The proposed new Mental Health Act must require local authorities to have a minimum number of approved mental health professionals (AMHPs) to tackle workforce shortages and ensure compliance with the legislation.
That was a key recommendation from an inquiry into the implications of revamped legislation on compulsory mental health care for social work, carried out by the all-party parliamentary group on social work and British Association of Social Workers.
AMHPs giving evidence to the inquiry reported unmanageable workloads and shortages of practitioners in many areas, particularly in relation to AMHPs with experience of working with children, older people and people with disabilities.
A new Mental Health Act
The government pledged to legislate for a new act following the report of the Independent Review of the Mental Health Act in December 2018. The review recommended a new act based on the principles of improving choice and autonomy, ensuring care provided therapeutic benefit and was the least restrictive possible, and that people were treated as individuals.
Ministers accepted two of its 154 recommendations straight away and promised to respond more fully in the New Year. In June of this year, it promised a white paper before the end of 2019 setting out its plans for legislation.
However, as a new act was an idea strongly associated with Theresa May, it is unclear whether the plan will survive this week’s change in prime minister.
AMHPs, the vast majority of whom are social workers, have a critical role under the existing, and any future Mental Health Act, co-ordinating assessments for admission to hospital or for community treatment orders, and ensuring that safeguards for people’s rights are upheld, including that restrictions on them are minimised.
The inquiry report said that the role required practitioners to have the “time to make the appropriate, least restrictive decision for an individual; time to get to know them, to explain their options to them, to talk to family members and to come to a collaborative decision”.
Insufficient numbers
AMHPs are approved by and act on behalf of local authorities – though some are employed by NHS trusts – and the act’s statutory codes of practice for England and Wales state authorities must ensure there are sufficient numbers to carry out their roles under the act.
There are an estimated 3,900 AMHPs practising in England, according to a Skills for Care briefing issued last year.
However, the Association of Directors of Adult Social Services reported, also last year, that ratios of AMHPs to population – 1:16,000 in November 2017 – were much lower than previous recommendations set out in 1991 (1:7,600 for inner city areas and 1:11,800 for other areas).
Boost your Mental Health Act knowledge
Improve your understanding of the Mental Health Act and how it interacts with the Mental Capacity Act at this year’s Community Care Live.
Lecturer and trainer Elmari Bishop will be delivering the session on the interface between the two acts, in relation to deprivation of liberty, on 15 October, day one of the two-day event.
You can reserve your place on this and others of our legal learning sessions, once you have registered for this year’s event.
This issue has become particularly acute in recent years because of the rise in the number of assessments under the MHA. The number of detentions under the act rose by 47% from 43,400 in 2005-6 to 63,600 in 2015-16.
Gaining resources
The inquiry said the situation meant that the existing statutory provisions needed to be strengthened to require a statutory minimum number of AMHPs per head of population.
“The introduction of ratios with statutory force would support local authorities in gaining resources to meet need and ensure provision of more rights protective and consistent service. It would assist in workload management and staff recruitment and retention. It would also help to underpin successful partnership with NHS colleagues and organisations.”
Bed shortages
The inquiry also pointed out that AMHPs were spending too much time finding beds for patients detained under the MHA.
Under Section 140 of the act, clinical commissioning groups in England and local health boards in Wales are responsible for ensuring there is adequate local provision of hospital beds for people detained under the act.
However, the inquiry found that AMHPs often had to put in place emergency cover in the community to safeguard people until beds became available, which could be hundreds of miles from the person’s support networks.
“Currently, the accountability of CCGs to meet this requirement is not well enforced, the report said. “CCGs appear to “devolve” responsibility to their provider Trusts on a day to day basis, and the root accountability of the CCG is lost, rendered invisible.”
The inquiry urged the government to make CCGs more accountable for making sure there are enough beds for patients and to let AMHPs know where patients are when placed out of area.
This year’s Community Care Live 2019 boasts over 30 free learning sessions to equip you to face the key challenges in social work practice today. You can also sign up to any of our eight legal learning sessions to help ensure you have the legal literacy your role requires. Register now to ensure you don’t miss out.
A trauma-informed approach to social work: practice tips 
Problem gambling: how to recognise the warning signs 
Find out how to develop your emotional resilience with our free downloadable guide 
Develop your social work career with Community Care’s Careers and Training Guide 
‘Dear Sajid Javid: please end the inappropriate detention of autistic people and those with learning disabilities’
Ofsted calls for power to scrutinise children’s home groups
Seven in eight commissioners paying below ‘minimum rate for home care’
Facebook
X
LinkedIn
Instagram
There certainly need to be sufficient AMHPs but crude headcounts or ratios to general population are not sufficient. Some individuals who are qualifed as AMHPs only work a small proportion of their time on specialist MHA duties.. Some wil be part-time, others (especially in rural areas) will have significant other roles and some on the register may have become wholly inactive in specialist MHA work. In the light of the new MCA Amendment Act, some AMHPs may split their time with AMCP duties. On the other hand, some AMHPs in urban areas may do little else than statutory MHA work. We need more sophisticated measures of AMHP availability and capacity to get the work done.
There also needs to be a duty for health authorities to ensure there are s12 Drs available! Even with a bed waiting, MHA assessments are regularly delayed by having no approved Drs available (or willing in many cases) to attend!
There is an existing duty re S12 Drs but it’s often undeliverable. This section needs rethought altogether. S12 was written on the assumption that lots of GPs would be willing to acquire and maintain specialist training in MH and be willing to sign up for out-of-hours sessions. In many parts of the country, there is little (or even zero) take-up of such roles. As independent contractors, GPs cannot be compelled to take on additional roles. If GPs want additional work/money, there are many more attractive options than doing MHA assessments at unsocial hours.
If hospital S12 Drs take on the role (as they often have to), that can compromise the “check-and-balance” that was intended in 1983 as they are then often in a position of liaising with a close (or senior) colleague – especially in rural areas where the pool of S12 Drs can be very small. We need something that works rather than imposing rules that are know in advance to be unworkable.