Approved mental health professionals: the local picture

Research by Community Care has revealed continuing pressures on the approved mental health professional workforce nationally, including reducing numbers of warranted AMHPs.

The findings have also highlighted the context for, and implications of, these pressures in local areas, after we asked councils for any reports they had prepared which looked at their AMHP workforce. These raised core recruitment and retention issues.

The ageing workforce and imminent retirements

Brent council says three of its AMHPs are approaching retirement, and all have reduced their hours in the past few years in anticipation of this.

Meanwhile, Worcestershire council says its “established and experienced” AMHP workforce provides “significant stability”, but 11 of the 38 AMHPs approved in the county are estimated to be within five years of the earliest local authority retirement age of 60. “It is very difficult to determine accurately what the impact of this will be on the service,” it adds.

Stress and burnout

Halton council says two very experienced AMHPs have withdrawn from the service’s rota because the work was having “a significant effect on their mental health and levels of stress”.

In Oldham, four vacant posts in the council’s AMHP teams are “impacting on the work/life balance of practicing AMHPs due to frequency on rota’s and late working”.

And Nottinghamshire council says pressures on the AMHP service could “lead to a reduction in quality of work and/or the worker experiencing high levels of stress or burnout. This is certain to have an impact on recruitment and retention of AMHPs, which is already challenging”.

Alternative jobs

AMHPs have been reducing the time they spend in the role or leaving the workforce for other social work positions. Wakefield council says people have been leaving to become independent social workers, an “unavoidable consequence” of the amount of work available doing Deprivation of Liberty Safeguards (DoLS) assessments.

Uneven working patterns

Leicestershire council says the majority of Mental Health Act assessments occur after 5.00pm. mainly due to the availability of doctors. Because of this, staff starting shifts at 8.30am had been “regularly working long hours including into the late evening”. However, the introduction of staggered shifts has significantly reduced the level of time off in lieu accumulated by AMHPs.

Local solutions

Association of Directors of Adult Social Services (ADASS) president Margaret Willcox, who made promoting the work of AMHPs a priority for her time leading the association, says challenges with recruitment and retention of AMHPs in some areas of the country are “one symptom of the overall funding crisis facing adult social care”.

She says the ADASS mental health policy network is currently reviewing areas that are having success recruiting and retaining AMHPs, and will look to share this best practice with other regions.

Local solutions to the problems of recruiting and retaining AMHPs are being introduced across the country.

Chief social worker Lyn Romeo’s 2016-17 annual report highlights the example of a new delivery model for the daytime AMHP service launched in Devon in 2015. Small, dedicated AMHP teams replaced the duty rota model, and each locality team became “empowered to define and direct their own work according to local need”.

Kent council responded to the “serious loss” of 26 AMHPs between February 2014 and April 2016 with a “higher than average intake” of trainees in September 2016. By the same time in 2017 it had five newly qualified AMHPs, with another two following in the November, and it currently has five taking AMHP training.

Brent council created a dedicated AMHP team and says given the shortage of AMHPs this is “the only way to deliver a safe statutory service”. It says this “would not necessarily be the ideal model to deliver effective services if there were enough AMHPs to choose a different model”.

Meanwhile, Leicestershire council says its introduction of an AMHP duty hub is “a much more efficient way of responding to referrals” and had reduced the number of times when it had to call in staff who were not on the AMHP rota. “Workers find it supportive of their practice and well-being,” it adds.

Referral hub

Steve Matthews, an experienced practitioner who blogs as The Masked AMHP, highlights the advantages in the area of the country where he works of having a group of practice consultants and team managers responsible for overseeing the AMHP service across a large geographical area.

They triage referrals and prioritise work, while AMHPs from social work and other teams go on a rota to carry out assessments.

“If there’s a hub where referrals are triaged, AMHPs are much less likely to be having to work late and generally we can allocate work so it can be completed during normal working hours.”

He says there can be problems associated with area-based duty provision, as AMHPs can have “completely unprocessed requests coming directly to you which you then have to deal with because you’re on duty”.

But there are advantages to the duty model over that of dedicated AMHPs. “You might be more likely to be burnt out if you are just doing AMHP work all of the time.”