A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care

Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on what Safeguarding Adult Reviews tell us about mental health social care services for adults in London. The report was co-authored with Unit Director Prof Jill Manthorpe and Research Fellow Stephen Martineau. (500 words)

Safeguarding Adult Reviews show that social care can be a matter of life or death when it comes to people experiencing mental health problems. In this new report we focus on a sample of Reviews that bear witness to the sad cases of people who may have been needing or using social care services to support them with mental health problems but who died or had been harmed and where multi-agency working was explored by the Review process. As with all such Reviews, they are designed to help learning and so improve individuals’ care and systems.

Our report ‘A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act’ was commissioned by LondonADASS (Association of Directors of Adult Social Services). We amplified the learning from Safeguarding Adult Reviews published across all London Councils between 2017 and 2020 and also consulted Coroners’ Reports to Prevent Future Deaths. Our analysis is being used by LondonADASS to inform debates about the proposed new Mental Health Act, where, curiously safeguarding appears to be overlooked.

Our research suggests that there are specific groups of people who require particular attention when it comes to improving adult social care for people with mental health problems. There are also two major problem areas: first, professional knowledge and use of the Mental Capacity Act 2005 and second, inter-agency working and communication. These are really important now but also give some ideas for people working on training and implementation of mental health and mental capacity law and practice. We recommend other areas where local councils and other groups could be creative in taking forward professional practice. These include more attention to knowing the risks of pressure ulcers, looking at Coroners’ recommendations that are sent to mental health services, generally in the NHS, and taking the opportunity to discuss good practice as well as learning from when things did not go well. We also make suggestions for the authors and commissioners of Safeguarding Adult Reviews around collecting better information and keeping an eye on the implementation of recommendations.

Elaine Allegretti, Director of People & Resilience, London Borough of Barking and Dagenham, who is LondonADASS’ Mental Health lead provided the foreword to our report. She said: ‘This report is the first of its kind to use these two data sources together to identify recommendations to improve the wellbeing of those with mental health problems in London and to highlight that safeguarding must be part of social care support for people experiencing poor mental health. Any new mental health law must include safeguarding of the rights of people with mental health problems from neglect, abuse and exploitation’. We will be working with LondonADASS to track the response to our recommendations. This study is part of our programme of research that is responding to the priorities in South London through strong collaboration with local councils, providers, practitioners and people using social care services and carers (the NIHR Applied Research Collaboration).

Caroline Emmer De Albuquerque Green is NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

Emmer De Albuquerque Green, C, Manthorpe, J & Martineau, S (2021) A matter of life or death: a rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act. NIHR Applied Research Collaboration South London; NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London, London.

HOPES 2 study launches! Helping older people with mental health needs to engage with social care

The HOPES 2 study commences this month. Led from the University of York by Dr Louise Newbould and Dr Mark Wilberforce, the project’s full title is ‘Helping older people with mental health needs to engage with social care: Enhancing support worker skills through a prototype learning and development intervention’. Dr Kritika Samsi, Research Fellow at this Unit, is also working on the study, which is funded by the NIHR School for Social Care Research. (542 words)

This project is about the care of older people living with dementia and complex mental health needs. Many studies show that outside help can be hard to accept for people living with poor mental health or memory difficulties. Understanding the purpose of care and communicating any worries can be hard. Sometimes people will reject the care verbally or physically, which can result in them being labelled as a ‘difficult person’. Providing care in these situations can be hard, when home care workers are under pressure to deliver care in often short timeframes. As a result, relationships between the individuals and service providers can sometimes fall apart. Our previous research suggests that “specialist support workers” within community mental health services may help older people living with dementia or with complex mental health needs to accept social care. However, these specialist support workers often say that they do not have the chance to learn or share knowledge, strategies and skills between themselves.

Our earlier research also found that the training available is often unsuitable for this group of workers because it is either too basic and does not account for their specialist knowledge from their experience in mental health work; or else too advanced as it expects them to have professional qualifications. The aim of this study is to develop a way of helping support workers to share and develop their knowledge of ways of reducing resistance to care. This will be based on what we are currently learning in the ‘Helping Older People Engage in Social care project’ (or ‘HOPES 1’).

The learning will be designed following three stages:

1) Describing what the new learning will include: We will examine what has already been written about developing learning for support workers, particularly what we know about its content and structure. We will also speak to practitioners in this area to ask them what should be included in the learning, how it should be delivered and what format it should take.

2) Co-producing the learning: We will combine the findings from (1), together with learning from the HOPES 1 study, to create a new learning resource. This will be achieved through a workshop with practitioners in support work, and through discussions with service users. Follow-up interviews will allow further detailed work on what we have learned.

3) Delivering the learning: The learning will be delivered in at least one site. This will allow us to see how this works in real situations. We will explore in more depth how people feel about delivering and receiving this intervention. This will allow us to develop the learning further. By the end of this short study we will have a prototype of this learning intervention which we can make available to the social care and mental health care sectors. If the initial delivery of the intervention and prototype are found to be suitable during this project we will then conduct a more in-depth evaluation.

The HOPES 2 Study, Helping older people with mental health needs to engage with social care: Enhancing support worker skills through a prototype learning and development intervention, is led by Dr Louise Newbould and Dr Mark Wilberforce (University of York) with Dr Kritika Samsi (HSCWRU), Gill Gregory, Ewan King, Wendy Mitchell, and David Niman.

It is funded by the NIHR School for Social Care Research.

A National Workforce Plan for Approved Mental Health Professionals

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. 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. Continue reading

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. Continue reading

At the World Congress of Psychiatry, Berlin 2017

Gaia CetranoGaia Cetrano is a Research Associate at the Social Care Workforce Research Unit, King’s College London. (800 words)

From 8 to 11 October I joined the World Psychiatric Association XVII Congress in Berlin. This was my second WPA Congress; I also attended the previous one in Madrid in 2014. Berlin is a great city, which has developed at a tremendous pace in the last few decades. It perfectly represents how things can change, and thus offered the best context for a congress entitled ‘Psychiatry of the 21st Century’.

Remembering the Madrid Congress, I was expecting this to be a big event, but this one exceeded all my expectations. When I arrived at the venue, Messe Berlin, to join the opening ceremony on the first day, I suddenly felt overwhelmed, if not intimidated, by everything around me. The venue was enormous, there were stands, films, exhibitions, music, and hundreds and hundreds of disoriented-looking people around me (around 10,000 in fact). The programme, with its 900 sessions, was impressive but daunting. Continue reading

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. 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

Mental Health Social Care 2016: Research findings informing policy and practice

Dr Joan RapaportJoan Rapaport reports from the annual event co-hosted by the Social Care Workforce Research Unit and Making Research Count. The day started with a presentation from a user-led study. (1,173 words)

‘The Girls Who Kicked the Hornet’s Nest’: Perspectives from a user-led study on service user experiences of mental health related violence and abuse in the context of adult safeguarding: Dr Sarah Carr, Associate Professor of Mental Health Research, Middlesex University and Alison Faulkner, Independent Survivor Researcher, Mental Health.

‘It’s rather like writing a dark thriller’ were Sarah Carr’s opening comments regarding the research into service user experiences into and concepts of targeted violence and hostility, and prevention and protection. This small-scale exploratory study, led and entirely conducted by mental health service users, fills a gap in safeguarding research. It further provides an embedded knowledge exchange approach between service users, practitioners and agencies throughout the research process. Continue reading

Four studies in mental health social care

Dr Joan RapaportOn Thursday 8 October the Social Care Workforce Research Unit held its second annual Mental Health Social Care conference, in conjunction with Making Research Count. Joan Rapaport, Visiting Research Fellow at the Unit, was there. (2,275 words)

In her opening comments, Jo Moriarty, Deputy Director of the Social Care Workforce Research Unit, highlighted that the seminar was taking place as part of Mental Health Awareness week and that 10 October is World Mental Health Day. She observed that as well as mental health social workers, delegates from a wide range of organizations, in particular housing, were represented in the audience. This confirmed that adult mental health was not specific to one area of practice. Continue reading