Why is there a near social work monopoly on the AMHP role?

Why aren’t more OTs, psychologists and nurses becoming approved mental health professionals? A new research project will try and find out

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By Stephen Martineau

Readers of Community Care will be familiar with both the widespread concern about mental health service provision, and ongoing talk of legislative changes.

The latter gained momentum in October with the appointment of the psychiatrist Simon Wessely as head of an independent review of the Mental Health Act 1983 (MHA).

To highlight just a couple of statistics forming the backdrop to his review: 

The AMHP role was originally proposed partly in response to shortages of its predecessors, approved social workers (ASWs). The move from ASW to AMHP in November 2008 meant that not only social workers but occupational therapists, chartered psychologists and mental health and learning disability nurses could now be approved by the local authority for the position.

But these groups have hardly been flocking to take up the role. In an estimate based on an informal survey of local authorities, Steve Chamberlain, chair of the AMHP Leads Network, suggested they constitute only 7-8% cent of the total AMHP body.

Why aren’t health professionals becoming AMHPs?

At King’s College London, we are examining the reasons for this low take-up by eligible health professionals. While we know a lot about the experiences of social worker AMHPs, there is very little research about these other groups.

Our study is commissioned by the Department of Health and our findings will feed into plans to introduce a national framework for AMHP certification, and a national register overseen by the proposed new regulatory agency, Social Work England.

If you are, or a colleague or friend is, a member of one of the eligible health professions (particularly if you are a non-AMHP nurse or psychologist), we are keen to talk to you about your experience, motivation and views in relation to the AMHP role.

We would also like to talk to other professionals working with people (adults) with mental health problems and their families (psychiatrists, other mental health service providers, advocates, police officers, paramedics and so on). The interview should take about 20 minutes and we are happy to talk to people over the phone.

We are now conducting an online survey of AMHP leads – and very much hope that this is completed across England. The study is funded by the NIHR Policy Research Programme, but the views expressed in this blog post are those of the author alone.

If you would like to take part in this research please go to the project webpage to find out all the groups we are hoping to interview. If you are an AMHP lead, the same page also has a link to an online survey we are conducting.

You can contact us via the webpage or email stephen.martineau@kcl.ac.uk

3 Responses to Why is there a near social work monopoly on the AMHP role?

  1. Anita Singh November 7, 2017 at 11:14 pm #

    Why there is a near social work monopoly on the role of the AMHP you ask? This in itself indicates how far removed the role has become from the essential element of independence. Historically the ASW was exclusively undertaken by Social Workers who were trained, approved and managed by the Local Authority and not the NHS. A strong focus was the independence of the assessor and the importance of upholding the rights of vulnerable people to have proper checks and balances in place, recourse to Mental Health Tribunals and to challenge whether a section was in fact necessary. I can think of times when a section was sought and the essential rights of the person being detained had not been properly explained to the individual, let alone independent advocacy. Other Psychiatric professionals such as nurses have close working relationships with the Psychiatrists seeking a section assessment and I question just how independent they can be in such a controversial role. I can think of assessments years ago when the person had not had their rights explained at all. In one case, two doctors concurred that a section was necessary, as they wanted to enforce treatment for 6 months. The young 17 year old Asian was prepared to remain voluntarily, but not for 6 months. When he was eventually discharged, he went to India, where the dosage of the major tranquilizers that were prescribed were almost halved, as Indian Psychiatrists thought the dosage was way in excess of what he needed. The slippery slope of expecting the NHS to take an independent view of other NHS colleagues is about dealing with a shortage and not about the rights of vulnerable people to have access to proper independent assessment with the necessary checks and balances in place.

  2. Maharg November 8, 2017 at 2:44 pm #

    What there is social work monopoly in the role of AMP. Possibly the word monopoly is wrong, others have the opportunity to be involved in this process but Anita Singh highlights above you may not be the best position to argue client’s case if the chain of command can outrank or make your life difficult. Being external does give you a little latitude and even though they express personal opinions over your perceive involvement, at least you can play the professional card, with the level of autonomy and independence from the NHS.

    The role was seen as a add-on of the other profession, where social work it was the change of name to the roles that were already engaged in.

    There may be also an element who will take on this role if not for the social worker.

  3. Colin Farnworth November 9, 2017 at 1:26 pm #

    I am not at all sure that the word ‘monopoly’ should be applied to the proportion of AMHPs that come from Social work. Monopoly is defined as ‘the exclusive possession or control of the supply of or trade in a commodity or service’ clearly in relation to the role of AMHP the door is open to other professionals, the fact that they rarely choose to step through it does not create a monopoly.

    That said however, some research into why the take up from other professions has been so poor may indeed have merit. Maybe it is because other professions do not see AMHP as a ‘good fit’ with their core role? Maybe they are not given the opportunity to train by their employer? Maybe they do not feel attracted to a role that can feel risky and stressful? Maybe they do not relish a job that can often lead to working unsocial hours and making difficult decisions? Some answers would be welcome.

    By using the word monopoly there is a subliminal (if not subtle) implication that this is a plum job that Social Workers are keeping to themselves. This is not a scenario that I recognise. What other profession is placed under an obligation to ‘be or be prepared to be trained as an AMHP’ before gaining employment in a mental health team? This is often the case in relation to Social Workers.

    I would like to coin the phrase ‘institutional AMHP ism’ I suspect that AMHP is a role that is fixed in the minds of many as being a Social Work prerogative including those who manage and commission services. I feel that this is more influential than any concern that other professionals will be less independent in their assessments or autonomous in their decision making. I do not see this as the reserve of Social Workers despite being one. I hope that the research will also consider the workforce planning in relation to a role which has over the years become more complex and more difficult to qualify in. When I look around me I notice that the demographic of AMHPs signals some issues for the future not too far distant on the horizon.

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