NHS commissioners and local authorities must give AMHPs more support, says DH

NHS providers and commissioners must improve support for Approved Mental Health Professionals facing problems securing hospital admissions for acutely unwell patients, under changes to the Mental Health Act code of practice.

The new code, which comes into force on April 1, says that AMHPs should not be expected to address delays to admission alone. While waiting for a bed to become available, NHS commissioners should work with mental health trusts to find alternative arrangements for patients – such as crisis house places – and these should be communicated to the AMHP team, the new code says.

“AMHPs should be supported by their local authority in these circumstances and should not be expected by commissioners and providers to address the delay themselves,” the code says.

AMHPs must report delays

The revised code of practice also says that AMHP teams and NHS providers must report delays in admission, and their impact on staff and patients, to commissioners and senior local authority staff to help inform service planning. The code of practice is statutory guidance for professionals and as a matter of law must be followed by them unless there are ‘cogent’ reasons for not doing so. The code is not, however, statutory guidance for NHS commissioning groups.

A series of investigations by Community Care and BBC News over the past 18 months have shown how patients and staff have been impacted by pressures on mental health beds. Scores of acutely unwell patients have been sent hundreds of miles from home due to no local beds being available and a series of deaths have been linked to bed pressures. Data obtained under the Freedom of Information Act found that more than 2,100 mental health beds have been closed in the past three years and funding for mental health trusts has been cut back.

Focus on commissioning

A Department of Health report accompanying the new code of practice said that a major concern flagged up during consultation was the need to ensure commissioners and providers take responsibility for ensuring sufficient beds.

The new code places a much stronger focus on the duties of commissioners. A new dedicated section on commissioning stresses that commissioners must ensure enough beds are available for patients in need of admission. Commissioners’ legal duty under section 140 of the Act to ensure arrangements are in place for ‘special urgency’ admissions is also highlighted and a new requirement to consider assistance for carers having difficulty visiting patients placed in hospitals long distances from home introduced.

The new code of practice contains 86 mentions of the word ‘commissioner’ compared to three mentions in the previous code, which was issued in 2008.

‘Clear lines of responsibility’

Faye Wilson, chair of the British Association of Social Workers’ mental health forum, said that the code “clearly sets out where responsibility lies”.

“The mention of section 140 is a step forward and the document shows that AMHPs should not be left to sort out every part of the system, particularly access to beds, without any support. The new code shows that, if there are problems in relations to bed access, commissioners must act. It also strengthens the voice and rights of carers who are sometimes having to make long trips to visit patients,” she said.

“My concern is that the changes won’t happen in practice without extensive training for commissioners. We need to make sure they have the essential knowledge about their statutory duties under the Act.”

The changes above are just a few of a series of revisions to the code of practice. Other changes highlighted by the Department of Health include:

• Five new guiding principles;
• New chapters on care planning, human rights, equality and health inequalities;
• Consideration of when to use the Mental Health Act and when to use to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and information to support victims;
• New sections on physical healthcare, blanket restrictions, duties to support patients with dementia and immigration detainees;
• Updated chapters on the appropriate use of restrictive interventions, particularly seclusion and long-term segregation, police powers and places of safety and;
• Further guidance on how to support children and young people, those with a learning disability or autism.

For further reading, Inspector Michael Brown, who runs the award-winning Mental Health Cop blog, has also analysed some of the key changes relating to section 136 of the Mental Health Act.