Three early papers on self-neglect

At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)

Patricia Shaw's contribution in the 1957 paper on ‘social breakdown in the elderly’

Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’

While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.

There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). Continue reading

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

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

Push and pull: doctors deciding to leave the UK for New Zealand

Stephen MartineauStephen Martineau is a researcher at the Social Care Workforce Research Unit in the Policy Institute at King’s. (670 words)

The Social Care Workforce Research Unit (SCWRU) last week hosted a lecture by Robin Gauld of the University of Otago, New Zealand. Professor Gauld, who is 2014 NZ-UK Link Foundation Visiting Professor, presented new research (done with Dr Simon Horsburgh) on the migration of medical professionals from the UK to New Zealand. Audience members, who included the High Commissioner of New Zealand and the Executive Dean of the Faculty of Social Science and Public Policy at King’s, also heard formal responses from Stephen Bach (Dept of Management at King’s) and Jill Manthorpe, Director of SCWRU. Continue reading

Towards a new national learning disability employment strategy

Stephen MartineauStephen Martineau is a researcher at the Social Care Workforce Research Unit in the Policy Institute at King’s. (782 words)

There is a flurry of policy activity in the field of learning disabilities and employment at the moment. Last Wednesday’s Summit on the topic, hosted by the British Institute of Learning Disabilities (BILD) in Birmingham, followed close on the heels of a run of associated consultation events. Led by a Department for Work and Pensions (DWP) civil servant, with the Department of Health (DH) also in the room, the focus of the meeting was a new national learning disability employment strategy. This is to be in final draft form by November, with a set of four learning and sharing events to follow, and sign-off by Mark Harper, Minister for Disabled People, expected in January 2015. Other indications that the topic of learning disabilities is ‘hot’ in Whitehall and Westminster, as DWP’s Simon Francis asserted on the day, include: the recent appointment of a Special Educational Needs Tsar (Lee Scott MP); the revamp of the GOV.UK website for potential employers of people with learning disabilities; and, a commitment to put much more of the information in this domain into easy read format.

It is too early to say much about the new employment strategy for people with learning disabilities in detail. The talk is of opening up a new funding stream, but quite what shape this will take (and whether, for example, it will entail new pilots)—this isn’t being discussed openly yet. Continue reading