Intergenerational event at Portcullis House

Charlotte Bice (17 years) and Jessica Bice (16 years), with their grandmother, Joan Rapaport, PhD took part in an intergenerational workshop at Portcullis House, 24 August 2018. The afternoon involved discussing different approaches that the young and older generation may adopt to achieve a successful outcome in resolving community challenges. The event was presented by The Way Ahead Engagement Project in association with the City of London, City Bridge Trust and Age UK London. (400 words)

Reflections on the day

‘This has been an enjoyable event’. ‘Great day’. ‘Ninety-nine per cent of the population should have this’.

We were excited to be right by the Houses of Parliament, to be sitting in the room where Select Committees hear evidence and to be working in a group to consider how we might help to improve our local amenities. The presentation How Parliament holds Government to account gave us a clear understanding about the respective roles of Parliament and Government, the duties of our MP and the work undertaken by a range of parliamentary groups. We were also told that if our MP failed to respond to a particular concern we could attend the Houses of Parliament and register our query on a green card. Our MP would then be obliged to stop what they were doing to come to see us in person! Continue reading

The Role of the AMHP: A Fool’s Errand?

Caroline Norrie and Nicole Steils are researchers at the Social Care Workforce Research Unit (SCWRU), King’s College London. (618 words)

The identity of Approved Mental Health Professionals (AMHPs) was the subject of a joint SCWRU and Making Research Count seminar held on Thursday, 23 August 2018, at King’s College London (KCL) as part of the Contemporary Issues in Mental Health series.

Dr Caroline Leah

Dr Caroline Leah

The presenter, Dr Caroline Leah, Senior Lecturer at the Faculty of Health, Psychology and Social Care at Manchester Metropolitan University, discussed findings from her recently completed PhD about the role and identity of AMHPs, as well as enabling the audience, many being practising AMHPs, the chance to participate in lively discussions throughout the seminar.

An AMHP is a professional who is authorised to make certain legal decisions and applications under the Mental Health Act 1983; their powers include sectioning service users. This professional will usually be a social worker, who has undertaken additional training. In 2007, however, the law was amended to allow other mental health professionals to train for and to undertake this role. It is therefore now possible for psychiatric nurses, occupational therapists or psychologists to qualify as AMHPs, although this is still unusual.

Caroline reported findings from a qualitative, case-study project which involved in-depth interviews with ten AMHPs from three regions in the North West. Study participants’ identities were compared across qualifying professions (social work, nurse and occupational therapy backgrounds) as well as rural, urban and mixed rural/urban locations. Caroline found AMHPs to have developed ‘hybrid professional identities’ due to their ‘liminal’ (being at the interface) position where they typically work with a wide range of professionals, for example the police, ambulance staff and hospital bed managers, yet their role is often poorly understood by colleagues.

Her study explored how the AMHP professional role is negotiated between the employing organisation’s culture (local authority or NHS Trust) and within working relationships amongst other professionals in the Mental Health Act context. Caroline argued that AMHP work that encompasses working across legal, therapeutic, social work and management domains demands a ‘hybrid identity’ to enable working with other professionals to achieve positive outcomes for service users.

In her research, Caroline used sociological interpretations of the terms ‘a fool’s errand’, and the ‘cloak of conformity’ to capture reported working situations where AMHPs, on the one hand, are charged with championing service users’ decisions about how best to treat their conditions using the ‘least restrictive option’, however, on the other hand, due to austerity and the reduction of community services, it is difficult to offer service users any community-based options. Caroline coined the term ‘ironic dialogism’, which she used as a concept to explain the protective ironic approach practitioners may adopt when being faced with the disjuncture between the experienced realities of the AMHP role and tensions of working with a broken ‘rule book’.

Caroline asked the audience if this description of working practice reflected their own experiences and she received whole-hearted agreement that this was the current state of play. The audience discussed their day-to-day working conditions: identifying vacant ‘beds’ for service users and why this had become central to their role; waiting times for ambulances; filling in forms that did not seem to make sense; personal safety and lone working; and feeling voiceless in complaining about their situation. Only one seminar participant reported that there was not a bed shortage in their region. Participants also addressed whether having AMHP hubs or co-located workers situated with police was most helpful.

Caroline ended the talk with a ‘call to arms’ for AMHPs attending the seminar to do at least one thing to support the profession and raise awareness among those with decision-making powers about current practice and how it could be improved.

Dr Leah was talking at the Contemporary Issues in Mental Health seminar series.

Research reveals reasons for low take-up of Approved Mental Health Professional role

Pay levels, poor awareness of the role, and a lack of associated career benefits all discourage health professionals from training and working as Approved Mental Health Professionals (AMHPs), according to new research by the NIHR Social Care Workforce Research Unit at King’s College London.

AMHP Final Report 2018Published today, Who wants to be an Approved Mental Health Professional?, finds that closer working between Mental Health Trusts and local authorities, higher remuneration and enhancing the reputation and profile of AMHP work would encourage more health professionals to take up such positions.

Greater engagement from the Royal Colleges of Nursing and Occupational Therapists, and the Nursing and Midwifery Council, may also make the AMHP role more attractive by helping to embed it in these health professionals’ career plans.

The research highlights how organisational barriers – such as difficulties in managing AMHPs across separate local authority and mental health trust teams – deter many health professionals from taking up the role.

The study consists of more than 50 interviews with individuals involved in AMHP services, as well as a survey of Local Authority AMHP Leads.

Unsurprisingly, health professionals interviewed for the research reported needing a high degree of motivation to become AMHPs, often having to overcome opposition from their managers. Some also feared being responsible for decisions to detain patients, which they thought would make it more difficult for them to establish and maintain therapeutic relationships.

Although the immediate nature of AMHP work, including crisis resolution, makes it attractive to many health professionals, the difficulty of arranging effective supervision was another challenge highlighted.

Despite the barriers, most participants were positive about health professionals’ ability to work effectively as AMHPs.

However, local authorities and NHS Mental Health Trusts were increasingly focusing on ‘core business’, which may mean the NHS is less enthusiastic about supporting health staff to become AMHPs, as the AMHP service is a local authority responsibility.

AMHPs are responsible for deciding, with the advice of two medical doctors, whether a person assessed under the Mental Health Act 1983 should be compulsorily admitted to hospital (also known as ‘sectioning’).

There is currently a shortage of AMHPs at a time when the number of Mental Health Act assessments is increasing. 95% of AMHPs are social workers, highlighting the need to recruit more health workers to the role. One of our main findings was that AMHP Leads regard it as difficult to enable health professionals to become AMHPs.

This research stresses the importance of local authorities and Mental Health Trusts committing to working together to encourage and support health professionals to become AMHPs. At a time of pressure on public services, it is natural that they focus on ‘core business’, so it will be important to ensure that the AMHP service is not seen purely as a local authority responsibility by all agencies involved.

The research has been welcomed by Lyn Romeo, Chief Social Worker for Adults, ‘I have asked my team to work with Health Education England, Social Work England and the Association of Directors of Social Services to ensure that we use this very helpful and timely research from the NIHR Social Care Workforce Research Unit to develop our workforce plan for Approved Mental Health Professionals so that we can encourage all relevant professionals to train to be AMHPs.’

We made these suggestions for overcoming barriers to health professionals becoming AMHPs, which we hope will be useful for the Independent Mental Health Act Review:

  • Give Local Authorities specific responsibilities to enable and fund health professionals working for Mental Health Trusts to take up AMHP training (which may require extra funding for Local Authorities)
  • Increase the amount paid to AMHPs
  • Make nationwide decisions about the amount to pay AMHPs and how to pay them
  • Equate AMHP pay with enhancements for other clinical nurse specialisms (e.g. nurse prescriber)
  • Engage with professional bodies, such as the Royal College of Nursing and Royal College of Occupational Therapists and regulators such as the Nursing & Midwifery Council. This would help foster greater confidence that becoming an AMHP is an important and rewarding means of career advancement for these health professionals.

The report (and a summary report) is available from the project page:

Stevens, M., Martineau, S., Manthorpe, J., Steils, N. and Norrie, C. (2018) ‘Who wants to be an Approved Mental Health Professional?’ London: Social Care Workforce Research Unit, King’s College London.

At the 7th International Health Humanities Network Conference

Dr Martin StevensMartin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit at King’s. (1,276 words)

I was pleased to be asked to chair a few sessions of this conference, on 2nd-4th August 2018, at St Mary’s Stadium, the home of Southampton Football Club. Overcoming the prejudice about all things Southampton inevitable in a Portsmouth resident, I have to admit it was a great venue.

This was the 7th International Health Humanities Network (IHHN) conference. The venue has alternated between the USA and Europe; this year the conference was run in collaboration with the Good Mental Health Cooperative and speakers and delegates came from the USA, Australia, Europe and Nigeria. The IHHN:

…provides a global platform for innovative humanities scholars, medical, health and social care professionals, voluntary sector workers and creative practitioners to join forces with informal and family carers, service-users and the wider self-caring public to explore, celebrate and develop new approaches in advancing health and wellbeing through the arts and humanities in hospitals, residential and community settings. (from the IHHN website)

St Mary's Stadium, Southampton

St Mary’s Stadium, Southampton

Continue reading

Newly published in Ageing & Society: ‘Day centres for older people – a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived’

Katharine OrellanaKatharine Orellana is a Research Associate in the Social Care Workforce Research Unit in The Policy Institute at King’s. (479 words)

Day centres for older people have been an integral part of social care in England since the 1960s. Recently, attention has focused on providing individualised support for older people with care needs. The relevance and desirability of group services, such as day centres, are questioned. Many are closing.

Our newly published review of the literature about day centres covers what people say about them and reports the evidence on centres’ benefits and purposes. Focusing on centres that do not specialise in the care of older people with dementia and covering the period 2005-17, it highlights both what is known and the gaps in evidence about these services. Continue reading

Home care workers supporting people with dementia at end of life

John WoolhamJohn Woolham is Senior Research Fellow at the Social Care Workforce Research Unit. (560 words)

The latest seminar in the current Perspectives series focused on research with older people took place on Monday 9 July. Kritika Samsi from SCWRU and Tushna Vandrevala from Kingston University presented findings from their research into how home care workers support people with dementia towards the end of their life. Their study investigated the experiences of home care workers working with people with dementia who were living in their own homes, the challenges they face, how these are managed and their views of the contribution of their work. Their presentation was based on semi-structured interviews with 30 care workers and 13 managers from 10 home care agencies in London and the south east of England. It was funded by Dunhill Medical Trust. Continue reading

An alternative approach to ageing

Today, we are posting the press release from the national charity, University of the Third Age, as it publishes a report that takes a fresh look at ageing. (409 words)

The U3A (University of the Third Age) has released research today which details a sustainable and positive approach to ageing built on group learning, skill sharing and volunteering.

The report Living Life, Extending Horizons, Challenging Conventions is based on the findings of a literature review, together with the results of a member survey and a series of focus groups around the country.

Sam Mauger, Chief Executive of the Third Age Trust (which supports U3As in the UK) said, “We think it is time to move away from the current public debate on ageing which is largely predicated on a deficit and dependency approach.

“The evidence from this research demonstrates the value of mutual aid and of reciprocity to confidence, self-esteem, and wellbeing.

“The U3A model is low-cost, defined by participants, and learner-led. It is not dependent on state funding; it has a life and existence of its own.

“More importantly this report demonstrates the value of communities of interest which are not defined by age, or by past experience, but instead are defined by the experiences still to be explored”.

U3A members reported major benefits to being part of the U3A learning model in terms of confidence, combatting loneliness, feeling supported in new communities, learning new skills and, perhaps most important of all, feeling valued and enjoying life.

Kelvin Rushworth from Wooler U3A in Northumberland said, “After my wife died of a brain tumour, I began the next phase of my life. For me, adjusting to living alone in a new area had many challenges. There is no doubt that U3A provides a wonderful, welcoming learning network: kindred spirits and friends galore!”

There are currently 1,030 U3As in the country with more opening all the time. Each U3A is a charity in its own right and hosts hundreds of interest groups chosen and run by the members, for the members.

Subjects cover a wide range of areas including architecture, Biology to Yoga, Zoology and everything in between.  There are around 10,000 interest groups taking place in the UK every week.

U3A national chairman Pam Jones, who celebrated her 80th birthday this year, said, “Members often call U3A a life-saver. If their circumstances change with retirement or losing a loved one, it brought meaning and purpose to their life. U3A is a community and a wonderful organisation”.

The report is available on the U3A website.

Child protection social work: call for study participants

Nicola Anderson is a child protection social worker who is also conducting a study of what affects child protection social workers working directly with parents. If you would like to take part or learn more about the research please contact Nicola: nicola.anderson@study.beds.ac.uk (441 words)

Engaging parents in direct work is an important part of working in child protection. Sometimes it can be a very difficult task as social workers are entering people’s private family life and interventions can feel invasive. Parents are justifiably reluctant to allow this. Parents can express their feelings to the social worker involved and this can sometimes become aggressive. Social workers meet aggression so often that reducing aggression has now become part of social work (Taylor 2011). Schools of thought are that social workers contribute to parents’ negative feelings as a result of their communication or practice styles. There are movements towards changing the way social workers communicate and work with families with the emphasis on respect, listening and ensuring parents understanding of and involvement in plans and processes, for example motivational interviewing and signs of safety. Continue reading

Integrated care from an international perspective

Jo Moriarty is Senior Research Fellow and Deputy Director at the Social Care Workforce Research Unit. (578 words)

The 18th International Conference on Integrated Care was hosted by the International Foundation of Integrated Care (IFIC) in partnership with the National Institute of Public Health and the Environment (RIVM and Vilans (the National Centre of Expertise for Long-term Care in the Netherlands) in Utrecht from 23-25 May 2018.  Michelle Cornes and I were both fortunate to be among the 800 or so delegates attending the conference.

The increase in the number of people with complex long-term conditions whose support needs span traditional boundaries across health, social care and housing has led to many developments aimed at improving collaboration across different organisations and enhancing quality of care for individuals.  However, there is no single definition of what is meant by ‘integrated care’. Continue reading

Personalisation: towards evidence that counts

Dr Martin StevensMartin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit at King’s. (811 words)

Personalisation has been a dominant theme in social care policy for 25 years and has also been a strong theme for the Social Care Workforce Research Unit. In addition to our involvement in the Evaluation of the Individual Budgets pilots in 2008 (Glendinning et al 2008), the Unit has completed studies on Risk, Safeguarding and Personal Budgets; personalised employment support: Jobs First; and, on Personal Assistants and Personal Budgets. The Unit has published extensively on this topic, which has also been identified as a context in many other studies. Continue reading