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”.
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“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.”
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?”
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.”
BASW Q&As on the AMHP workforce
Can a local authority reapprove lapsed or retired AMHPs?
Yes. Local authorities can authorise an AMHP to act on their behalf if they believe that the person is competent and meets the requirements to be an AMHP.
The person must have been previously approved as an AMHP (there is no time limit in the regulations from last approval), or if never approved as an AMHP, they must have completed the AMHP training course within the past five years. The person is required to undertake 18 hours of appropriate training during the year following their approval.
Can a local authority add trainee AMHPs to the workforce without full exam board approval?
It is for local authorities to decide who is a fit and proper person to be an AMHP. The regulations require a person to have completed the course, but students who have finished their course who are felt to be competent but awaiting exam board approval can be authorised by the authority to support the local AMHP service (as is happening in the NHS with final-year nurses) if all of indicators are that the person will pass the exam board stage and the local authority is confident they are competent.
Can the 18 hours statutory requirement for annual training be relaxed during the Covid 19 period?
It is not going to be possible to change the regulations for the Covid 19 period, however each local authority can make their own decision about how they will be satisfied around competence. It is possible for local authorities to decide to be more flexible about acceptable training and the use of remote learning through Powerpoint presentations and legal tests. BASW is considering whether it can provide learning material online that local AMHP leads could choose to use.
Relaxation of requirement to write full AMHP report post-assessment
The Mental Health Act and code of practice are clear that AMHPs should leave a summary of information on the ward and this has to continue (code, paragraph 14.93). The code also says that, ‘An outline report does not take the place of the full report which AMHPs are expected to complete for their employer (or the local authority on whose behalf they are acting – if different.(14.95)’. It is therefore up to the local authority to determine how detailed a report they expect and the timescales for this to be done. It is suggested that as a minimum an AMHP report should contain sufficient information to allow the reader to understand: who was consulted and why; that the AMHP was satisfied that the statutory legal criteria were met; what the AMHP did to ensure the person was interviewed in a suitable manner, and a clear explanation from the AMHP why they decided that admission under section was the most appropriate option.
Can Mental Health Act assessments be carried out via Skype or other methods?
BASW is exploring the practicalities of the issue with partner agencies in regard to the legal need for assessments to be undertaken in a ‘suitable manner’.
Are AMHPs ‘key workers’?
Are AMHPs entitled to PPE?
Yes. If this is needed for a safe assessment in line with guidance, then AMHPs should use PPE in line with public health advice.