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
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.
References
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.
An earlier version of this post was published by Community Care on 2nd October.
See also:
One in five AMHPs wants to quit role amid ‘unacceptably high’ stress levels
National AMHP survey: reaction from the social work frontline
We are just consulting with members and the wider amho community on where the Amhp competency fit into the pcf and its pitched at experienced level, for those of you wanting to input into this consultation you can find the survey at https://www.surveymonkey.com/s/WYPHXNS
The findings of the AMHP survey have not been met with surprise by AMHPs. I have received many messages on Twitter from AMHPs saying how much the findings have chimed with their experiences. While this suggests that the survey has not been unduly affected by response bias, it remains very worrying that it seems to be painting an accurate picture of the poor psychological state of the AMHP workforce. Many AMHPs are taking the findings to their managers to argue for more support. This needs to happen both locally and nationally.
Community Care are supporting these discussions by hosting a live online discussion of the findings of the survey on Monday 15th October from 7.30-8.30pm. Please join Janine and I and others for a discussion of the implications of the findings for AMHPs. More information can be found at: http://www.communitycare.co.uk/Articles/05/10/2012/118577/Live-social-work-chat-stress-support-and-the-future-for.htm
I found the research mirrors my experience of my AMHP role. The issues mentioned, i.e. lack of beds, the amount of time it takes to arrange for two S.12 doctors; amount of time being left with the client and their families whilst waiting for ambulances, and others stressors involved in the job.I felt that the person/s who wrote the article must have shadowed AMHP’s in their work, in order to achieve, in my opinion, accurate results in their research.
I have a good working relationship, with both NHS staff and Police, and this I find a source of support, the joint working is incredible helpful in extremely stressful situations. I also find my work colleagues, where I am based as a CAMHS Social Worker/Clinician, they are a source of support. As an aside my work colleagues, and Managers have also read the Research which confirms their view of the AMHP role.(They are not social workers/amhp’s).
Having said the above, I do enjoy my AMHP role, and would not want to stop this work, I do find it satisfying completing a good assessment, and giving a good service to our clients. I enjoy the work, but the systems need to be changed. May be an AMHP team, where we did not have a full time job in a different field. An AMHP team fully supported by our Managers, with equipment to support us in our AMHP roles.
Thanks for doing that research, made me feel both good, that the research had been done, and further highlighted what I already knew..
12 years ago, when I took over as BASW’s lead on mental health legislation, I argued that the ASW role was becoming unviable, for the reasons now being cited, and that the only solution was to split it and make the Trusts responsible for conveyance, and this became BASW policy when we issued our detailed proposals in December 2001.
Basically, my argument was that the problems with beds, police and ambulance, none of which had been a significant issue in 1983, had become endemic and could not be alleviated by exhortations from central government but required structural solutions. ASWs, individually and collectively, were in an impossible position as they carried the legal responsibility for the admission process (and were personally liable if anything went wrong) but had no leverage against the Trusts, PCTs, ambulance and police services which controlled the resources which they needed, and which had little incentive to be helpful in the absence of any legal duties or performance targets.
The local authorities on their part had bigger fish to fry in relation to these bodies and had little interest in jeopardising relationships by using whatever limited levers they might have, even though lack of adequate police and ambulance support meant that ASW practice did not conform to their own health-and-safety standards. Placing responsibility for conveyance on the Trusts (albeit that the AMHP might continue to oversee the admission as agent of the Trust) would drastically change the dynamics, whilst leaving the AMHP’s independent quasi-judicial role intact, and would require conveyance to meet Trust standards for safe transporting of patients, control-and-restraint and health-and-safety (effectively requiring them to make their own nurse-staffed transport arrangements rather than relying on police and paramedics.)
However, our proposals didn’t attract much support from ASWs. I think there were probably several reasons – the ASWs at the time were more exercised at the possibility of the nurses taking over (and I had to agree that if the job was made easier they were more likely to want to do it); the majority of ASWs were long-serving, within sight of retirement (almost 50% over 50) and not interested in radical change; and the role, and the ability to master the difficulties associated with performing it, were seen as a major source of status for social workers who were increasingly in a minority in multi-disciplinary teams based in Trusts. In other words, whilst ASWs were complaining loudly that the pin was hurting, they didn’t actually want to stop sitting on it.
In addition, there was virtually no interest from the employers. This wasn’t because they were happy with the situation, but that it simply didn’t register on their radar. When the Parliamentary process started we tried to engage with the ADSS, and I assumed that they would already have been talking to the DoH officials about the Bill. Not at all – they wanted to know who our contacts were as they hadn’t got any, and thereafter, whilst they didn’t object to anything we were putting forward they did virtually nothing to help, even though between them the ADSS and LGA had a formidable Parliamentary machine. It became clear that, although the local authorities were very interested in mental health from the commissioning standpoint, the majority had little interest in their ASW service or workforce, which many of them would have been happy to hand over to the Trusts (and it seemed likely at the time that that would happen in any event, so it wouldn’t be their problem) and they weren’t prepared to do anything which might compromise their relations with the government or the NHS on the commissioning issues.
Nevertheless, I was able to persuade the National ASW Leads Network to support an amendment to Section 6 to make the Trust responsible for conveyance. The initial debate on the amendment is in Hansard at HL Committee, 17th Jan 2007, Columns 673-680 Amendment 33, and there was a further and longer debate in the H of C Committee, when Anne Coffey reintroduced it in a modified form, backed by a substantial amount of new evidence from Claire Barcham and the Leads Network ( HC Committee (Mental Health Bill-Lords) 15th May 2007 Columns 427-431 new clauses 18 and 19.) Attached to the HC papers are memoranda from BASW and the Leads Network.
The government, however, refused to accept it, saying that the problems could be addressed via guidance on local protocols. These haven’t worked, as I didn’t for a moment think they would, and I think the arguments we put forward then are still valid and indeed have been strengthened by the passage of time. If the current generation of AMHPs really does want to get off the pin, and their employers have accepted, as many now seem to, that they have a long-term responsibility for the AMHP service and are prepared to do something to help their staff, it would be possible to resurrect this proposal. The government will no doubt, as governments always do, come up with 1001 good reasons why it can’t be done, but it should be noted that Earl Howe, who proposed the amendment in the Lords on our behalf, is now a junior minister in the DoH.
I’m afraid I won’t be able to join in the online discussion on October 15th, but I hope something useful comes out of it. This is a problem which has been allowed to go on for far, far too long.