Warning over ‘severe’ AMHP shortages as hundreds leave

Social work leaders call for improved national workforce planning as figures reveal AMHP numbers are shrinking at time of rising demand

Picture: Time to Change
Picture: Time to Change

Councils are struggling to replace more than 200 Approved Mental Health Professionals who have quit or retired in the past three years as demand for their services increases.

Figures obtained from 120 of 152 councils in England through Freedom of Information requests reveal the number of AMHPs, the group of mostly social workers qualified to carry out Mental Health Act assessments, fell 7 per cent from 3,139 in 2013-14 to 2,915 in 2015-16.

Councils are responsible under the Mental Health Act code of practice to make sure “sufficient AMHPs are available to carry out their roles” but several admit they’re short of what’s needed.

Some are struggling to tackle “severe” shortages, with councillors at one authority worried shrinking AMHP numbers pose a “significant threat” and another council warning of a “high risk” of its AMHP service facing “a crisis in the near future” unless more staff are found.

One council that had enough AMHPs “on paper” said its capacity had still reduced in recent years, as some AMHPs had gone on long term sick and several had cut their hours.

Growing pressure

While some AMHPs have simply left after reaching retirement age, responses from councils reveal fears that many are opting to quit due to growing pressures on teams, with staffing shortages and problems finding beds for patients increasing the strain on staff.

The number of Mental Health Act detentions, the only official indicator of demand on AMHP teams, hit a record high in 2014-15, the most recent year figures are available for. The number of patients being sent out of area for beds due to local units being full rose 13% last year, with some sent hundreds of miles.

In response to shrinking AMHP numbers, several councils have set up dedicated AMHP teams to boost assessment capacity. These see AMHPs working full-time on Mental Health Act assessments, rather than traditional rota systems where they carry caseloads when not on AMHP duty. One council said the case carrying model was simply “not viable” given the stress staff were under.

‘Lack of workforce planning’

Social workers accused local government leaders of a failure to carry out any national planning for AMHP provision despite repeated warnings about the pressure on this part of the workforce.

Ruth Allen, chief executive of the British Association of Social Workers, said: “We hear from members that some AMHPs are handing in their warrants because they’ve had enough of the risks around lack of access to beds and lack of effective prevention and crisis services.

“That won’t be everywhere, we know it’s a mixed picture in services, but it’s a dreadful situation to have a key area of specialist statutory work where you’ve got doubts over whether it is even bearable for staff.

“ADASS [the Association of Directors of Adult Social Services] and the Local Government Association need to show more leadership around workforce planning in this particular area.

“It has been left with individual local authorities to work out, some of whom are doing some really good work around AMHPs and the wider social work role in mental health, but there’s not been a strong push from the national bodies to really get to grips with this.”

Longstanding concerns

Steve Chamberlain, chair of the AMHP leads network, said concerns that the AMHP workforce was reaching “breaking point” had been raised for years but not heeded.

In 2013 the network warned AMHPs were being placed in “intolerable” situations, after a survey it carried out revealed the impact of bed shortages. A year earlier an academic paper warned of “unacceptably high” stress levels among AMHPs, with four in ten respondents reaching the threshold for depression and anxiety disorders.

A 2016 CQC and Department of Health report identified concerns about councils’ ability to provide a 24-hour AMHP service, the lack of data on AMHP numbers and lack of council oversight of AMHP provision where this had been delegated to NHS trusts.

“The signs have been there but we’ve seen no real urgency to make sure there’s proper workforce planning or succession planning,” said Chamberlain.

“There hasn’t even been any central monitoring of AMHP provision so we are reliant on figures like yours to gauge the situation.

“Some AMHPs are saying they see the role as an important, interesting, valued job but the resource problems they’re facing every day, such as finding beds and sometimes being left unsupported working late into the night, is making it so stressful it’s not worth it. It takes two years to train an AMHP from start to finish – if we’re losing the numbers these figures indicate then it’s worrying.”

In February the chief social worker for adults, Lyn Romeo, wrote to directors of adult social services to tell them to ensure they had “effective workforce management and succession planning, to enable ongoing sufficiency of AMHPs and good workload management”.

Ray James, Immediate Past President of ADASS, said: “The AMHP role is one of the most important, complex and challenging of all social work roles.

“We recognise the growing challenges experienced by many councils in recruiting and retaining skilled and experienced practitioners, and remain keen to work with government, the LGA, the Principal Social Worker Network and others to do all we can to support this important work now and in the future.”

The government plans to introduce a national system of registration for AMHPs in 2018 – a move welcomed by both Allen and Chamberlain.

How councils are being hit by the shortage

Community Care asked councils how many AMHPs they had warranted to carry out Mental Health Act duties on their behalf. We also requested copies of any analysis the councils had made of AMHP provision in their areas. Local reports showed:

  • In Middlesbrough, AMHP numbers dropped from 21 in 2012 to 9 in 2015. A report published by the council’s social care scrutiny committee last month warned current levels were “unsustainable” and recommended at least 16 AMHPs were needed. It said the shrinking number of AMHPs posed a “significant threat” as demand for services was increasing. The council is scheduled to train up six AMHPs in the next training cycle. The scrutiny committee recommended that AMHP salaries should also be increased, as several staff had joined a neighbouring authority offering higher pay.
  • In Essex, a review of mental health services carried out by the council and NHS bodies found a “severe shortage” of AMHPs and estimated another 50% would be needed to be trained by 2017. The report found “the role has become less financially and professionally attractive”, partly as a result of pressures on services. A council spokesperson said the shortage was a “national” issue and the council was addressing it as a priority, adding: “while we are actively encouraging further recruitment, we understand further dialogue is necessary on a regional and national level.”
  • In Hampshire, AMHP numbers fell from 60 in 2013-14 to 46 in 2015-16, a drop of 23%, while the number of assessments the teams carried out rose 12% over the same period. A report produced by the council recommended 55 AMHPs were needed and warned there is “a high risk that the service will experience a crisis in the near future without sufficient AMHPs to carry out this specialist role”.
  • In Northamptonshire, AMHP numbers fell from 48 in 2012 to 34 in 2016, a drop of 29%, while assessments rose 19% over the same period. The council said an analysis using a recommended AMHP: population ratios found around 59 AMHPs could be needed.

30 Responses to Warning over ‘severe’ AMHP shortages as hundreds leave

  1. Cburn September 7, 2016 at 2:45 pm #

    “financially attractive” are they joking? As an Amhp who happens to work in the NHS, we get absolutely nothing for being Amhps. Even those in the council only get about £50 a month. How does that compare to a s12 approved Dr who gets £200 for a single assessment, with a fraction of the work involved. Hardly any resources with potentially high levels of personal and professional risk… I wonder why people are leaving?

    • Samra September 8, 2016 at 10:07 pm #

      “the role has become less financially and professionally attractive” – the article isn’t saying the role is financially attractive.

      • Cburn September 9, 2016 at 4:39 pm #

        Quote: “the role has become less financially and professionally attractive”

  2. Chris Bellis September 7, 2016 at 3:42 pm #

    As a retired AMHP with a wife who is also an AMHP, but performing another mental health role at the moment, I can safely say that the employers can go and whistle. They treat you like dirt for decades and then wonder why you leave the job. Some things are not worth it. How come we are under a moral obligation to work under all sorts of conditions for little pay, but the doctors aren’t?

  3. Kathryn J Ralph September 7, 2016 at 3:55 pm #

    I’m an AMHP in Shropshire, the council thinks it’s kidding us into thinking we get two increments for being AMHP’s,. It once you reach the top of scale 11, it stops. All other S/W’s can progress to the same pay without being AMHP’S.
    DORSET has it better, their AMHP’S are all grade 12.

    • Kathryn J Ralph September 13, 2016 at 6:00 pm #

      I would like to correct my previous statement, Shropshire actually pay us AMHP’S 2 increments, but the pay in Shropshire is so poor it’s hardly noticeable. It’s about time we were paid a decent wage for a very stressful role that is not recognised in comparison to doctors.

  4. James Nilsen-Clarke September 7, 2016 at 4:12 pm #

    I used to enjoy the challenges of the role however, with the increased demand alongside the pressures created by the poor attitudes of joint agencies, such as the police and ambulance service, I became tried of being blamed for attempting to do my job. I’ve had a break for a few months having left the NHS and I’m seriously considering not going back to the role. I feel like a different person without being placed in those extremely stressful situations. For me to return to the role on a full time basis I’d need to see a real change in attitudes and pay structures which reflect the challenges of the role and strain it places on the individual undertaking this.

  5. Graham September 7, 2016 at 4:50 pm #

    Clicking on any link in this article will show that this problem has been developing for at least the past 3 years without anyone doing anything about it. My own AMHP team has experienced nearly a doubling of referrals and a halving of available AMHPs over that time. People leave because of pressures of the job, but they also reduce hours because, as an ageing workforce, we are more likely to be able to afford to work less, and (certainly in my case) do not have the energy to do this high pressured job 5 days a week, often well into the evening because of lack of- out- of hours staff.

  6. Roger Hargreaves September 7, 2016 at 6:20 pm #

    This situation was developing as long as 16 years ago, at the start of the process which led to the 2007 Mental Health Act, and BASW put forward a set of proposals to reduce the demands on what are now AMHPs, and to increase the pressure on the NHS to provide adequate resources, by shifting the legal responsibility to the NHS provider Trusts as soon as an application was signed rather than when the AMHP delivered the patient to the hospital, thereby making the Trust responsible for finding a bed and arranging conveyance, and liable for any consequences of not doing so. However, there was almost no support for these proposals from ASWs, who seemed generally content with their legal position as it was, despite their lack of power to obtain the resources they needed. This may have been because (according to a BASW survey) around 50% were over 50 and so within sight of retirement, but also because the exceptional demands of the job, and in particular of managing admissions, gave them a status within mental health services which social workers otherwise struggled to achieve.
    An opportunity was therefore lost and the problem kicked down the road for another generation to address. And now, since the Supreme Court decision in Cheshire West we have a further factor – a huge demand for Best Interests Assessors, who are drawn from broadly the same pool as AMHPs and with identical entry requirements, but who after only a tiny fraction of an AMHP’s training can work independently earning thousands a week in a much more congenial role.

    • Nick Woodhead September 19, 2016 at 10:23 am #

      Roger, I remember going to a conference in London in 2006 where you presented your paper “The AMHP-Oiler of Wheels or Guardian of Rights” It remains a valid question. The other ‘lost opportunity’ in 2007 was the refusal by the Government to place MHA conveyance responsibility clearly within legislation. Relying instead on the Code’s expectation that local services (ambulance/police) would ‘cooperate’. Ha!

  7. Susan September 7, 2016 at 6:46 pm #

    Agree with many of the issues raised. It’s not the AMHP’s responsibility to find a bed, yet often AMHPs are left to directly liaise with bed managers & a bed may be some distance away, creating further practical problems for the AMHP.

    The lack of financial recognition, while not being most people’s main concern, is an issue which needs to be dealt with. How can it be right that AMHPs, with all the legal responsibilities they carry & complex decision-making they have to undertake, are often paid less than CPNs & certainly nowhere near as much as the doctors who assess with them?

  8. Kay September 7, 2016 at 8:35 pm #

    Who would have the pressure of being an AMHP for such little money when you can do BIAs

  9. Claire September 7, 2016 at 8:42 pm #

    And Wales????? Come on Community Care, a little bit of effort and you could have included Wales. We want to read good journalism about these issues here too. We too are losing AMHPs, the problem is dire!

  10. Josephine September 7, 2016 at 9:47 pm #

    I was a former ASW but didn’t do the conversion training because even back then the role was stressful, we were shrinking in numbers and the risks and pressure of work and carrying caseloads was too much. I did over 10 yrs as an ASW ! It was enough. All this against a background of dwindling resources, bed cuts and poor financial reward. Nothing has changed! The introduction of the AMHP role was supposed to have boosted the numbers of trained professionals working under the MHA but it’s clearly failed in that respect ! No one asked us what we thought and when we spoke, no one listened !
    My conclusion is that the role was never valued as it should have been! Although it’s not just about money Drs were disproportionately rewarded for their part in the process and we were not ! There’s no shortage of s.12 Drs though!

  11. N'hants AMHP September 8, 2016 at 12:22 am #

    There are not 34 AMHPS left in Northants so far as I can count….the situation countrywide is horrendous. I have been an ASW/AMHP for a number of years and simply can’t handle the stress and uncertainty of the role, whilst also feeling undervalued and poorly paid.

  12. Matt September 8, 2016 at 8:11 am #

    I agree with all comments above. The situation is unsustainable and unfair. The risks are immense

  13. Nicky September 8, 2016 at 10:15 am #

    I left the AMHP service 2 years ago, I had trained hard to be an AMHP and enjoyed the work but carrying a heavy case load as a community mental health social worker, being physically/verbally assaulted whilst on AMHP duty, working in isolation in high risk situations whilst trying to manage the bed and transport issue was too much. My health/wellbeing was being affected and when I looked at the slight increase in pay to undertake the role I decided it was not worth it and so gave up my AMHP role. I am a trained BIA and have taken my social work career off in a different direction and never looked back. I cannot see a time when I would return to being an AMHP again, which is disappointing as I recognise that money was invested in my training.

  14. Graham September 8, 2016 at 10:26 am #

    Dedicated AMHP teams (no caseholding) which renumerate well (grade 12 or higher) are the only effective way to retain these experienced qualified professionals. Any practitioner who is on less than £40k, operating with these levels of stress and responsibility will inevitably question value of the role. Especially when far less stressful non-AMHP opportunities are available for marginally less money.

    • BIA John September 20, 2016 at 4:07 pm #

      this is the way forward, but most LAs, ( including my own) are too thick to understand this fact. I proposed it years ago when I saw this train coming. the synergies with bia work are also apparent to anyone who wants to create a modern fit for purpose workforce dealing in peoples rights at the point of deprivation of liberty. c`est la vie.

  15. Tired and frustrated AMHP September 8, 2016 at 11:07 am #

    I get £33.00 per month for being an AMHP. Our local authority is privatising all of it’s services there is no pool of staff to draw from to train. The training and continuing registration is long and arduous. I get £33.00 more per month than care managers who are not social workers and have NVQ qualifications. We are painfully short staffed and FOI requests do not include people who are sick, or not undertaking the role anymore. Hardly any staff are being trained. We have had periods when there is no AMHP on duty at all. I value the qualification and have 20 plus years experience, it’s a shame my local authority does not value the role or me.

  16. Ruth Cartwright September 8, 2016 at 1:06 pm #

    It is interesting to note that one move to try and resolve this problem some years ago was the replacement of the ASW by the AMHP. It would appear, however, that crowds of other professionals have not flocked to the cause. The work carries a huge responsibility, being independent in a crisis situation which could see someone admitted to hospital against their will with all the implications that has for them short and long term. This can involve arguments with medical colleagues as hospital is not always the answer. And of course the crisis is often out of hours, and there is the shortage of beds and non-availability of suitable transport to contend with. I’m surprised people are still coming forward at all, frankly, but that independent voice is much needed.

  17. gary September 8, 2016 at 1:31 pm #

    I was the Lead ASW a LA/NHS and remember doing a workforce analysis over 10 years ago.
    It was not rocket science, the majority of staff would be reaching retirement within this period,
    and the warning signs for investment in the service where made to both the Director of Social Services and the equivenlent Health Director. This was when money was being thrown into the NHS agenda for change and the setting up of multiple teams (crisis resolution, early intervention etc).

    Meanwhile ASWs continued to gradually decline in numbers while the LA approach was to increase the geographical area to covered. One whole county instead of north and south, with fewer staff…..?
    Then came the AMHP role, thinking they could plug the gap with all those other health professionals
    and insulting social workers by taking the term out of the job title.

    I had done the role for over 12 years, and it never ceased to amaze me how undervalued we were as practitioners. I have done many social work and management jobs in many different situations, but nothing was as difficult or potentially as dangerous as the ASW/AMHP role.

    I learnt such a lot doing the job and gained skills that i could could never have got in any other role.
    I look back quite proudly at the job i did and the values i brought to the role. Equally i cannot believe some of the scenarios i was involved in. The amount of unpaid unsocialable hours that I did as it was part of the job and didnt meet the critera of say EDT.
    Loss extra increments and travel allowance were further kicks in the teeth for dedicated professionals.

    I can honestly say the all the problems that have been raised were always there but at least you had peer support and understanding. It was a very tough job which has now become almost impossible to do without developing severe stress.

    Like the social work profession itself we have always been undervalued and underpaid, and ASW/AMHPs are a classic example of an almost total neglect of responsibility by both LAs and the NHS who have mismanaged this statutory service for years.

    I feel genuinely sorry the practitioners out there who are having their own mental health compromised by having to carry out this role.

    I can honestly say WHO IN THE RIGHT MIND WOULD CARRY ON DOING THIS JOB (but I understand some folk have to).

  18. Philip Benjamin September 8, 2016 at 3:24 pm #

    There should be a number of options for someone to contract with a council to provide AMHP services within a local area and with the NHS to receive a rebate for every person diverted to a more humane and less expensive option, for which there are many models of peer led respite services. One outstanding model is the Afiya Respite House, part of Western Massachusetts Resource and Learning Center (Western Mass RLC).
    I would like to speak with anyone else interested in looking at this opportunity!

  19. Anonymous NHS manager September 8, 2016 at 7:57 pm #

    I’ve been in a large NHS mental health trust for decades. Some of you will recall how difficult it was to get s12 doctors to undertake assessments around 20 years ago, especially in London.

    The situation literally changed overnight when their assessment fee was doubled. I can see there being no choice soon but to very significantly increase AMHP salaries nationally to both retain and recruit.

    Can’t think of a comparable role that is so poorly rewarded and look forward to the day when some of the pressures ease and remuneration improves!

  20. Apple Crumble September 9, 2016 at 1:47 pm #

    There is a shortage because the route to this is very limited, either funded by an employer only or if you work within mental health services. Sometimes employers identify people who don’t have the stamina or resilience to do this work and other who want too can’t.

  21. Roger Hargreaves September 12, 2016 at 8:12 am #

    A big increase in pay might encourage some existing AMHPs to stay on a bit longer, but it won’t produce large numbers of new recruits from within social work as the pool of potential candidates is very small if mental health experience is a requirement – most mental health specialists will already be AMHPs or in training. The only solution is to make the job more do-able, which was the aim of the BASW proposals 16 years ago, and which, combined with a pay increase, would then draw in candidates from mental health nursing which in the short term is the only occupational group which can supply the numbers required.

  22. Joe September 12, 2016 at 1:30 pm #

    Structural problems of having a robust AMHP service is an outstanding problem for Local Authorities all over the UK. In the north of England in country side area it is difficult to stay as AMHP as travelling is extensive with long delay of services to attend a MHACT assessment meeting. It feels like an obstacle course where you try to keep all the parties s.a. S 12 dr’s, ambulance service, mh hospital, police staff on board to achieve a respectful and caring outcome for people with acute mental health needs.
    As AMHP it feels more you are on your own and expected to drop your daily work duties to react to urgencies, rather than keeping up planned working activity.
    As a wider area in the county needs to be covered by a single AMHP, no one seemed to face up to a reality of the outfall how more the job become unpredictable.

  23. Khandi September 18, 2016 at 11:27 pm #

    My amhp status lapses in Oct and im seriously considering not going through reapproval

  24. john davies fryar September 20, 2016 at 4:17 pm #

    It is my view that we are looking at things from the wrong angle, it is true we need more AMHPs it is True we need more beds, but what we need is a completely new system of assessments, possibly based on a system they have in New Zealand were only one med rec is required and detention last for only a few days before another assessment including a second opinion doctor. Some times it is impossible to find a doctor who will come out before 17:00 and many GP don’t have a working knowledge of the need and necessity of MHA assessment.

  25. OG, Oge(Amoge) September 22, 2016 at 4:03 pm #

    This a very good profession with high work loads, risk , stress, commitments and can be done well with passion as well as empathy. It is not everyone that can handle the kind of job they do, the staffs deserve better.
    Some MP’s that are doing practically nothing are receiving huge amount of salaries while key workers in front line of strenuous jobs are receiving peanuts and their workplace are not conducive.
    It is high time something is done about all health and social care professionals especially in the area of mental health and social work to make their job easy and less stressful. No amount of money can make up for the kind of work they do, they should be treated well and paid better than they do.
    Finally if government cannot do something about the situation Mental health and social work professionals should do something by themselves to better their situation because people treat you sometimes only the way you allowed them to

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