By Nick Perry, AMHP and visiting lecturer
In February 2023, Community Care reported concerns from the Approved Mental Health Professionals (AMHP) Leads Network about the risks to people in crisis from severe delays to Mental Health Act (MHA) assessments, on the back of rising demand since the Covid-19 pandemic.As someone working full-time in a dedicated local authority AMHP team, this was a picture I recognised. My own MHA assessment numbers skyrocketed from 94 assessments in 2019, to 179 in 2020, coming back down to 159 in 2021 and 135 in 2022.
I can also attest to the network’s observations regarding the difficulties accessing beds, doctors and transport, and generally delivering on the least restrictive option principle set out in the MHA code of practice.
'A system more stretched than ever'
Citizens in mental health crisis face a system more stretched than ever and the pressures are also taking their toll on the AMHP workforce.Back in September 2022, Community Care reported that AMHP numbers had decreased by 3% from 2020-22, amid long-term retention issues arising from an ageing workforce and a lack of take-up from professions other than social work.
I am 47 this summer. I started warranted AMHP practice when I was 31, having been qualified as a social worker for five years prior to that. My retirement age is projected (at the moment in any case) to be 67. I cannot see myself being able to work for another 20 years in this role, given the increased intensity and emotional impact of the work.
What has sustained me in my AMHP practice over the past few years is undertaking more therapeutic training, and bringing this perspective to bear on my work. With resources so stretched, giving AMHPs the skills to make the best use of their client contact is hugely important to their resilience.
This isn’t only my view. Research with child protection practitioners in Tenerife found how a solution-focused approach could help protect workers from burnout (Beyebach & Medina, 2014).
New standards - and opportunities - for AMHP training
Last year, Social Work England consulted on revising the approval standards for AMHP training courses, publishing finalised standards in November 2022. At the time, it said it would “prepare supporting guidance to give more detail about how course providers can demonstrate that they meet the standards”.It is not yet clear whether the guidance will make recommendations on course content - but what an opportunity to do so?
Not only could this help AMHP training programmes provide trainees with specialist legal expertise in relation to the MHA, and a solid knowledge base on mental disorder. It could also help them deliver the therapeutic training that will enable AMHPs to make best use of pre-assessment contact; to keep assessments firmly focused on the client’s best hopes, and to deliver as anti-oppressive an experience of the MHA assessment process as possible.
At the turn of the year, David Watson, a teaching colleague from the AMHP training programme at Brighton University, and I had an article published in the Journal of Ethics & Social Welfare – Solution-focused practice and the role of the approved mental health professional.
Benefits of solution-focused practice
The main contention of this article was that learning the techniques of solution-focused practice could assist AMHPs to deliver least restrictive (and least oppressive) outcomes and experiences, and that these skills should be a mainstay of the training and the CPD of AMHPs in England and Wales.The article highlights some of the key questions and techniques of the solution-focused approach, such as asking the client about their best hopes going forward, and what might be the tiny signs of moving in the right direction. It then shows how these can be applied in an AMHP’s pre-assessment contact with a client, via a case study example
It seems to me that with the Social Work England guidance to come, and a bill to reform the MHA expected before the next election, due in last 2024, we are at a moment of real opportunity.
There is the possibility of making serious and important decisions to invest in the education, therapeutic skills and future resilience of our AMHP colleagues to come.
As a follow up to our article I have begun to collate views from AMHPs across the country on some of these issues. It seems clear from the headline responses that there is much support for more focus within AMHP qualifying (and ongoing) training on the pre-assessment contact with clients, and the possible benefits that this can bring, not only in respect of assessment outcomes and person-centred practice, but also in respect of AMHP wellbeing and retention.
