The number of approved mental health professionals (AMHPs) in England fell by 4% last year, adding to longstanding concerns about shortages of practitioners doing the role.
In a government-commissioned workforce briefing, Skills for Care estimated that there were 3,730 AMHPs in England, based on a survey answered by 148 of 150 local authorities in October 2019, down from 3,900 in 2018.
Of 135 local authorities to answer the survey in both 2018 and 2019, there was drop of a similar proportion, with 43% of these authorities seeing their AMHP numbers fall, while 40% showed an increase and 17% reported the same number.
Beneath the headline figures, the Skills for Care briefing showed that 11% – about 410 – of staff concerned were not working primarily as an AMHP or regularly on the AMHP rota, while 67% combined the role with another one and just 22% worked solely as an AMHP.
The survey was designed by the Department of Health and Social Care (DHSC) and AMHPs Leads Network, which also distributed it.
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.
Longstanding workforce shortage concerns
Local authorities have a statutory responsibility to ensure that there are sufficient numbers of AMHPs to meet local service needs. However, concerns have repeatedly been raised about workforce shortages, including in a report last year by the all-party parliamentary group on social work and the British Association of Social Workers, which called for a statutory minimum number of AMHPs in each area. A Community Care survey in 2016, answered by 120 councils, found a 7% drop in AMHP numbers from 2013-14 to 2015-16.
At the same time, demand for AMHP work has been rising due to ongoing increases in the number of detentions and community treatment orders issued under the Mental Health Act.
Drivers of the shortages include an ageing workforce, widely reported stress, the failure to recruit significant numbers of AMHPs from the health professionals eligible to do the role and lack of and disparities in pay.
The Skills for Care report, citing figures from the National Minimum Data Set for Social Care for 2018, said that 32% of social worker AMHPs were aged over 55, compared with 22% of all social workers, and 70% aged over 45 (51% of social workers).
Steve Chamberlain, chair of the AMHP Leads Network, said it was concerning that the number of AMHPs nationally appeared to have reduced during the past year.
“This reflects the network’s own research over the past 5 years, while the Skills for Care survey provides a fuller and more accurate picture. It is important to be aware that this figure will inevitably be an overestimate of the availability of AMHPs across the country, the survey counted number of individuals, and not full-time equivalents,” Chamberlain said.
So an AMHP who was approved but only worked one or two days per week would be counted equally with one who is full time, he added.
“It is crucial that all local authorities work carefully to ensure that they are able to continue to provide an AMHP workforce that is able to respond to their local demand and comply with their statutory obligations.”
Meanwhile, it also identified considerable regional disparities in the salary uplift social workers received for becoming AMHPs.
While the average uplift was 12%, or £4,000, in 2018, this ranged from 2% in London (£700) to 18% in the West Midlands (£5,900).
Meanwhile, government-funded research last year into why so few health professionals were becoming AMHPs, 94% of whom are social workers, identified inconsistencies in salary, including between AMHPs employed by local authorities and those within the NHS.
The national workforce plan for AMHPs, issued last year by the Department of Health and Social Care, Social Work England, Skills for Care and Health Education England, set out plans to improve the consistency of AMHP training and practice and enhance support and working conditions for practitioners.
This included calling on employers to tackle disparities in salary between AMHPs, and ensure that they were paid at senior practitioner level in recognition of their expertise.
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.
It also called on employers to use flexible working patterns and morale audits to tackle stress.
Chamberlain said the AMHP network would welcome a more consistent approach to AMHP pay.
“The role is highly skilled and entails making decisions in circumstances of high risk and often pressurised situations. AMHPs also regularly work beyond their contracted hours and are unlikely to be able to recover the additional time worked,” he said.
“The pressure on AMHPs is increased by the logistical difficulties caused by resource shortages (including lack of alternatives to admission, lack of beds to admit patients when necessary, delays in transportation when necessary).”
Plans to replace Mental Health Act
The Skills for Care briefing comes with the government developing a white paper on reforming the Mental Health Act, based on an independent review of the legislation published in 2018.
In a foreword to the briefing, interim chief social workers for adults Mark Harvey and Fran Leddra and DHSC mental health social work lead Mark Trewin welcomed the report, adding: “We now have clear information to consider what actions the sector will need to take to ensure we have the right number and right people in place to undertake this essential role, both now and in the years ahead.
“This information will also be very useful to those working on the Mental Health Act review white paper preparations, who understand the vital role of the AMHP in delivering aspects of the proposed legislation.
“We know that detention rates are increasing and AMHPs are dealing with increased challenges in local systems as they support people and fulfil their roles.”