A project to help evidence the value of approved mental health professionals’ (AMHPs) role has started work.
Local government leaders have commissioned a team of practitioners to explore the feasibility of developing a national dataset for the role, encompassing the wide range of work that AMHPs do.
Such a dataset has long been sought by AMHP leaders as a way of identifying the value AMHPs bring to the mental health system, in particular in preventing admissions under the Mental Health Act 1983 and promoting the least restrictive option, as required by the MHA code of practice.
The project has been commissioned by Partners in Care and Health, a partnership of the Association of the Directors of Adult Social Services (ADASS) and the Local Government Association (LGA) designed to support improvement in council adults’ services.
The appointed team, from social work consultancy DCC-i, includes five AMHPs and an expert on working with people with lived experience.
Existing AMHP data and what it misses
Currently, Skills for Care publishes annual data on the AMHP workforce and NHS England produces yearly statistics on the use of the Mental Health Act 1983, the latest of which showed a 7.7% drop in the number of people detained under the MHA, which followed a 5.7% fall the previous year.
Most such detentions will have been based on an application from an AMHP following an assessment by the practitioner, agreed with two doctors, that the criteria for detaining the person under the relevant section are met and detention is the most appropriate way of providing care and treatment to the person.
However, despite the decline in the number of detained people, the AMHP Leads Network has argued that demand for AMHP work is increasing year on year, with a rise in the number of requests under section 13 of the MHA for a practitioner to consider a person’s case where it is deemed detention may be required.
In many such cases, AMHPs do not make an application under the MHA but find less restrictive alternatives to detention for the person; however, this work is not captured in existing datasets.
‘A lot of hidden stuff in the AMHP role’
Discussing the potential outcomes from the project, DCC-i chief executive and chief social worker Daisy Long said: “There’s lots of hidden stuff in the AMHP role which, if that wasn’t there, what would then be the pressures on systems that are already pressurised? You don’t just sign section papers. The prevention role of the AMHP is more social work than care management.”
Specialist associate Steve Chamberlain, the former chair of the AMHP Leads Network, added: “No one has ever captured the work that AMHPs do to prevent admissions. [The project will be looking to capture] the breadth of AMHP activity that’s not about imposing the MHA on people but preventing it.”
Diversity of existing data
There has been a bigger than expected response from AMHP services to an invitation to take part in the project, with 44 local authority areas signed up to take part and provide the team with details of what data they currently collect and how.
“Some are collecting in really advanced ways with some beautiful dashboards and some are on manual spreadsheets or nothing at all,” said Long. “We’re in the process of receiving what’s being collected at the moment.”
Chamberlain added: “One of the big debates we really need early on is to clarify definitions. It’s easy to define when someone is sectioned. When does a referral become a referral? When does it become an MHA assessment? We need to work out definitions because no one’s done it before. Data quality is a crucial part of the project.”
Based on this, the team will develop a dataset, which the test sites will trial and report on for 10-12 weeks, with DCC-i then analysing this to inform the finalised proof of concept for the minimum dataset.
The project, which will run until next March, will also draw upon the views of people with lived experience of receiving AMHP services in developing its recommendations.
The project team also includes Jo Sutherland, David McGill and Surj Sall-Dullat, who are all AMHPs, and Gavin Rogers, who will lead on getting feedback from people with lived experience.
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If it’s at all useful, say to set an historical perspective, it’s worth checking in with Dr Shashi Shashidharran, then if not now, with one of the Birmingham North NHS Trust; and also if he’s available Dr Keith Rix (retired) and Dr Di Tamlin; Keith and Di led on alternatives to custody in the early1990s and, separately, Sashi on alternatives to compulsory admissions ~ at the heart of these initiatives was the previously unprecedented use of low secure admissions primarily impacting young black men. Addressing institutional racism was in sharp focus in both initiatives ~ it was undoubtedly a tough time in Leeds at the time and not dissimilar, in some ways, to the more recent issues that have caught public attention. And, for a longitudinal perspective an approach to the High Security Psychiatric Estate, I am sure, will yield great practice insights, say for example, The Ritchie Report but the wider trawling of patient admissions into the secure estate will hold merit, as would the Appleby Inquiry. Further, the early treatments using ‘day-hospital’ of the then new diagnosis of BPD was hugely important for women previously on s3 renewals ~ the current use of detentions under the auspices of BPD, to me, seem wholly incompatible with that first envisaged!
At a time of increasing pressure in mental health; it astounds me why people would choose to take on the AMHP role.
Late evenings, added responsibilities, and often the last person left to oversee things .. I know I’m not the only one who asks themselves why do it.
For very little, if any, extra pay!!
I agree with the above comment, when I started the AMHP role 7 years ago I thought it was difficult, and now it is ten times more difficult! Mainly due to bed availability being dire, the Police and ambulance services more stretched, and magistrates making us wait days if not weeks to get warrants.
But I thought “you don’t just sign section papers”? Yet here we are bemoaning bed availability, difficulty accessing police and ambulances and magistrates delaying obtaining warrants. Thankfully there’s always families and neighbours to manage risk and distress to compensate. Funny old world.