Wednesday, 29 August 2018

How many AMHPs is “sufficient”? ADASS guidance on AMHPs

The Association of Directors of Adult Social Services (ADASS) have recently issued guidance for Directors on Approved Mental Health Practice.

While I am glad that they are explicitly addressing the important role of AMHPs within local authority services, I am, however, both intrigued and surprised at some of the contents.

I suppose that one of the things I find a bit dispiriting is the very basic nature of some of the information contained. For instance, the question is posed (and answered) “Who can be an AMHP?”

It is also stated that “local authorities have a statutory obligation to have sufficient AMHPs to provide a 24/7 service”. Are there any Directors of Adult Social Services who are not aware of that?

I suppose that, while AMHPs themselves are all too aware of the practical difficulties their job entails, and the deficiencies in services, all Directors should be reminded of their duties to support AMHPs. Hence the reminder that AMHPs must be given 18 hours of refresher training a year.

I am also pleased about the following statement:

AMHPs are advanced practitioners whose training enables them to understand and manage risk effectively. Working within teams across wider adults, children’s services, and mental health services; AMHPs can support colleagues and ensure referrals for Mental Health Act Assessments are made only where necessary and appropriate.

Something of which I am very aware, certainly in my own local authority, is that most AMHPs are within adult mental health teams. Very few are in older people’s teams or learning disability teams, even though a significant proportion of these service user groups may require assessment and/or detention under the Mental Health Act.

And unfortunately, Children Services do not see any benefit in training their social workers to be AMHPs, despite the Code of Practice stating:

At least one of the people involved in assessing whether a child or young person should be admitted to hospital, and if so whether they should be detained under the Act (ie one of the two medical practitioners or the approved mental health professional (AMHP)), should be a child and adolescent mental health services (CAMHS) professional. Where this is not possible, and admission to hospital is considered necessary, the AMHP should have access to an AMHP with experience of working in CAMHS, (para19.43)

It is very important that Directors should encourage social workers from across the spectrum to train and practice as AMHPs. This should extend to instructing managers to put suitable candidates forward, and facilitating their training and time spent on the AMHP rota by providing extra staffing to cover their absence from their usual work.

The document also provides some very interesting statistics relating to what is meant by “sufficient AMHPs”, which is contained in CoP para14.35 (“Local authorities are responsible for ensuring that sufficient AMHPs are available to carry out their roles under the Act”)

The document gives the following information:

In 1991 the Social Care Inspectorate recommended a ratio of between 1:7,600 (inner city) and 1:11,800 (other) approved staff (AMHP) to population (dependent on locality). In November 2017 the average was 1:16,000.

I have to say that I wasn’t aware of these recommendations from 1991. What is particularly shocking is the almost universal failure of local authorities to achieve the recommended ratio, especially in light of what the document goes on to say:

As the numbers of assessments have increased, the numbers of AMHPs have decreased. An inner city area of 250k population should have 33 full time equivalent daytime AMHPs, a shire county with a population of 1.1million would need 100 full time equivalent AMHPs.

I am, however, encouraged by the document’s final paragraph:

A key determinant of when assessments take place, and the stress placed on AMHPs as they coordinate assessments relates to availability of resources.  Common issues of concern include 1) transport problems, 2) lack of beds, 3) rising numbers of assessments and 4) lack of police resources. Monitoring these issues and developing whole system’s responses are key. Solutions to delays therefore need a multi-agency response and understanding of the local issues. Safeguarding processes should be used to record concerns and monitored at a strategic level.

I very much hope that Directors will work to address these issues before the pressures on AMHPs becomes so great that there will be no-one left willing to undertake the role.