Long ago at the beginning of the tortuous process that eventually delivered the Mental Health Act 2007, it was suggested that the approved social worker (ASW) role should be opened up to other mental health professions. The proposal enraged many social workers, who questioned whether nurses and occupational therapists could stand up for service users suffering an acute mental health crisis.
Wouldn’t the new approved mental health professionals (AMHPs) inevitably succumb to the medical rather than the social model of care? Wouldn’t nurses and occupational therapists simply defer to the psychiatrist when making an assessment? And would existing ASWs be able to work with their new multidisciplinary colleagues?
Now, these questions are about to be answered. The first cohort of new AMHPs have just completed their courses and are nervously awaiting the results. Those who pass will join the AMHP rotas in September.
According to professional social care adviser Robert Goemans, who has been running AMHP training for Lincolnshire Partnership NHS Foundation Trust, most of the fears about the new role are unfounded. Indeed, he believes the shake-up may help the service become more sensitive to the needs of service users. “I don’t think the AMHP role will differ very much from the old ASW at all,” he says. “It’s just opened it up to a wider range of professions. “When the Mental Health Act came in we took the opportunity to start the training from scratch. One of the things we did was to set up a focus group that included service users. They played a big part in how we developed the course and were a great help.”
The result was a six-month course featuring coursework, research and placements with existing ASWs. The training is based around four guiding principles: values; perspectives; interventions; and the law. Of the five Lincolnshire students who completed the course, four were nurses and one a social worker. There was little difference in how either profession approached the course, says Goemans.
“We all expected there to be much more difference between the professions than there actually was. But nursing has changed a lot in recent years and they have more in common with social workers than perhaps we realised.”
The selection process also ensured that nurses accepted onto the course were those who tended to see things from a more social perspective. “It’s probably true to say that the weaker applicants we had were old-school nurses with a very traditional view,” says Goemans. “But the best applicants were also nurses who had been involved with initiatives such as Wrap (wellness recovery action plans) and knew more about it than the social workers.”
In fact the AMHP role appears to be just as much a challenge to the values of social workers as it is to nurses. Andrew Morrans, a care co-ordinator in one of Lincolnshire’s mental health teams, sees the AMHP role as a natural progression in a career spent in mental health social work. Nevertheless, he found the course extremely testing.
“As a social worker the emphasis has always been on the social perspective in which self determination is one of the key principles,” he says. “But as an AMHP you are potentially doing the opposite in taking somebody’s liberty away. The course itself is also quite demanding both in terms of the academic workload and the emotional demands. But that is understandable given the powers we’ll have.”
Once qualified, Morrans will remain in his current post, but be placed on the AMHP rota. (Current ASWs had to complete transitional training and then became AMHPs when the Mental Health Act became law in October 2008.) Initially he will shadow an experienced AMHP before eventually going it alone. It is a prospect he views with excitement but some trepidation.
“The course can’t prepare you for every eventuality because every assessment is unique,” he says. “But it does make sure that you are making those decisions on an informed basis. Sectioning does seem quite a brutal tool. It has to be the last resort.”
As a social worker Morrans has no qualms about other professions taking on the role of AMHP. “There seems to be a myth that social workers have a monopoly on values. But we’ve been working very closely with our colleagues in health for some time.”
Barbara Compton is a mental health nurse working as a care co-ordinator in a recovery team. She decided to apply for the AMHP course to help ease the pressure on the two AMHPs already on the team.
Already considered an “honorary social worker” by her work colleagues, Compton never felt that her nursing background would be a hindrance to taking on the role.
“I don’t think [the course] changed my values – I had pretty strong values before – but it did make me think about how I apply those values. Several guest speakers made it quite clear that they didn’t think that nurses should be on the course. But to be fair several did come up to us later on and admit that they had changed their perceptions and that maybe nurses weren’t all doctors’ handmaidens after all.
“The course was very intensive and really did make you reflect on your own practice. You are very aware that this is somebody’s life and dignity and future. It’s particularly difficult with the elderly and the young – I’ve got young lads myself so I find that hard. And with the elderly you are aware that this may be the last time they leave their house. It’s not a pleasant task and has to be done with sensitivity and care. You can’t just go into it all gung ho.”
Helen Hale, a mental health liaison nurse for older people hopes to use her AMHP qualification to stand up for older people’s rights within the mental health system.
“Working with older people I’m aware of the discrimination they face and the course has given me a lot of legal information that I can use to challenge that,” she says. “The course took over my life from dawn to dusk for six months. I found it very hard to go back to academic studying and research. I’d sit in the library in tears some nights.”
Nevertheless, the social perspective aspects of the course were not as much of a stretch as might have been envisaged. “I’ve always been taught not to treat people as labels or as diagnoses and to take a holistic approach,” she says. “Mental health nurses do tend to take a social perspective.”
Emma Hickey, a mental health nurse on an assertive outreach team, was also struck by the emphasis on value-based care. “We were all valued out by the end,” she says.
Nevertheless, she acknowledges that there are differences in the way that nurses and social workers approach their work. “It’s true that during my day-to-day job I do have to stick needles into people and administer medication, which is something social workers don’t have to do. So come September, if I’ve passed the course, I’m going to have to be very aware of the two different roles. I could be a nurse for four days a week and an AMHP with a slightly different approach for one day a week.”
From a social worker’s perspective, Morrans has no qualms about other mental health professionals being able to take on a role that was previously only open to social workers. “It’s helpful that there will be a mix of professions in the new role. The ASW has become a bit of an ageing profession with many coming up to retirement, so this should help with recruitment.”