AMHP workforce 35% short of what is needed for 24-hour service, say leads

The approved mental health professional workforce is 35% short of what is required to provide a 24-hour service, AMHP leads have warned.

The finding, from Skills for Care’s latest report on the AMHP workforce in England, suggests practitioner shortages are increasing amid a mounting number of people being made subject to the Mental Health Act 1983 (MHA).

The Skills for Care report, based on a survey of leads, showed that estimated AMHP numbers have remained broadly steady from 2019-24 at about 3,800, with 1,500 full-time equivalent (FTE) roles as of April 2024, up from 1,400 the year before.

Increasing shortages of staff

However, AMHP leads told Skills for Care that to fully staff a 24-hour service, they would need 35% more FTE staff, up from 30% in 2023.

Over this time, the AMHP vacancy rate has also increased, from 11.2% to 12.7%, though this implies that councils are not recruiting to fulfil their requirement to deliver a round-the-clock service (see box).

AMHP leads also appear to be more pessimistic than last year in relation to future workforce growth. In 2023, they estimated that 44.9% additional practitioners would start AMHP roles in their organisations over the coming five years, but that figure fell to 39.5% in this year’s survey.

In both years, they estimated that about a quarter of their current workforce would leave over the subsequent five years.

There had also been a growth in turnover year on year, with 13.4% of AMHPs recorded as having left in the previous 12 months in 2024, up from 11.8% last year. This was driven by increasing proportions retiring (3.1%, up from 2.5%) or moving out of an AMHP role (4.4%, up from 4%).

Greater use of Mental Health Act

The shortages come with NHS England figures showing 22,623 people were subject to the MHA as of March 2024, up from 21,016 12 months earlier and the highest monthly figure recorded in a series going back to 2016.

AMHP leads have also long warned that the number of MHA cases understates practitioners’ workloads as it does not capture their work to find alternatives to detention for people in crisis.

Responding to the workforce survey, the AMHP Leads Network said: “While the workforce numbers may remain stable, this is stability at a level already in clear deficit to requirements. Coupled with the surge in demand most services are reporting, this reflects the huge stress and pressure most areas are reporting.

“It’s a very difficult time to be managing an AMHP service or working as an AMHP – which again is perhaps reflected in the figures showing the main reason for loss of AMHPs is people leaving the role altogether.”

Persistent recruitment challenges

The survey also highlighted the ongoing challenges facing the sector in recruiting and retaining AMHPs:

• Social workers make up the overwhelming majority of AMHPs at 95%, a proportion that has remained static for several years. Just 4% are nurses, 1% occupational therapists and very few psychologists, suggesting it remains a struggle to attract practitioners from the latter three professions.
• About four in five (79%) are employed by councils with NHS trusts employing about 16%, figures that have remained relatively stable since 2019. Some trusts are not supporting their social workers to undertake AMHP training, while some councils are also not supporting NHS-employed staff to do so, said NHS England guidance on support for mental health social workers and AMHPs in health settings.
• A significant proportion of AMHPs are approaching retirement, with 32% aged 55 or over, compared with 24% of local authority adult social workers.
• The workforce is less diverse than the adult social work workforce as a whole, with 79% of AMHPs being white, compared with 72% of social workers.

The Skills for Care data also showed that a growing proportion of AMHPs are working full-time in the role (28%, up from 21% in 2018 and 26% in 2023).

Data ‘shows need for adult social care workforce plan’

In response to the data, an Association of Directors of Adult Social Services spokesperson said: “Adult social care is supporting growing numbers of people with mental illness, yet the number of AMHPs have remained static over the last five years.

“This is emblematic of the wider recruitment problem in social care, where pressure on local council’s budgets means they unable to employ enough people to provide the care and support we all need to live well, work and care.

“To solve this, we are calling on the government to commit to an adult social care workforce plan and make social care a career aspiration with real prospects, through training and development opportunities, as well as improving pay and conditions.