If you are interested in reading the findings of the 2012 survey of Approved Mental Health Professionals (AMHPs), I advise you to sit down now. They don’t make easy reading.
Conducted by Janine Hudson, an AMHP in Kent, under my supervision as part of the MSc in Mental Health Social Work with Children and Adults at King’s College London, this national survey was completed by 504 AMHPs in England. To our knowledge, this is the largest survey of stress and burnout amongst AMHPs conducted since the role was created by the Mental Health Act 2007 to replace Approved Social Workers (ASWs) in England and Wales. Its findings paint a depressingly familiar picture of an over-worked and under-valued workforce.
43% of respondents reached the threshold for a probable mental disorder. This is an improvement on the 60% of ASWs who met the same threshold ten years ago in our earlier survey (see references below). But it is worryingly high in the context of the important decisions which AMHPs are making. Undertaking statutory duties under the Mental Health Act can be incredibly challenging and if you are suffering from depression or anxiety the difficulties of the role are compounded. We need to care about the mental health of AMHPs and ensure that they are provided with the appropriate support required to undertake the role. There was little evidence of workload concessions being made to AMHPs responding to our survey. If protecting the mental health of AMHPs means reducing caseloads or providing workload relief, this needs to be done now.
Two in five respondents did not want to continue practising as AMHPs or were unsure about doing so. The respondents to our survey were primarily social workers; only 21 were from other mental health professional groups. As the career progression route in mental health social work in most local authorities and NHS Mental Health Trusts leads to the AMHP role, this is worrying.
I know many mental health social workers who do not want to train as AMHPs and many who have done so who don’t like the role. Requiring these practitioners to become AMHPs if they wish to progress in their careers is surely wrong. I understand the reasons for this expectation – to maintain the number of AMHPs on the duty rota to ensure that statutory obligations are met – but could it lead to unsafe practice? The Professional Capabilities Framework for social workers in England is not explicit about the requirement for mental health social workers to become AMHPs for career progression, though employers frequently are. As The College of Social Work takes ownership of the PCF in England, it is timely to explore this now to potentially open up career options for mental health social workers who do not wish to take on the AMHP role.
Of all the problems AMHPs face in their role, the one which they most frequently cited was the lack of beds. The drastic reduction in psychiatric beds over the last decade has compounded the difficulties which AMHPs face. Co-ordinating Mental Health Act assessments is difficult enough without the worry of trying to find a hospital bed if one is required at the end of the process. The reduction in beds has diverted resources from hospitals to community care, but at the expense of crisis care, as AMHPs know to their cost. Dedicated crisis beds may go some way to helping AMHPs find a place for someone who needs it, but this requires in-patient facilities to run at less than 100% bed occupancy which will be difficult to achieve in the current financial climate.
The opening up of the ASW role to other mental health professionals has not helped to reduce the emotional exhaustion faced by AMHPs today. About only 125 of the approximately 5,000 AMHPs in England are nurses or occupational therapists. Although fewer places on AMHP training programmes are available now than ten years ago because of the public sector cuts, it is social workers who remain predominant on these courses. It is still seen as predominantly a social work role, so what is the rationale for continuing to offer it to other mental health professionals?
Practitioners reported in our survey that peer support was the most important thing which helped them to stay in the role. It seems that AMHPs are best understood by other AMHPs. With the decline in the number of AMHPs who have a social work manager, and the withdrawal of mental health social workers from partnership agreements with NHS Mental Health Trusts, an important source of support for AMHPs is potentially being eroded. AMHP forums locally provide essential support, but these need to be recognised and supported by employers as hubs of best practice where expertise is shared and enhanced.
Of course, no research is not without its limitations. Our survey was online and completed by only about 10% of all AMHPs in England. It may have under-represented those who were too stressed to find time to complete it. Equally, it may have under-represented those who did not feel exhausted and felt that they had nothing to complain about. Of course, we don’t know what the responses of the other 90% would have been. However, important policy decisions have been made on the basis of much smaller surveys in the past and a sample of over 500 should not be easily dismissed.
If there is one thing which should change as a result of these findings, it is the quality of support provided to AMHPs. ‘Ermintrude’, a blogger and AMHP writing for The Not So Big Society blog, agrees with this: “In order to care and plan best for others, we really do need to look after ourselves and our own mental wellbeing.” I would add that it is primarily the responsibility of employers to look after the well being of AMHPs and they should be held to account for the poor mental health of the workforce charged with the most demanding role in community mental health care in the UK.
Finally, I would like to thank all AMHPs who took the time to participate in the survey – your collective voices have spoken. I just hope that someone is listening.
Evans, S., Huxley, P., Webber, M., Katona, C., Gately, C., Mears, A., Medina, J., Pajak, S. & Kendall, T. (2005) The impact of ‘statutory duties’ on mental health social workers in the UK. Health and Social Care in the Community, 13, 145–154.
Evans, S., Huxley, P., Gately, C., Webber, M., Mears, A., Pajak, S., Medina, J., Kendall, T. & Katona, C. (2006) Mental health, burnout and job satisfaction among mental health social workers in England and Wales. British Journal of Psychiatry, 188, 75-80.
Huxley, P., Evans, S., Gately, C., Webber, M., Mears, A., Pajak, S., Kendall, T., Medina, J. & Katona, C. (2005) Stress and pressures in mental health social work: The worker speaks. British Journal of Social Work, 35, 1063-1079.
Huxley, P., Evans, S., Webber, M. & Gately, C. (2005) Staff shortages in the mental health workforce: the case of the disappearing approved social worker. Health and Social Care in the Community, 13, 504-513.