health and Social Care Trusts in Northern Ireland have a duty under Article 115 of the Order to appoint a sufficient number of ASWs to carry out functions under the Order and to ensure that they are and continue to be competent in this role. LINK TO ASW Contacts List

What are the specific duties of the ASW under Part II of the Order? The specific duties of the ASW under Part II of the Order relate to the assessment and if necessary application, for a person to be:

• Compulsorily admitted to hospital for assessment or
• Received into Guardianship.

Although appointed by their employing Trust, ASWs are required under Article 40 of the Order to make independent decisions regarding these actions and must be satisfied, having regard to the wishes expressed by relatives, all other relevant circumstances and the criteria set out in the Order that an application ought to be made and it is necessary or proper to do so.

What are the duties and responsibilities of the ASW in relation to Compulsory Admission to hospital for Assessment? The ASW is required by law to make an independent professional judgement in relation to whether an application for detention in hospital should be made. In order to do so the ASW is required to:

• Interview the person whose detention in hospital is being considered.
• Identify and consult with the person who appears to be the Nearest Relative*. See Role of Nearest Relative
• The ASW must also consult with a second ASW, prior to making the application, if the nearest realtive objects. LINK TO MHO C
• Gather relevant information as part of the assessment process.
• Consult with the medical practitioner who has made the medical recommendation.
• Consult with relevant others, including other health and social care professionals with prior knowledge of the person.
• Advise the person and nearest relative of the outcome of the assessment and their rights under the Order.

The nearest relative will not necessarily be the person identified by the patient as their next of kin and indeed the patient has little control over who will be seen as the nearest relative. However, recent judicial decisions have considered the patient's Article 8 Rights under the ECHR in this context, and determined that, in certain circumstances, a patient's wishes in refusing to accept the nomination of a nearest relative as defined in the legislation may be respected.

In England, Wales and Scotland mental health legislation has been revised as a result of these rulings. It is hoped new legislation in Northern Ireland will address this issue. As a result of this case law, the ASW is allowed, in some exceptional circumstances, a degree of flexibility in who can be considered as the nearest relative¹.

1 Case Law - Following a judgment, R (E) v Bristol City Council (2005) EWHC 74 (Admin) in which the Judge involved, Bennet J., considered the duty of the ASW to consult with the nearest relative and the rights of a patient under Section 3(1) of the Human Rights Act 1998, ASWs can interpret the words "practicable" and "reasonable delay" in a way that takes into account the person/patient's "wishes, health and well being".

When satisfied that admission to hospital is the most appropriate way of providing the care and treatment needed by the person, the ASW has a duty to make the application, founded on a medical recommendation, for their admission to hospital for assessment.

In circumstances where a decision is made that admission to hospital is necessary the ASW, as applicant, has a duty to ensure that the person is conveyed to and admitted to hospital in a lawful and humane manner.

The ASW must work closely with the medical practitioner, nearest relative and others in this task. In most situations the ASW will seek assistance from the Northern Ireland Ambulance Service.

In exceptional circumstances where there is a risk of physical harm to the person and/or others in the conveyance of the person to hospital, the ASW is required to advise and seek assistance from the police and liaise with and co-ordinate these services.

In situations where a decision is made that an application should not be made the ASW has responsibility with the medical practitioner to consider and if necessary agree alternatives to admission as part of a care plan in conjunction with the person and nearest relative.

The ASW must also produce a comprehensive report which sets out the circumstances of the case, the information gathered and the assessment, decision making and management process involved. This must include consideration of the human rights implications of their action. This report contributes to the process of assessment during the detention in hospital for assessment period and to the multi disciplinary comprehensive risk assessment..
LINK TO Guidance ASW Report MHO B
LINK TO Pro-Forma MHO B

The ASW may have already completed an MHO A at the point of admission. LINK TO MHO A

Although this is a statutory social worker rather than an ASW role, ASWs may be also are involved in the preparation of social circumstances reports under Article 5 (6). This report must be prepared in circumstances where a nearest relative has acted as applicant. Again the information gathered contributes to the process of assessment during the detention in hospital for assessment period and to the multi disciplinary comprehensive risk assessment.
LINK TO Guidance Article 5 Social Circumstances Report
LINK TO Pro-Forma MHO D
LINK TO Guidance for ASW Assessment for Admission

What are the ASW's duties and responsibilities in relation to Guardianship? ASWs have 2 distinct roles in the guardianship application process and these must be carried out by 2 different ASWs.

• Article 40 of the Order places a duty on the ASW to make a guardianship application where, after taking into account the views of the relatives and any other relevant circumstances, he is satisfied that an application ought to be made by him and that it is necessary and proper for the application to be made by him. The ASW's duties and responsibilities include:
• Interviewing the person whose reception into guardianship is being considered.
• Identifying and consulting with the person who appears to be the Nearest Relative. If the nearest relative objects to the application the ASW must consult with another ASW before proceeding (3rd ASW).
• Gathering relevant information as part of the assessment.
• Consulting with the medical practitioners who has made the medical recommendations
• Consulting with relevant others including other health and social care professionals with prior knowledge of the person.
• Advising the person and nearest relative of the outcome of the assessment and their rights under the Order.
• Another ASW is required to make the recommendation in relation to guardianship.

What i s the role of the social worker in relation to the Mental Health Review Tribunal? The social worker is required to carry out a number of tasks in relation to the Tribunal. Again the Order and Rules do not stipulate that an ASW rather than a social worker must prepare and present the Mental Health Review Tribunal social circumstances report, in relation to a patient detained in hospital or received into guardianship under the Order.

The tasks of the social worker include:

• To advise the patient or person under guardianship of their right to appeal to the MHRT.
• To advise the patient re legal representation.
• Prepare social circumstances report for the Tribunal
• Give evidence at the MHRT hearing.

The social worker is acting in a professional capacity but also as a representative of the Health and Social Care Trust, as the detaining authority or authority who has received the patient into guardianship. One of the most challenging aspects of this work is to maintain a supportive and empowering relationship with the patient while ensuring that the patient receives the appropriate care and treatment.

LINK TO Guidance MHRT Guardianship Social Circumstances Report
LINK TO Pro-Forma MHRT Guardianship Social Circumstances Report
LINK TO Guidance MHRT Detained Patient Social Circumstances Report
LINK TO Pro-Forma MHRT Detained Patient Social Circumstances Report

What is the role of the ASW in relation to Part III of the Order? ASWs also have responsibilities in relation to Part III of the Order in relation to Guardianship and Supervision and Treatment Orders for persons who are involved in criminal proceedings.

These include:

• Preparation of Mental Health Review Tribunal Social Circumstances Reports for persons subject to Part III
• Duties in relation to those subject to Guardianship Orders under Part III
• Duties in relation to Supervision and Treatment Orders:

Approved Social Workers are clearly identified as having the specific role in relation to Supervision and Treatment Order as provided for under Part II of Schedule 2A within the Mental Health (NI) Order 1986 (revised 1996). The role involves co-ordinating and compiling a comprehensive assessment detailing the needs of an individual and assisting the decision if the responsible trust can safely meet these needs prior to the implementation of the order. The Approved Social Worker is pivotal in co-ordinating and working in partnership with a range of key agencies.

The ASW is responsible for ensuring the order is maintained and liaising with the courts as required and, as supervising officer, is responsible for maintaining regular contact with the supervised person and working to develop a productive relationship with the service user despite the coercive context. This often necessitates the approved social worker dealing with a high level of both risk and uncontrolled variables. In preparation for the expiry of a Supervision and Treatment Order, the ASW has the leading role in co-ordinating assessments and planning how to continue delivering services to the patient who is often associated with a high level of risk and stigmatisation. ASW Role in Risk Management As a professionals with a comprehensive knowledge of the legislation, Code and Guide, ASWs also have a role in proving advice and consultation to the multi disciplinary team as part of the risk assessment process.

Promoting Quality Care states that "Healthcare staff need to be aware of the powers available to them under Mental Health (Northern Ireland) Order 1986 that can, if necessary, be used. Detention should always be used as a last measure where a service user is considered a significant risk to him/herself or others". LINK TO Promoting Quality Care Good Practice Guidance on Risk Assessment September 2009