Who wants to be an Approved Mental Health Professional?

Stephen MartineauAs the Unit embarks on a new piece of Department of Health commissioned research examining the role of the Approved Mental Health Professional (AMHP), Stephen Martineau and colleagues report from the AMHP Leads Network conference, held in London last week (10 July), and map out some of the background to the study. (977 words)

AMHPs carry out a variety of tasks when it comes to the use of compulsion under the Mental Health Act 1983 (MHA). Chief among these is coordinating the assessment under the MHA of individuals whose mental disorder is such that it fulfils the statutory criteria; the application for a formal admission to a hospital must be ‘founded’ on medical recommendation, as the pink form for a detention under the MHA has it, but the AMHP takes the decision.[1]

Form A2 Section 2 appl by AMHP for admiss for assess-page-001

Form A2. Section 2 MHA: application by an approved mental health professional for admission for assessment (photo links to pdf)

Of course, this is only the very barest description of what is involved in the job: last week, someone who had been the subject of a MHA assessment by an AMHP wrote vividly of the experience in Community Care. Elsewhere, the Masked AMHP has asked, and answered, the question: What is an AMHP?

In making a MHA assessment of a person, AMHPs bring to bear a ‘social perspective’. And it is social workers—initially under the MHA, Approved Social Workers (ASWs)—who have been historically associated with the role. But in 2008 ASWs became AMHPs, and with the change in designation came a loosening of the ties to the social work profession: it was now also possible for certain kinds of nurses, occupational therapists and psychologists to take up the role.

Nearly nine years on, AMHPs are still overwhelmingly drawn from among social workers, current estimates suggesting that out of the 3,800–4,000 AMHPs in England, the newly eligible health professionals number something under 300 (with apparently, as yet, no psychologists among them). Why, our study asks, is this figure not larger?

At the AMHP Leads Network annual conference

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Indian YMCA in London

As it happens, the early phases of our study coincided with the AMHP Leads Network conference, held at the Indian YMCA in Fitzrovia on 10 July. We learnt a great deal about the current context for our research at the conference. The estimated total number of AMHPs in England, mentioned above, was reported to delegates by Steve Chamberlain, AMHP Leads Network Chair. In this, he was drawing from surveys the Network has conducted; remarkably, there is no central register of AMHPs, though plans are afoot to have Social Work England take this on when the new regulator comes into being (possibly) in September 2018.

We learnt, also, that commencement of the provisions making significant amendments to sections 135 and 136 MHA, contained in the Policing and Crime Act 2017—delayed because of the election—is scheduled for September 2017, with regulations due to be laid before Parliament over the summer (a timetable, which the results of enquiries made by Mental Health Cop seem to support).

Also scheduled for September 2017 is the publication of the report of the appreciative enquiries the Care Quality Commission (CQC) has conducted in 12 places. These visits (the idea for which sprang from the Mental Health Crisis Care Concordat) examined the AMHP service and rates of detention in the chosen localities. Concern about the rise in the number of detentions under the MHA is widespread: detentions rose by 46% in the decade to 2016.

HM Gov 2008 AMHP regs-page-001

The five areas of competence, thought by some to be repetitive and outdated, are contained in Schedule 2 of these Regulations from 2008 (photo links to pdf)

On the broader question of inspecting AMHP services, one CQC representative at the conference said that variation in the manner (as opposed to quality) of AMHP service provision was such that CQC ratings couldn’t readily be meaningfully applied. We were a decade away from that, she suggested.

Among the research that was discussed on the day was work by Robert Lewis and Karen Linde on different models of AMHP service provision, and work (discussed by Anna Beddow) reviewing the competencies that AMHPs are expected to have before they can be approved by the local authority. This latter work is completed and the results are now with Chief Social Worker for Adults, Lyn Romeo, who also spoke at the conference. If anything, this proposed reset of the competencies would give even greater prominence to the social perspective in the AMHP role.

‘As we work towards a new Mental Health Act…’

The conference took place in the wider context of potential legislative reform. Matthew Lees, the Department of Health Policy Lead on Mental Health, indicated that the idea of replacing the MHA—mention of which was made in the background briefing notes to the Queen’s Speech (‘As we work towards a new Mental Health Act…’ p. 56 of the notes)—enjoys real traction in the Department.

Matthew Lees, Lyn Romeo, Emad Lilo, Claire Barcham, and Steve Chamberlain at the AMHP Network Leads Conference, 10 July 2017

Matthew Lees, Lyn Romeo, Emad Lilo, Claire Barcham, and Steve Chamberlain at the AMHP Leads Network Conference, 10 July 2017. Photo: Emad Lilo

The Mental Health Alliance (a coalition of over 75 organisations), which published a report in June on the topic, would no doubt welcome this. Mr Lees contrasted such prospects with those for the draft bill, published by the Law Commission earlier this year, aimed at fixing the Deprivation of Liberty Safeguards; he pointed out that the same background briefing notes, the mental health reform section of which he had written himself, contained no mention of it.

In the still wider context, and well beyond the confines of the conference hall, last month also saw what may prove to be a significant intervention by the United Nations Special Rapporteur in the field. The report is worthy of brief mention here since the critique it contains has an obvious pertinence to the use of the MHA as it stands today. The Rapporteur, Dainius Pūras, calls for ‘a revolution in mental health care’; he strongly criticizes, for example, the use of a biomedical (as opposed to a psychosocial) approach and a reliance on coercive practice.

AMHPs, as we have seen, sit in an interesting position in the terms of these debates, bringing to bear a social perspective to their assessments, while also playing a central role in arranging compulsory admission under the present Act. No doubt our study will be much concerned with the systemic and other constraints on eligible health professionals taking up the AMHP role. Yet these broader debates, and their relevance for the way other professionals view the kind of work AMHPs do, will never be far away.

Follow the conference: #AMHPleads17

Stephen Martineau is a researcher on the study, ‘Who wants to be an AMHP?’. The other researchers are Martin Stevens (PI), Prof Jill Manthorpe, Caroline Norrie and Nicole Steils. All are based at the Social Care Workforce Research Unit, King’s College London.

[1] The ‘nearest relative’ under the Mental Health Act 1983 may also perform this role. Please also see Claire Barcham’s comment to this post for more on what the AMHP must do and consider when it comes to detentions under the MHA.

Researching in care homes – what was learnt from a study of handovers?

Caroline NorrieCaroline Norrie is Research Fellow at the Social Care Workforce Research Unit, King’s College London (330 words)

What can researchers of care services learn from our recent handover study?  We asked ourselves this question and discussed this at the annual conference of the British Society of Gerontology held in Swansea last week (pictured below is the new beach side campus) at the start of July. Our paper summarised the findings of our unique exploration into handovers in care homes and then we paused to ask what could be relevant to other researchers studying care home practice and systems. Continue reading

Notes from the inaugural conference of the Italian Society of Social Work Research

Gaia CetranoGaia Cetrano is a Research Associate at the Social Care Workforce Research Unit, King’s College London. (1,100 words)

In May this year I was proud to take part in the first conference organized by the new Italian Society of Social Work Research (SOCISS) in Turin, Italy.

The origins of SOCISS date back to 1983 when a group of teachers of social work founded the Italian Association of Teachers of Social Work (AIDOSS). AIDOSS assiduously worked over 30 years to develop common thinking on theories of social work, as well as on the organization of university curricula, and the role of training and research. Then what happened? The Association committee reunited in 2016 and approved a new constitution outlining its new objectives, which included strengthening the dialogue between theory and practice in social work and promoting social work research in Italy and internationally. I think it is very important that the status of the association has now changed to that of a scientific society as this will hopefully help professionals, researchers and academics to acquire a stronger voice and also be in a better position to communicate and negotiate with other disciplines. Continue reading

Providing Support and Care from a Distance

Caroline White of the University of Hull is seeking participants in a new study. (462 words)

Family members and friends often provide support, help and care to others, instead or in addition to paid sources of care and support. These people (often referred to as carers, although this term is not embraced by all) are collectively estimated to save the UK economy £132 billion per year (according to figures from Carers UK in 2015) and have been the subject of much research and policy development. The majority of existing research about carers concerns those who support someone who lives with or near to them. However, as we become an increasingly geographically mobile population many parents, adult children, siblings, other relatives and friends find themselves living at a distance from those they care for and about. A new research project at the University of Hull is working to find out more about the experiences of those who provide help, care and support to a relative or friend who lives at a distance from them (we are meaning that they have to travel for one hour or more to visit them). Continue reading

Mental Health Workers – We need your help for our research

Tasneem ClarkeTasneem Clarke, Research Officer at the Money and Mental Health Policy Institute, based at King’s College London, discusses the Institute’s latest research, which asks: what can mental health practitioners do to support people in financial difficulty? Please take this two minute quiz to register your interest and help her come up with pragmatic solutions to this difficult issue. (736 words)

Money and mental health – a toxic relationship

As practitioners in mental health services know, life can be messy. The people we work with are rarely only facing one issue; from relationship breakdown to past traumas, economic disadvantage or long-term physical and mental health problems – issues interweave and make each other worse. Continue reading

Bringing it all together – re-valuing older people by combining research, training and practice

Valerie LipmanValerie Lipman is a Postdoc Intern at the Social Care Workforce Research Unit in the Policy Institute at King’s College London.

Here’s a challenge for learning institutes in the UK: how can they deliver on-site direct services for the vulnerable groups whom they’re studying and promoting? I talked to Dr Indrani Chakravarty, the founder and Director, of the Calcutta Metropolitan Institute of Gerontology (CMIG) about her experience of doing just this and how she marries research with real practice. Continue reading

Older People & Human Rights

Dr Joan RapaportJoan Rapaport reports from the 9th Annual Joint Conference of Age UK London, the Social Care Workforce Research Unit and Making Research Count. (1,789 words)

The conference, held on the Guy’s Campus of King’s College London, was chaired by Jo Moriarty, Deputy Director of the Social Care Workforce Research Unit, and attracted a capacity audience. Speakers’ presentations are available on the SCWRU conference webpage.

Human Rights Act: overview of current changes: Caroline Green, PhD student, Social Care Workforce Research Unit

Whilst human rights have been around for hundreds of years both globally and in Britain, Caroline acknowledged that our understanding mostly relates to post World War II developments. The European Convention on Human Rights, drafted in 1950, contains numbered ‘Articles’ each of which protects a basic human right. The European Court of Human Rights, based in Strasbourg, rules on cases brought under convention from the 47 signatories. Continue reading

Adult Social Care – where’s the evidence?

Jo Moriarty Nov 2014bJo Moriarty and Martin Stevens are Senior Research Fellows at the Social Care Workforce Research Unit. (1,192 words)

People often talk about the absence of a social care evidence base, but ‘patchy’ is a far better description. Until we arMartin Stevense more explicit about this, it will be difficult to make progress in achieving evidence based policy and practice. We took part in two Meet the Researcher sessions at an event jointly organised by Research in Practice for Adults (RIPfA), the British Association of Social Workers (BASW) and the Association of Directors of Adult Social Services (ADASS). They were part of a day-long seminar designed to bring Directors and Assistant Directors of Adult Social Care and researchers together to discuss current and future adult social care research. Continue reading

Which people with dementia receive less medical attention; what can social care do to promote equality?

Open Access from Age and AgeingClaudia Cooper and Jill Manthorpe introduce their new article, which is open access in Age and Ageing. (726 words)

Women with dementia make fewer visits to the GP, receive less health monitoring and take more potentially harmful medication than men with dementia, our new research has found.

The study, published in Age and Ageing in early December, was funded by Dunhill Medical Trust. We found that only half of all people with dementia had a documented annual review even though GPs are offered financial incentives to carry these out. Women were at particular risk of staying on antipsychotic or sedative medication for longer. This might be because they have fewer GP appointments where their treatment can be reviewed. Continue reading

Progressive children’s legislation in reverse gear?

Children Act 1989 report (1991)The Policy Institute at King’s and the Social Care Workforce Research Unit have reproduced a 1991 report into the implementation of the Children Act 1989, and updated it with a new foreword and introduction, the latter by Jane Tunstill, who here discusses current legislative proposals. (1,408 words)

It is no coincidence that the longest-running play on the London stage, The Mousetrap, which is still being shown after 64 years, is based on a key tragic event in the history of childcare policy in this country. Agatha Christie recognised that the death of Dennis O’Neill in 1945, at the hands of his foster parents, was a topic to engage the attention of her readers, and audiences have certainly proved her right. The tragedy, and subsequent enquiry, directly triggered the Children Act 1948, which introduced a national framework of children’s departments responsible for the systematic oversight of the welfare of children.

The recent release of Ken Loach’s new film, I, Daniel Blake, has reminded commentators of the popular feeling aroused by his 1965 film, Cathy Come Home. The image of children being taken forcibly from their homeless parents by social workers had a powerful impact on attitudes and national child care policy. Indeed, the British Association of Social Workers (BASW) issued guidance in 1971 that no social worker should receive a child into care because of homelessness alone. The 2013 film Philomena attracted huge popular acclaim for its portrayal of the Roman Catholic Church’s forced adoption of the babies of single mothers, and 2016 saw a papal apology for the practice. Continue reading