Stephen Martineau was at a day conference last week focusing on a new national workforce plan and proposals to introduce AMHP service standards as well as changes to the AMHP competencies. (1,030 words)
Recent empirical research at this Unit on the Approved Mental Health Professional (AMHP) workforce has focused on why so few in the eligible health professions are taking up the role. AMHPs are responsible for organising and undertaking assessments under the Mental Health Act 1983 (MHA) and, where statutory criteria are met, authorising detention under the Act. Traditionally a social worker role (they were formerly known as Approved Social Workers), it has been open to occupational therapists, learning disability and mental health nurses, and psychologists since November 2008. But about a decade since these professionals were enabled to become AMHPs, they still only make up around 5% of the AMHP workforce.
Just as the NHS is engaged in its own workforce planning (interim proposals were published last month), a national workforce plan for AMHPs is in preparation. Mark Trewin of the Department of Health and Social Care (DHSC) presented a draft version of the plan at a conference ‘celebrating, supporting and developing the AMHP role’ in London on 2 July. Taking place under the aegis of Skills for Care, Social Work England and the AMHP Leads Network, the day drew together AMHPs, service users, sector leaders, and policymakers to discuss the challenges facing this workforce.
For while the low take-up of the AMHP role by health professionals has been our focus, it is only one element of the larger picture. The draft plan describes a ‘looming demographic, recruitment and retention crisis’, referring to the fact that DHSC estimates of a workforce numbering around 3,400 in England mean there has been a 17% drop in the number of practising AMHPs since 2009. In November last year, Skills for Care reported that while 21% of the social worker workforce are aged 55 or over, this rises to 30% when looking at AMHPs alone (Skills for Care, 2018). At the same time, the draft plan notes that the number of assessments and detentions under the MHA has been rising. There were an estimated 142,000 assessments in 2016-17, with 45,000 of these leading to detention.
New service standards and refreshed competencies
At the conference, a draft set of standards for AMHP services was presented by Robert Lewis and Karen Linde, who argued that with so many assessments taking place across England it was extraordinary that such standards did not already exist. The standards would ensure consistency of provision across the country. It was suggested that when it comes to AMHPs, ‘No-one owns us’: the fact that AMHPs work between the local authority (who formally approve them) and NHS trusts contributes to their lack of profile and status. (Reference was also made to the consideration by Lisa Morriss of AMHP work as ‘dirty work’.) It was contended that the standards would render AMHPs more visible and comprehensible to other professionals, and bodies such CCGs.
The conference also discussed suggested changes to the set of competencies, against which AMHPs are assessed in order to be warranted for the role. Anna Beddow (University of Manchester) has drawn these amendments up together with DHSC, the AMHP Leads Network and following consultation. They will be considered by Social Work England for inclusion in the new MHA regulations. The new regulator for social work, represented at the meeting by Executive Director, Sarah Blackmore, is itself preparing to take on responsibility for AMHP training and liaising with the Royal Colleges of Nursing and of Occupational Therapists to ensure there is consistency across the workforce in this regard.
A national workforce plan
The background section of the draft workforce plan refers at length to both our work on non-social work AMHPs and also our subsequent review of the literature examining factors encouraging and discouraging social workers in their decision whether to take up the role. Perhaps the primary finding of this latter study was the dearth of work in this area, with only 23 publications identified for consideration in our review. We plan to publish one peer reviewed article from each of these studies.
The draft plan itself ranges widely, but focusing for the moment on why the 5% health professional figure isn’t greater, a few proposals jump out as being consistent with our study findings:
- The plan calls for a specific pathway supported by the occupational therapist and nursing colleges to support the development of the AMHP role in their respective workforces;
- Local authorities and NHS trusts should have a shared workforce plan for AMHPs from non-social worker backgrounds;
- And disparity in pay between NHS and local authorities should be reduced. Those employed as AMHPs should be paid at similar levels irrespective of who is employing them.
‘If someone I knew…’
Lest there was any doubt on the matter, the draft plan makes reference to the DHSC’s work developing a new Mental Health Act and associated regulations. This follows on Sir Simon Wessely’s independent review of the 1983 Act, published in December last year (and the Liberty Protection Safeguards which came into law on 16 May this year, to be implemented 1 October 2020). Also in relation to legislative provision, the conference was supplied with draft guidance for local authorities and Clinical Commissioning Groups on how to implement section 140 MHA (this section, which deals with the reception of patients in cases of ‘special urgency’, reportedly being poorly understood by professionals and organisations).
As well as the Chief Social Worker for Adults, Lyn Romeo, (who, along with Mark Trewin, was a member of our study’s advisory group) and Tony Deane (@asifamhp on Twitter), delegates also heard from Steve Gilbert OBE. Steve was a service user member and Vice Chair of Sir Simon Wessely’s Review. He urged delegates to consider three questions from a first-person point of view:
- If someone I knew was having a MHA assessment, how would I want them to be treated?
- How would I want them to feel after the event?
- In my professional position, what could I do to affect their experience?
Finally, for some further reading from us, here are the links to three previous posts on our blog on this topic:
- AMHP study lead Dr Martin Stevens on the study findings.
- A report from Caroline Norrie and Nicole Steils on a seminar given at our Unit by Dr Caroline Leah (Manchester Metropolitan University): The Role of the AMHP: A Fool’s Errand?
- My earlier post from the AMHP Leads Network conference 2017.
Stephen Martineau is Research Associate at the NIHR Health & Social Care Workforce Research Unit at King’s College London. Who wants to be an Approved Mental Health Professional? study page.