National AMHP survey: reaction from the social work frontline

The findings of the National AMHP survey 2012 raise some very important issues for mental health social work – not least the high levels of stress and potential mental health issues among an overworked and underappreciated workforce.

There needs to be more analysis and debate on the findings and how they compare to other studies and professions. For example, previous studies of psychiatrists and palliative care doctors have shown a worrying level of psychiatric comorbidity.

But from the sample of AMHPs surveyed by Martin Webber and Janine Hudson it is clear that a failure to act risks worsening the continual problem of recruiting and retaining sufficient numbers of experienced AMHPs.

When contacted by Community Care for reaction to the findings, I circulated the report to some AMHPs who are BASW members. Here’s what three AMHPs had to say about it (note: two of the respondents asked that their comments be treated anonymously)…

 Anonymous AMHP 1: “I’m surprised only 22% of AMHPs wanted to quit”

Whilst I believe that the AMHP role is important and one that I am positive about, frankly given the conditions we now have to operate in I am surprised that only 22% want to quit.

Bed shortages are getting worse and the police are more reluctant to assist. They also appear to be gradually opting out of assisting with conveyance (ensuring detained patients are transported to hospital).

At times it leaves the AMHP in legal custody of a patient for whom an application for admission to hospital has been made but with no means of enforcing the conveyance of the unwilling patient. 

We had several patients recently held at the police station. What should have been a simple job for the AMHP to arrange admission took so long due to a lack of beds.

The legal position for AMHPs is also getting ever more complex. Case law judgements are regularly being made and AMHPs at risk of being taken to court if we are thought to have got things wrong. 

What needs to be done?  In my opinion there needs to be a statutory obligation placed on the part of someone (psychiatric hospitals or the ambulance service perhaps) to provide a secure ambulance service for conveyance to hospital.

There should also be an obligation placed on the part of the police to assist if the AMHP believes the patient is likely to abscond or resist getting in the ambulance. 

A change to the Code of Practice if not the Mental Health Act Act itself may be needed to enforce these changes.

The “New Roles” guidance introduced alongside the AMHP role as part of the Mental Health Act 2007 also needs re-writing to give clear practical guidance.

The government, presumably the Department of Health, needs to give local authorities prompt and clear guidance as to the implications of any significant case law judgements and what this means for AMHP practice.

One statement from the government could save innumerable hours where staff in each local authority puzzled over a legal judgement and variously came to conflicting, ambiguous, or no advice at all as to what it meant for AMHP practice.

Some of these measures, such as more beds and emergency service support, have cost implications. But others would not have significant costs, like revising guidance. More advice from central government more could also save costs by avoiding duplication of effort within local authorities.

 Anonymous AMHP 2: “The system contributes to the frustrations”

The survey describes what it is like to be an AMHP but not necessarily the systemic context which contributes to some of the many frustrations and challenges.

This includes the organisational changes over the last few years which may have compounded management arrangements (i.e. integration or not with mental health trusts).
 
There is also an incongruous disparity between professionals. Doctors get a fixed (generous) fee for doing an assessment whereas AMHPs don’t. The doctors leave after their part of the assessment process is completed (whether or not to make a medical recommendation) and we are left to see the admission through or arrange the alternative care package – often taking many hours and in potentially risky circumstances.
 
Some of the structural and organisational issues include:

*The challenges of finding a doctor for the assessment
*Finding alternatives to admission that are accessible
*Checking if there is a bed, police support and ambulance available – without a 4 hour wait.

These things all contribute to the stressful nature of the job.

In the AMHP survey there is mention of, but little discussion, about functional AMHP teams as opposed to social workers who do AMHP as an added “extra” to their day job. Whether such dedicated teams will improve supervision/debriefing opportunities that could impact on the wellbeing of AMHPs in the future is also of interest.

It may also worth be reflecting on whether the findings of this study have relevance with regards to the low take-up by other professionals of the AMHP role.

 Jane Shears, practising AMHP and a BASW member: “Don’t forget the positives”

I would want to highlight the strengths of the AMHP role. Peer support, looking out for each other, being the professional who makes the decision whether or not to admit someone, are all empowering elements of the role.

These are things we have some control over and are where we feel we can make a difference. Regarding lone working – yes it can feel isolated sometimes, but if there are effective lone working policies these can be ameliorated.

 My thoughts

There are questions that need followed-up from this survey – after all it was completed by 504 AMHPs out of about 4,000. There is always the risk that people who are more dissatisfied may complete surveys so there needs to be caution in interpreting the findings.

However it’s clear that, as the member above states, there are things that could be done to improve the AMHP role that don’t have significant cost implications. By contrast the human cost of failing to act to support a stressed and overworked workforce could be vast.