As 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 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

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.

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 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.

[On the prospects for the Law Commission proposals for DoLS, and possible alternative arrangements, see Community Care, 25 July 2017]