Occupational therapists as Approved Clinicians

An AC is a mental health professional who has been authorised to carry out duties under the Mental Health Act (England and Wales). The role is open to occupational therapists, psychologists, nurses, social workers and doctors working in mental health and/or learning disability services. It's sometimes called the Multi-Profession Approved Clinician (MPAC) role. 

Once you are an AC, you can become the allocated Responsible Clinician (RC) for people, leading on their care and treatment while they are subject to the Mental Health Act.  

Organisations allocate RCs from a pool of ACs (HEE 2020). The allocated RC should be the clinician with the most appropriate expertise and skills to address the person’s main treatment need. This could include habilitation and rehabilitation, as defined by the Mental Health Act, which OTs could lead on.  

As a RC your responsibilities under the Mental Health Act can include:  

• assessing whether the criteria for renewing detention are met 
• reviewing and renewing detentions 
• granting Section 17 leave 
• making decision about people’s treatment  
• recall or revoke detention of people on Community Treatment Orders (CTO) 
• discharging from detention 
• oversee guardianship orders. 

(Oates et al 2018). 

Although OTs have been able to work in this senior clinical role since 2007, only one has been through the process to become an AC. A review of OTs in 2021 showed that many are interested to find out more about the role (King 2021).

As an OT working as an AC, you’ll have a real opportunity to enhance personalised care. You can do this while promoting a stronger focus on psychosocial interventions in the treatment of people detained under the Mental Health Act.  

You’ll have the opportunity to apply the mental health legal framework in a recovery focused way, in line with OT values. You can provide interventions that focus on people’s strengths and promote their independence. You’ll be able to adopt a positive approach towards risk taking and recovery, working collaboratively with carers and families while leading the multi-disciplinary team (MDT). 

Your journey towards becoming an AC offer prospects for career and pay progression. As one of the most senior clinical roles an OT can hold, you will have real opportunities to change people’s lives and influence how clinical care is delivered. 

It offers you the chance to reach your full leadership potential as a senior clinician who can shape how services are delivered. Most importantly, the AC role enables OTs to progress and retain a clinical role without diverting into a management pathway.  

Becoming an AC uses a competency-based approach rather than being driven by job title or grade. However, to start the process of becoming an AC, you’ll need to be a senior OT with the level of capability and authority to make autonomous decisions as an AC (HEE 2020).  

It is likely that OTs will be at level 7- 8 of the professional practice and leadership pillars of the RCOT Career Development Framework.

If you are at an earlier stage in your career, you can consider how your CPD activities could enhance the skills and experience to support your AC competencies.  

For example, improving your knowledge and understanding of mental health law; working alongside current ACs; reading mental health tribunal reports; attending mental health tribunals as an observer and becoming familiar with the relevant Mental Health Act Codes of Practice for England or  Wales.  

To become an AC, you will need to demonstrate competency in eight core areas in England and nine in Wales. The following is a summary, and you can find the full competency lists and further country specific guidance below: 

Guidance for seeking AC Status via the portfolio route (England) 

Summary of AC core competencies in England: 

• The role: comprehensive understanding of the role, legal responsibilities, and key functions.  
• Legal and policy framework: applied knowledge of legal and policy framework/codes of practice/ NICE guidelines.  
• Assessment: ability to assess mental disorder and clinical risk, incorporating biological, psychological, cultural and social perspectives.  
• Treatment: an understanding of how physical, psychological, and social interventions can be provided in least restrictive settings. Ability to formulate,  review and lead on treatment. 
• Care planning: ability to manage and develop care plans combining health and social care in line with the care programme approach. 
• Leadership and multi-disciplinary team working: ability to lead a team with potentially diverse views while maintaining an independent view; ability to make decisions in complex cases without the need for supervision in each case; recognised limits of own skills and when to seek help. 
• Equality and diversity: up to date knowledge and understanding of equality issues including those concerning race, disability, sexual orientation, and gender. 
• Communication: ability to communicate decisions and underlying reasons for these: ability to balance need for confidentiality with need to share information; ability to complete statutory documentation, written reports and provide evidence to courts and tribunals.
   

Approval of ACs (Wales) 

Summary of ACs core competencies in Wales 

• The role of the AC: Understanding of the function of the AC and RC. 
• Values-based practice: ability to promote the rights, dignity, and self-determination of patients consistent with their own needs and wishes. 
• Assessment: high level of skill determining whether a patient has capacity to consent to treatment. 
• Care and treatment planning: skills and knowledge to undertake safe, effective care planning, ensuring implementation and review. 
• Treatment: skills and knowledge to harness the specialist treatment expertise of the MDT. 
• Leadership and multi-disciplinary team working: skills and knowledge to effectively lead a multi-disciplinary team based on sound evidence. 
• Equality, diversity and rights: ability to identify, challenge and redress discrimination and inequality in relation to AC practice. 
• Mental health legislation and policy: up to date working knowledge of relevant Welsh legislation including for human rights, children and social care. 
• Communication: ability to consider needs of patients with protected characteristics and of individuals who have Welsh as their language of choice. 

To achieve the AC competencies, you’ll need to complete a detailed and comprehensive portfolio with evidence of your competency. You submit this to one of the regional approval panels (in England) or the approval panel in Wales, for appraisal.  

Collecting evidence for your portfolio can take a few years and will include regular mentoring and shadowing of an AC. Until more OTs are in the role, your mentor could have a different professional background to yours. 

It is important that you’re supported by both local and board level managers in this process. To evidence this, you’ll need letters from both a clinical director and a professional lead supporting your application in your portfolio. 

You can find examples of a portfolio framework and checklist.

You can also contact the relevant regional panels for advice about your portfolio. There are four regional panels in England and one in Wales. 

London Regional Panel: s12acadmin.cnwl@nhs.net 

South of England Regional Panel: office@winterhead.co.uk 

North of England Approvals Panel (NEAP): tewv.neap@nhs.net 

Midlands & East of England Regional Panel: rdash.mha.approvals@nhs.net 

Welsh Approval Panel:  Meryl.Roberts@wales.nhs.uk 

Further information can be found about the Wales AC key competencies and legislation in the PDF.

The flow chart gives a suggestion of the process (see below) that may in place in your organisation. There may be local differences based on you and your organisation's needs. 

There are three types of training that may help you: 

Training specific to your individual needs. For example, you may identify that you need to learn more about providing evidence at courts and tribunals. You could attend a course that supports healthcare professionals to develop and improve this skill. This type of training is not mandatory but will help you build skills and evidence this in your portfolio. 

Training that prepares trainee ACs for the role and approval process. For example, there are now courses at London, Exeter and Northumbria that are designed to run alongside your clinical development. This training is not mandatory and does not lead to AC approval. However, it is designed to support you to develop the relevant knowledge and understanding of mental health legislation and its application in the AC role.  

Mandatory AC induction course. Prior to submitting your portfolio, you must attend one of the AC induction courses. They are to ensure that ACs understand the statutory aspects of the role in relation to the mental health legislation. You must show attendance at the course as part of your portfolio. 

We interviewed AC Donvé Thompson-Boy from England, about how she stepped into the role and the impact she has had.

Data about use of the Mental Health Act for different ethnic groups is nationally collected. It shows that black people are five times more likely to experience use of the Act than white people (NHS Digital 2021). 

Black Caribbean and black African people have the highest rates of detention under mental health legislation both in the UK and internationally (Barnett et al 2019). 

People from black, Asian and minority ethnic groups have said that mental health professionals: 

• lack knowledge about what is important to them and their experiences 
• don’t fully understand racism and discrimination  
• stereotype black people with mental health issues as aggressive either consciously or as part of unconscious bias (Rethink 2020). 

Your development of advanced equality and diversity competencies is an important part of tackling this. This will include: 

• up-to-date knowledge and understanding of relevant equality issues  
• ability to identify, challenge and redress discrimination and inequality in relation to AC practice 
• understanding of the need to actively promote equality and diversity 
• understanding of how your culture and values can affect decisions you make about use of the Mental Health Act. 

For example, taking part in regular reflection to become more aware of biases and prejudices that lead to discriminatory behaviour will be crucial. Sharing these reflections in peer groups and supervision can amplify your learning.  

This commitment to regular self-reflection and applied learning to practice means your development will be active rather than passive. It's not sufficient to just attend unconscious bias training. 

Being able to talk openly about equality and diversity means you will be better positioned to act fairly and responsibly in a situation. For example, it could involve challenging discrimination at work, where power and privilege may be perpetuating it. 

We were keen to inform and inspire OTs about becoming an AC to increase the number of therapists in this role and explore: 

• how occupational therapists working in mental health and/or learning disabilities can become ACs
• how workforce planners, educators and strategic leads can think about how to create the right learning and workplace environment, to encourage this change in the profession.

The aim of the event was to:  

• promote understanding of and interest in the AC role 
• raise awareness of the value and contribution that occupational therapists can make as an AC 
• make the AC approvals process and the experience required to meet the associated competencies clearer 
• guide educators and leaders on how to increase the opportunities for OTs interested in AC roles.

If you want to connect and/or collaborate with other OTs interested in the role please email: genevieve.smyth@rcot.co.uk. 

Barnett P, Mackay E, Mathews H, Gate R, Greenwood H, Ariyo K (2019) Ethnic variation in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data. The Lancet, 6(4), p305-317. 

Department of Health (2015) Mental Health Act 1983: Code of Practice. London: Department of Health 

Department of Health (2017) Guidance for seeking Approved Clinician Status via the portfolio route. London: Department of Health 

Health Education England (2020) Multi-Professional Approved/ Responsible Clinician: Implementation Guide. London: HEE. 

King T (2021) Approved / Responsible Clinician Roles: Exploring the Gap for Occupational Therapy. Southeast England: HEE. 

NHS Digital (2021) Ethnic facts and figures service; Detention under the Mental Health Act. London: Health and Social Care Information Centre. 

Oates J, Brandon T, Burrell C, Ebrahim S, Taylor J and Veitch P (2018) Non-medical approved clinicians: Results of a first national survey in England and Wales. International Journal of Law and Psychiatry, Vol 60 pp 51-56.  

Odeh A (2022) Do you know enough about the Approved Clinician role? OT News, November 30 (11), p30- 32. 

Rethink (2020) Black, Asian and Minority Ethnic Mental Health Factsheet. Birmingham; Rethink. 

Thompson-Boy D (2019) Bring your skills to bear as an Approved Clinician, says England’s only occupational therapist in the role. OT News. November 27 (11), p10. 

Welsh Government (2016) Mental Health Act 1983 Code of Practice for Wales. Cardiff; Welsh Government. 

Welsh Government (2018) Mental Health Act 1983, Approval of Approved Clinicians (Wales). Cardiff, Welsh Government. 

UK Public General Acts (1983) The Mental Health Act. HMSO, London.