Mental health bed pressures making AMHP role ‘untenable’, warns BASW

A shortage of mental health beds and alternatives to admission for people in crisis is making the role of Approved Mental Health Professionals “untenable”, the British Association of Social Workers has warned.

AMHPs are the group of mostly, but not exclusively, social workers who carry out Mental Health Act assessments alongside doctors. Problems getting beds for patients assessed as needing urgent hospital admissions are leading to care that is “potentially dangerous” and driving some social workers to quit the AMHP role, BASW said.

The comments form part of BASW’s response to the Department of Health’s consultation on revisions to the Mental Health Act Code of Practice.

The Code of Practice states that the responsibility for finding a suitable hospital bed lies with doctors and is not the duty of the AMHP. BASW said that the guidance was “fine in theory” but was “unsatisfactory to the point of negligence in the face of realities” of practice.

“AMHPS are increasingly being left with medical recommendations for admission and a patient in urgent need, but no bed to admit them to. This is not only frustrating but potentially dangerous. Is it acceptable in such circumstances to admit the patient to the local acute admission ward even if there is no bed and where it may mean they have to sleep on a sofa in the lounge?,” BASW’s response said.

“The inability to obtain beds and be able to complete assessments is one of the factors making the role of the AMHP untenable and is a reason why some AMHPs who are not required to undertake this role by their contracts are opting out, putting further strain on the remaining AMHPs.”

BASW said that the code of practice needed to make clear reference to section 140 of the Mental Health Act – part of the legislation that outlines the responsibilities of commissioners to identify hospitals to be used in “special urgency” admissions. The section 140 duties were “frankly, being ignored” in many areas, BASW said.

The DH consultation asks for recommendations on how local systems can be strengthened to ensure AMHPs are not put in this position.

BASW’s response recommends that problems accessing beds are immediately escalated to the most senior officer in the commissioning agency at the time it happens, day or night, as well as the local authority lead. The AMHP must be given a timescale for the situation being resolved, and carers notified, and any failure to comply reported to CQC and treated as a serious incident, BASW recommended.

Over the past year, a series of investigations by Community Care and BBC News have highlighted the impact of bed shortages on professionals and staff. The number of patients sent to beds long distances from home rose by a third last year and problems accessing specialist beds for acutely unwell children has seen hundreds admitted to adult psychiatric wards.