AMHP workforce shrank by 4% last year, finds survey

Figures add to ongoing concerns over shortages of approved mental health professionals, driven by ageing workforce, stress and salary disparities

mental health act
Photo: Gary Brigden

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.”

Salary disparities

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.”

9 Responses to AMHP workforce shrank by 4% last year, finds survey

  1. PIP February 5, 2020 at 12:48 pm #

    I have been an AMHP for 14 years and did 7 years as an AMHP on the Out of Hours service. I stopped being an AMHP 5 years ago due to the position I was in as a social worker not allowing me to be an AMHP. I obtained a new job where I can be an AMHP again. As I have not practiced in the role for 5 years they will not allow me to be an AMHP via a portfolio route but says that the only way I can be an AMHP again is to do the whole course again. And they wonder why there is a shortage…..

  2. G Mathews February 6, 2020 at 8:34 am #

    Sadly it doesn’t matter how many AMPHS you have if there are insufficient psychiatric beds to meet demand.

    • Manjit k February 6, 2020 at 9:01 pm #

      I am an AMHP but also a social worker, it’s very difficult as you have a full caseload but then are expected to be on the rota for AMHP duty.
      There is no consideration for the additional paperwork, reports etc as you are still expected to ensure cases are up to date. There is out of hours working plus the additional stress of not knowing what you are walking into .
      It’s the part of my job I enjoy however juggling everything is impossible.

  3. David February 6, 2020 at 9:42 am #

    Exactly there is a need to address the scarcity of psychiatric beds so people don’t have to deteriorate and then wait to be admitted on a section of a MHA.

  4. Neil Sanyal February 6, 2020 at 11:08 pm #

    I have just retired after 32 years as a social worker and 27 years as an ASW/AMHP. I never worked in a hub and always did my AMHP duty as a caseworker. I got far more stress from the casework than I ever did in my AMHP work. So much so that I decided to work 2 days per week for another, more local, LA as an AMHP in their small hub, but it’s 9 – 5 with no nights or weekends. I didn’t want to just throw all my experience and knowledge away and my new LA AMHP manager is very grateful to have those.
    I my humble opinion the emergence in the last 7 years of 24/7 AMHP Hubs, especially large county-wide ones, piles on the stress and exhaustion and is counter-productive for recruitment and retention of AMHPs. Most NHS trusts will never release their CPNs to do the AHMP course as they don’t want one day per week of their time away from NHS work. And the nurse knows that when they return they will usually get no increase in pay.

    • shaun monk February 7, 2020 at 12:39 pm #

      I hear your points Neil. However I think the greater problem is we are responding to poor commissioning, an acute lack of resources, and to a certain extent statutory agencies not understanding their statutory responsibilities. For both casework/care management and amhp work we end up working to a scenario that is strongly influenced by NHS limitations, ie the overwhelming deference by local authority managers to NHS pressures. I believe it would be helpful if our executive officers had more backbone and pushed back sometimes, ie the person who has a rushed discharge 1 week ago that represents having been picked by the police under s136. The person who goes on extended s17 leave as part of a longer plan moving towards discharge who finds their inpatient bed has gone and they have to make do with cobbled together community support after a 2 days of that leave.

  5. Not My Real Name February 11, 2020 at 11:13 am #

    “94% of whom are social workers”

    This was not what was supposed to happen when Approved Social Workers became AMHPs. It was fairly obvious it was what would happen, but it was not the plan. We should have had a mix of professionals sharing the burden by now, but it hasn’t happened.

  6. B singh February 20, 2020 at 5:18 pm #

    The move away from multi agency teams will continue to exacerbate this issue . The AMHP role is part of a continuum of need and risk. It should be shared with health collegues in the decision making process to request an MHA in the first place.

    Amhps have lost control of the whole process through the breakdown of integrated arrangements

    We should relook at the national service frameworks that came out under Blair government.

  7. Terry McClatchey March 2, 2020 at 9:25 am #

    This is not an encouraging indicator of how well LAs will be prepared with a new parallel workforce of trained and accredited AMCPs in time to launch LPS in October. Some AMHPs may be expected to do both roles. As we don’t even have a draft CoP for LPS, it’s now difficult to see how training and accreditation can take place in time to have sufficient numbers to meet new statutory duties.