AMHP numbers fall at two-fifths of councils despite rising demand for support

The number of Approved Mental Health Professionals (AMHPs) appointed to carry out Mental Health Act duties has fallen at more than two-fifths of councils, a Community Care investigation reveals.

Data obtained under the Freedom of Information Act from 119 local authorities in England and Wales showed that 51 councils (43%) had fewer social workers, and other professionals, warranted to undertake AMHP duties in January 2013 than at the same point in 2012.

Unions and social work leaders said that the drop in AMHP numbers was of “serious concern” at a time when mental health social workers are struggling to manage rising caseloads alongside statutory AMHP duties. Fears were also raised that a shortage of AMHPs could harm practitioners’ own mental health and put patients at risk.

The findings reveal the extent of the reduction in AMHP provision, months after the Care Quality Commission warned that some local authorities had cut AMHP numbers despite rising workloads and demand for support. Last year, the number of Mental Health Act detentions hit its highest level since the introduction of the 2007 Mental Health Act.

Local authorities have a duty under the Mental Health Act 1983 Code of Practice to ensure “that a sufficient” number of AMHPs are available to carry out their roles under the Act. There is no set number of AMHPs specified by the Code of Practice, but it states that councils must provide a 24-hour AMHP service “that can respond to patients’ needs”.

Councils contacted by Community Care attributed a number of reasons to the fall in AMHP numbers. These included staff quitting posts, going on sick leave and retiring. Local authorities in parts of England said that some AMHP trainees had also “not qualified as expected”, meaning they could not fill the gaps left by outgoing staff. 

Faye Wilson, chair of the British Association of Social Workers mental health reference group, said social workers had reported of a number of concerns over AMHP shortages.

“We know that some local authorities have allowed AMHPs to take redundancies and consequently there are not enough of them. Yet the CQC has warned about the rising number of Mental Health Act detentions and the bed pressures that AMHPs are having to deal with.

“If you reduce AMHP numbers, even by just one or two, the extra pressure on AMHPs to fill rotas is a recipe for staff burnout and stress,” Wilson said.

BASW received reports that several AMHPs at one English council had quit after refusing to accept the local authority’s demands that they do night time on-call duties for “no extra payment”, said Wilson. Other social workers who had rejected the demand had been “stripped of AMHP status” by the council and made to work in other teams. 

Helga Pile, social work lead at Unison, said: “At a time when caseloads for social workers are going through the roof and staff numbers are falling, the additional pressure of doing AMHP duty can be too much.”

“This goes to highlight once again the need for much better support for AMHPs and for much tighter requirements on local authorities about what the statutory duty to appoint ‘a sufficient number’ should mean in practice,” Pile added.

AMHPs in other areas told Community Care they felt “unsupported” in their roles due to a lack of senior managers with mental health experience.

One social worker, who had seen a “very experienced AMHP” removed from their team “with no notice”, said: “I feel unsupported but no-one at the top level has mental health experience. AMHPs need good leadership and regular support to feel valued in a role, which is becoming increasingly pressurised.”

Social work academic Martin Webber, who led a national survey of the AMHP workforce that was published earlier this year, said that more evidence of falling AMHP numbers at councils was “very concerning”, particularly as stress levels among the workforce were already high.

“A smaller workforce is undertaking a larger volume of work, which is not only damaging to the health of individual practitioners, but it could pose additional risks to the health and safety of people suffering mental distress and the people around them,” said Webber.

“Serious investment is needed to support existing AMHPs and free up other practitioners to undertake the role. Increasing the workload on a smaller number of AMHPs is likely to increase the risk of adverse incidents occurring.”

Daisy Bogg, a social worker AMHP and a member of The College of Social Work’s AMHP community of interest, said that the drop in AMHP numbers could in part be attributed to the fact the AMHP workforce is ageing (the average age is estimated to be 50+), so  councils may be “struggling” to replace AMHPs that have retired.

“But in some cases local authorities may well be getting rid of posts or freezing them, particularly as AMHPs are an expensive resource and we’re in a time of austerity,” Bogg added.

“What does the fall in AMHP numbers mean on the ground for social workers? People do more shifts and for AMHPs your job can turn into something that feels a bit like a conveyor belt exercise,” she said.

“You go on shift and because there are less of you, you do assessment, after assessment, after assessment because you have to. It impacts stress levels and if you’ve got a social work caseload alongside AMHP duties, then having less AMHPs on rotas makes managing that balancing act even harder.”  

Data from local authorities in Scotland on the number of Mental Health Officer posts (the equivalent of the AMHP role in Scotland) found that more councils north of the border had increased provision. Of 16 councils in Scotland that returned data, six had increased Mental Health Officer numbers, seven had maintained them and three had reduced provision.

*Note: Due to slight differences in the methodologies used by individual local authorities to calculate their full-time-equivalent (FTE) AMHP provision it was impossible to calculate an accurate ‘total’ number of AMHPs in England and Wales.

But it was possible to compare like-for-like data at each individual council to establish whether, from their own calculations, they had increased or reduced the number of  FTE AMHPs warranted for Mental Health Act duties.

Andy McNicoll is Community Care’s community editor

Additional reporting by Alex Turner