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.
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.”
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.