Negotiating Uncertainty: Mental Health Professionals’ Experiences of the Mental Health Act Assessment Process

Part one: Literature review. Aim: A literature review was carried out to explore the current knowledge about how the application of mental health legislation affects both clients and clinicians. Method: A computerised literature search was carried out using various databases. Results: Researchers have found that a significant proportion of mental health clients who are placed under mental health legislation experience negative emotional reactions and perceived coercion. However, the relationship between legal status and negative outcomes seems to be mediated by procedural justice. The few studies of clinicians' experiences suggest that applying the legislation can be associated with practical difficulties, stress and pressure. Discussion: Methodological issues in the existing research are discussed alongside suggestions for further research. Part two: Research report. Aim: The current study aimed to explore how mental health professionals experience the Mental Health Act assessment process and how they cope with any effects. Method: The data from semi-structured interviews with eleven mental health professionals was analysed using the grounded theory method (Pidgeon & Henwood, 1996). Results: The core category of the generated theoretical model was ‘negotiating uncertainty’. Interwoven factors that contributed to uncertainty were legal liability, the pressured context of assessments, external conflict and the tension between incompatible identities. Strategies used to tolerate and contain the uncertainty included internal psychological processes and external support. Discussion: The clinical implications of the findings are discussed, including the need for increased occupational support for professionals. Suggestions for further research are also provided. Part three: Critical appraisal. A reflection on the research process is provided, including issues of ongoing adaptation and overall learning outcomes.