Covid-19: AMHPs’ protective equipment needs not sufficiently considered, warn sector leaders

Approved mental health professionals (AMHPs) feel their personal protective equipment (PPE) needs haven’t been properly considered in the early stages of the coronavirus pandemic, social work leaders have warned.

They also questioned how the already-stretched AMHP workforce will cope as the pandemic worsens and how practitioners will be able to fulfill their duties under the Mental Health Act while abiding by government-imposed social distancing rules

British Association for Social Workers (BASW) chief executive Ruth Allen, a former mental health trust social work director, said that –  as with social workers more generally – AMHPs “feel their need for particular types of protective provisions have not really been in the thinking of the early stages of this crisis”.

“The focus so far has been on the need for gear in clinical settings, it’s not that AMHPs or any other social workers will always need to gown up in the same way, it’s just that they need to know when it might be appropriate to and when it might not be,” she said.

‘Conflicting information’ on PPE use

Allen added: “AMHPs need to be well-advised on the right and proportionate PPE, for instance, under what circumstances might they need a mask, when might gloves be appropriate and the consideration of when to use and when not to use.”

AMHP leads network chair Steve Chamberlain voiced concern about the circulation of “conflicting information” about PPE.

“My view and our view is that it should be available to all, the problems we’ve identified are around national government messaging, so when do you use PPE? Because people can be asymptomatic,” he said.

“It’s also about the ability during a mental health crisis to control the environment when you’re two metres away,” Chamberlain added.

Allen said social distancing rules “are going to throw up all sorts of issues” for AMHPs in particular.

“In some cases, it will be possible for AMHPs to keep distance and still undertake their work, but being able to interview people in a way that’s required by law and make them feel comfortable, that’s quite difficult if you’re keeping two metres away.”

Already-stretched workforce

Both Allen and Chamberlain voiced concerns about how the worsening pandemic could deplete the already-stretched AMHP workforce.

In a government-commissioned workforce briefing last year, 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. This added to an already bleak picture of a workforce of older-than average practitioners that was struggling to deal with rising numbers of Mental Health Act assessments and recruit from professions outside of social work and afflicted by stress and pay inequalities.

“They may be having to self-isolate and be in high-risk groups, so without people having the illness, you might have lost quite a number of AMHPs as it is,” said Allen.

“If you’ve got five people who can’t do home visits and two who can’t work because they’re high risk; a lot of AMHP managers are looking at this and thinking ‘I’ll be down to skeleton staff’,” she added.

Allen said addressing workforce availability was going to “fall very much on local areas”.

She added: “What local areas need to do is have really carefully thought through workforce plans for their AMHPs. How will they keep AMHPs healthy? Can they get previous AMHPs back onto rotas? [Can they] maybe extend the hours of people working part-time or get managers back into practice?”

Video interviews

BASW, the AMHPs leads network and the Department of Health and Social Care (DHSC) have been in discussions about how the AMHP workforce will need to change their ways of working during the pandemic.

“There’s been lots of discussion about video interviewing but now it’s on the agenda it’s really complex; my own personal view is that we will be developing guidance on this,” said Chamberlain.

“I think we need to explore that carefully, it’s not easy but I suspect we will be going down that route and having to explore the complexities around it. Ethically, nobody has created guidelines for this because nobody has gone down this route yet,” he added.

Chamberlain said while it was helpful that courts and legal bodies were doing video interviewing, they were in far more controlled circumstances than AMHPs.

“In mental health assessment terms, I don’t know of anyone who’s done it,” he added.

Allen said that video interviews won’t be suitable for every case.

“The thing is, you can’t switch on a protocol that doesn’t exist in the first place. [But] people that we’re working with now are increasingly able and willing to use Skype and Facetime, [because] now people use it as part of their intimate personal lives.”