Extending Legal Powers of Detention to Psychologists: Challenges to Traditional Ethos and Culture
Dr. John L. Taylor
Professor of Clinical Psychology, Northumbria University, and Associate Director for Psychological Services, Northumberland, Tyne & Wear NHS Foundation Trust, UK
The provision of mental health care through involuntary hospitalization for persons deemed to be dangerous to themselves or others in California and other states is the domain of psychiatry, and it is psychiatrists who make the need for continuing care or discharge decisions. In the UK, the England & Wales Mental Health Act 2007 introduced the approved clinician (AC) role that extends legal powers previously reserved to medical practitioners to psychologists. A key competency of ACs, who are appointed by the Secretary of State for Health & Social Care, is the ability to identify the presence and severity of mental disorder and determine whether that is of a nature or degree that warrants compulsory detention. In contrast to US practice, ACs in the UK can act as the responsible clinician (RC) for patients compulsorily detained under the Mental Health Act. RCs have overall responsibility for a detained patient’s care and treatment, including medication. In essence, RCs in the UK are required to take statutory responsibility for the continued detention or release of patients who carry extant risk of harm to themselves or others. Intriguingly, the introduction of this extended role was strongly contested by a number of stakeholders, including lawyers and psychologists.
The AC/RC’s operation of this risk assessment-management function is closely scrutinized by judge-led tribunals which bring into focus the relationship between psychology and the law. Some ten years after the implementation of this role, psychologists and other eligible professions have exercised all of the powers available to them under the law – albeit in small numbers. In this presentation, the nature and development of the AC role is described in terms of the legal debate that accompanied it and the relationship between the law and psychology that shapes its operation. Emphasis is given to how the power invested in this role for psychologists can be harnessed through effective clinical leadership to promote change and improvements in services to better meet patients’ needs and improve access to evidence-based interventions.
John L Taylor is Professor of Clinical Psychology at Northumbria University, Newcastle upon Tyne and Consultant Clinical Psychologist and Associate Director for Psychological Services with Northumberland, Tyne & Wear NHS Foundation Trust in the UK. He is a registered clinical and forensic psychologist. Dr Taylor is Chair of the British Psychological Society (BPS) Mental Health Act Advisory Group and Approved Clinician Peer-Review Panel, a Past President of the British Association for Behavioural and Cognitive Psychotherapies (BABCP), and a former Chair of the BPS Faculty for Forensic Clinical Psychology. Dr Taylor was one of the first two psychologists to be approved as an Approved Clinician in England following the MHA 2007. He has published more than 140 research papers, articles, books and book chapters mainly concerning the mental health and forensic needs of people with intellectual and developmental disabilities. Dr Taylor received an award for Outstanding Contribution to Applied Practice from the BPS Faculty for Forensic Clinical Psychology in 2017 and was made an Honorary Fellow of the BABCP in 2018 for his work on developing CBT for people with intellectual and developmental disabilities.