In England and Wales, approved mental health professionals (AMHPs) undertake interviews with service users as part of wider Mental Health Act assessments. AMHPs act as the ultimate decision-maker in relation to statutory detentions. They have legal duties to consider the least restrictive outcomes for service users, including alternatives to hospital. Yet they are increasingly unable to act on this, resulting in conflicting pressures. This article draws on a qualitative research study incorporating ethnographic research and interviews with AMHPs. Evidence suggests that service restructures are creating different approaches to practice with contradictory priorities, for example, whether the work is values-driven and relational or whether approbation is attached to a ‘need for speed’. AMHPs are increasingly deliberating about what makes ‘proper’ or ‘good’ AMHP practice, asking ‘who are we for?’ and referring to their work as ‘political activity’. AMHPs’ sense-making and language are indicative of moral distress. Organisational politics may lead to the work being seen as a technical-rational endeavour, not a moral one, leading to dissonance. More broadly, AMHPs and service users are, together, bearing the brunt of austerity measures and there are increasing unmet needs. Overall, there is a need to establish an ideological, theoretical and political base for practice.

中文翻译：

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经批准的心理健康专业人员的道德困境经历：“我们为谁服务”？

在英格兰和威尔士，经批准的心理健康专业人员 (AMHP) 会与服务使用者进行访谈，作为更广泛的《心理健康法》评估的一部分。AMHP 是法定拘留的最终决策者。他们有法律义务考虑对服务使用者限制最少的结果，包括医院的替代方案。然而，他们越来越无法对此采取行动，从而导致相互矛盾的压力。本文借鉴了一项定性研究，结合了人种学研究和 AMHP 访谈。有证据表明，服务重组正在创造不同的实践方法，但优先顺序相互矛盾，例如，工作是否是价值观驱动的和相关的，或者认可是否与“对速度的需求”挂钩。AMHP 越来越多地思考什么是“正确”或“良好”的 AMHP 实践，并询问“我们为谁服务？” 并将他们的工作称为“政治活动”。AMHP 的意义建构和语言表明道德困境。组织政治可能会导致这项工作被视为一种技术理性的努力，而不是道德上的努力，从而导致不和谐。更广泛地说，AMHP 和服务用户共同承受着紧缩措施的冲击，未满足的需求不断增加。总体而言，需要建立思想理论政治实践基础。