Approved Mental Health Professionals (AMHP) play an important role in the statutory procedures for assessment under the Mental Health Act 2007. They are intended to provide a counterbalance to the medical model of care represented by medical practitioners’ role in the process.
CQC report on AHMP services
The CQC has published a report in relation to the running of AMHP services. A marked 40% increase in sectioning per year (2005/06 – 2015/16) and 33% increase in applications for Deprivation of Liberty Safeguards (DoLS) during 2016/17, has led to increased pressure faced by AMHPs.
As AMHPs are authorised by their respective local authority, there are no set governance processes on how these services are run. Monitoring has raised concerns about how they function, and the wide levels of variation in service provision across the country.
What the CQC found
A combination of data review, site visits and engagement activities undertaken by the CQC this year found various factors supporting the effective delivery of AMHP services, and current challenges and barriers to the AMHP role:
- Acute care system capacity – A nationwide reduction in beds affects the ability of AMHPs to complete assessments on time, and the lack of accessibility has meant premature discharge and repeat admissions for patients. Alternative pathways such as police support services, and voluntary sector arrangement have had to be utilised.
- Workforce – The recruitment and retaining of AMHPs by local authorities has been problematic. It was found that the role was seen to be unattractive to new social workers, and there have been calls for a national register and concurrent national AMHP job description. One reason cited for the decreasing recruitment was the lack of financial incentive for other professions taking on the role, due to the financial disparity between local authority rates of pay and NHS rates of pay.
- Variation in health and social care integration – Both good and bad use of section 75 agreements have been reported. These are the legal agreements between the mental health trust and local authority made under section 75 National Health Service Act 2006. Withdrawing these agreements has led to trust staff feeling a lack of integration in the community team, and the beginnings of a post-code lottery for access to services.
- Mental health commissioning – Calls for the integration and joint planning of health and social care commissioning have arisen due to the limited access to low level prevention resources and limited funding which is available. Focus groups have pointed out that the system is reactive rather than proactive, and as such requires further support and resources.
The CQC’s report is likely to be used as an informative resource for representatives and the government-commissioned panel tasked with carrying out a review into the Mental Health Act and the causes of the rising use of detention and over-representation of BAME groups who are being detained.
The report cites a number of good practice examples from the site visits that the CQC carried out. It helpfully highlights the following models which can be used in further consultation and planning into how the system is run:
- AMHPs covering emergency duty team work without carrying a caseload, and investment in creating further posts to release AMHPs from the community mental health team where they are carrying a caseload (Greater Manchester Mental Health NHS Foundation Trust)
- Setting up the MHARS (Mental Health Acute Response Service) in Gloucestershire and Herefordshire has vastly improved the response for people experiencing crisis, with a response being able to be offered in one hour. Calls are triaged and forwarded onto the relevant people, via a police control room, with a rota of crisis staff (2gether NHS Foundation Trust)