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.
