Local authorities have been urged to tackle disparities in salary and stress among approved mental health professionals as part of a plan to improve the recruitment, retention and development of AMHPs.
The national workforce plan for AMHPs, issued by the Department of Health and Social Care, Social Work England, Skills for Care and Health Education England, is designed to improve the consistency of AMHP training and practice and enhance support and working conditions for practitioners.
AMHPs – the vast majority of whom are social workers – assess the need for and make applications for the use of compulsory powers under the Mental Health Act 1983, whilst ensuring people’s human rights are upheld during the process.
The plan has been developed following a number of reports that have identified significant pressures on the workforce. These stem from increasing demand for MHA assessments and growing recruitment and retention problems. The latter have often been linked to stress and poor morale relating to the severe challenges AMHPs face in finding beds or community alternatives for people in mental health crisis.
The plan is designed to improve workforce planning and development while also influencing AMHP training requirements developed by Social Work England – which takes over responsibility for AMHP education next month – and regulations on the deployment and competencies of AMHPs arising from the planned overhaul of the Mental Health Act 1983.
The plan said that councils and mental health trusts should monitor the workloads and morale of AMHPs and audit these regularly. It also said local authorities should consider flexible working patterns for AMHPs and the relationship between their AMHP work and other responsibilities, in order to reduce stress.
Steve Chamberlain, chair of the AMHP leads network, said: “The network would fully support the points about stress made [in the plan]. We believe the exhaustion and burnout is not because of the nature of the role (which is onerous, but AMHPs are highly skilled and tend to value the specific skills required), but because of the ever increasing logistical problems surrounding the assessment, due to resource problems (particularly lack of alternatives to admission, lack of beds when admission needed, problems with transportation).”
The plan also called on employers to tackle disparities in salary between AMHPs, and ensure that they were paid at senior practitioner level in recognition of their expertise.
Figures from 2017, published by Skills for Care last year, found that social workers with an AMHP qualification were paid between 3% and 12% more than social workers in general in every region of England.
However, government-funded research last year into why so few health professionals were becoming AMHPs, identified inconsistencies in salary, including between AMHPs employed by local authorities and those within the NHS, and in relation to whether people received flat-rate payments for being on AMHP rotas that did not take account of the time they spent doing the role.
The plan said salary levels should be reviewed regionally and across organisations to reduce disparities and ensure people were paid at similar levels regardless of their employing organisations.
How many AMHPs are enough?
Each council has a statutory responsibility to ensure there are sufficient numbers of AMHPs to meet local service needs. However, concerns have repeatedly been raised about workforce shortages, including in a report this year by the all-party parliamentary group on social work and the British Association of Social Workers that called for a statutory minimum number of AMHPs in each area.
Skills for Care reported last year that there were 3,900 AMHPs in England – though at least 400 of these were estimated not to be in practice – meaning there were around 20 per local authority area. In a background section, the workforce plan cited 1991 figures on the number of AMHPs required per head of population – which current figures fall well short of – but said these estimates were “very out-of-date, and the evidence base for this population-based planning [was] weak and untested”.
While it did not issue any recommendations on numbers, the plan said local authorities and their NHS partners should ensure they understand and monitor the number of AMHP required locally, including the number they needed from different service areas (adult mental health, learning disability, older people, sensory impairment or children’s services). They should also carry out workforce and succession planning to ensure the ongoing sufficiency of AMHP numbers.
The plan also includes proposed service standards – by Robert Lewis, AMHP service manager in Devon, and academic Karen Linde – which it said all councils and mental health trusts should adopt in their employment of AMHPs. These cover the leadership, oversight and scope of AMHP services, as well as how practitioners’ safety and professional development can best be promoted.
Key points in AMHP plan
On improving oversight
- The Care Quality Commission should inspect AMHP services as part of its mental health inspections.
- There should be a nationally agreed data collection process for the AMHP role and MHA detentions.
- Advice and support should be provided to ensure section 140 of the Mental Health Act – which requires NHS commissioners to inform local authorities about the availability of beds for admission in an emergency and for those who are under 18 – is properly implemented.
On improving management
- Local authorities must have an AMHP lead officer who directly manages the service and oversees all AMHPs, while the service should also be overseen by the adult principal social worker, who should preferably have AMHP experience.
- AMHPs should receive appropriate supervision from senior social workers with AMHP experience.
On improving recruitment
- Local authorities and higher education institutions should develop a training pathway for prospective AMHPs, potentially including shadowing assessments.
- AMHP training courses should be made more accessible and flexible.
On improving retention
- Local authorities should consider flexible working patterns for AMHPs to reduce stress, and regularly audit the morale, pressures and workloads of the AMHP workforce.
- Councils should work to reduce disparities in AMHP salaries, leave and benefits, and ensure they are paid at senior practitioner level in recognition of their expertise.
On improving training and development
- Social Work England should implement national education standards for AMHP training and re-approval, and clearly specify the quality required of AMHP courses.
- There should be comprehensive AMHP service standards followed by all employers, including robust criteria for the warranting of qualified AMHPs.
In relation to other recommendations (see above box) AMHP leads network chair Steve Chamberlain said the network particularly welcomed the call for a national minimum dataset on AMHP work and the focus on the implementation of section 140. On the latter point, Chamberlain said: “This has been roundly ignored since 1983, and even today there are less than a handful (literally) of written policies in place across the country.”
While the network supported having an AMHP lead in every area – something which he said was common but not universal – he suggested it would be better to separate this from the adult principal social worker role as the latter already had a sufficiently wide remit and many PSWs were unlikely to have AMHP experience.
There are no timescales provided in the document for implementing the plan, with details on this only likely to be produced after the election, potentially alongside further details on the reform of the Mental Health Act.
Community Care Inform Adults subscribers can read our guide to working as an AMHP. It covers the context of the role, the process of a Mental Health Act assessment and decision making and recording. Not sure if you have access to Inform Adults through your organisation or have other questions? Find help here.