One in five AMHPs wants to quit role amid ‘unacceptably high’ stress levels

Over a fifth of those trained as approved mental health professionals want to quit the role, a state of the profession survey has found.

Of the 504 approved mental health professionals (AMHPs) who responded to the 2012 National AMHP survey, 22 per cent said they no longer wanted to continue in their AMHP role. A further 18 per cent said they were “unsure” of whether they wanted to continue practising as AMHPs.

“Unacceptably high” stress levels

The study, the first of its type since AMHP status replaced the approved social worker (ASW) role under the Mental Health Act 2007, also exposed “unacceptably high” stress levels among AMHPs. Four in ten respondents reached the threshold for depression and anxiety disorders.

Social workers who led the study said the findings highlighted the need for employers and professional bodies to step up support for AMHPs.

In a piece for Community Care, Martin Webber, who oversaw the research, said:

“Undertaking statutory duties under the Mental Health Act can be incredibly challenging and if you are suffering from depression or anxiety the difficulties of the role are compounded…If protecting the mental health of AMHPs means reducing caseloads or providing workload relief, this needs to be done now.”

The reader in social work at York University and registered social worker added: “I know many mental health social workers who do not want to train as AMHPs and many who have done so who don’t like the role. Requiring these practitioners to become AMHPs if they wish to progress in their careers is surely wrong.”

Hospital bed shortage increases pressures

The wide-ranging survey also revealed:

• A shortage of hospital beds for clients is piling pressure on AMHPs. A lack of availability of ambulance, police and doctor support for Mental Health Act assessments had also “led to delays and late working”.
• Many AMHPs felt drained after working extra unpaid hours in an effort to cope with the competing demands of AMHP and non-AMHP duties.
• AMHPs valued support from peers but felt undervalued by employers. They felt they received little recognition and were poorly paid compared to other professionals involved in Mental Health Act assessments.
• Complaints over “inadequate management”. Frequent lone working meant many AMHPs felt exposed to violence and complained that they were “singled out for blame” following any incidents.
• Despite a government pledge to train other professionals in the AMHP role, social workers still “overwhelmingly” fill the posts.
• There is no difference in stress levels between social workers and other professions trained as AMHPs.
• AMHPs value the “enhanced knowledge and skills” gained from AMHP practice.

Janine Hudson, a social worker and AMHP who led the research under Webber’s supervision, said the failure of NHS Trusts to train non-social work professionals in AMHP roles “needs to be addressed”.

Hudson told Community Care: “When you boil the findings down the message is clear. When professionals are expected to carry ever increasing workloads and manage the competing demands of different types of work and organisations, and much of what is necessary to do that is beyond their control, they are eventually overwhelmed.”

“When this happens, and employees are not valued or supported, something has to give. Unfortunately for 43% of these AMHPs it was their own mental health. Ironic – absolutely – but also an opportunity for organisations to foster what respondents told us is good about the role and address that which is not. It remains to be seen whether they rise to the challenge.”

‘Absolutely vital’ that AMHPs are supported 

Paddy Cooney, interim director of the NHS Confederation’s mental health network, said:

“AMHPs are working with vulnerable people who are experiencing crisis and it is absolutely vital that they get the support they need when they need it, from the health service and local authorities responsible for their appointment, and also from other agencies.”

“It’s not sustainable for a sole mental health professional to spend eight or 12 hours with a patient in crisis, waiting for a free bed, for an ambulance to turn up or for police assistance if required,” Cooney added. 

One mental health social worker and practising AMHP said of the findings:

“Whilst I believe 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 and appear to be gradually opting out of assisting with conveyance (transporting detained patients 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,” the AMHP added.

But Jane Shears, a BASW member and practising AMHP, said the “strengths of the AMHP role” highlighted in the research needed to be considered too. 

“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,” Shears said.

Joe Godden, professional officer at BASW, said the report raised “some very important issues” for the sector.

“If there isn’t action then the continual problem of recruiting and retaining sufficient numbers of experienced AMHPs may get worse and the impact on the mental health of AMHPs is of significant concern,” he said.

Related articles: Analysis: ‘A depressingly familiar picture of an overworked and undervalued workforce’ 

Andy McNicoll is Community Care’s community editor. Follow him on Twitter @andymcnicoll