Reductions in Mental Health Act (MHA) detention numbers are masking increased demand for approved mental health professionals' (AMHPs) services and unmet need for care.
That was the warning from the AMHP Leads Network after official data showed that MHA detention numbers in England fell by 7.7% on a like-for-like basis from 2021-22 to 2022-23, following a 5.7% drop the year before.
In the vast majority of those cases, an AMHP - who is typically a social worker - will have made an application, with the recommendation of two doctors, for the person to be detained following an assessment.
Increased demand for AMHP services
However, though detention numbers have fallen, the network said AMHP services were reporting increased demand year on year.Under section 13 of the MHA, councils must engage an AMHP to consider a person's case if it has reason to believe that an application may need to be made to detain them in hospital or take them into guardianship.
Network co-chair Christina Cheney said the number of such section 13 requests for consideration was growing. This appeared related to "significant pressures on all community and crisis mental health services who, unable to meet demand themselves, will often refer on for assessment by an AMHP".
AMHPs, she added, were "rising to the challenge" of finding alternatives to detention for people in crisis by mobilising the support structures around them. However, this work was not being captured by the official figures, published by NHS England, she warned.
Lack of beds 'preventing necessary detentions'
A second issue was that AMHPs were finding it harder to admit people to hospital when detention was necessary "for sheer lack of beds", leaving significant unmet need, she added."While AMHPs work hard to prevent detention being the outcome of an assessment, they report that frequently when it is the only safe option, it often is not possible because no bed is available," said Cheney.
"In these circumstances, people are often left at risk, admitted to acute hospital or held for long periods in A&E, police custody or at home."
Concerns echoed by ADASS and NHS leaders
The network's concerns were echoed by the Association of Adult Social Services (ADASS) and the NHS Confederation's Mental Health Network, which represents sector providers and commissioners.“AMHPs do a great deal of work finding solutions to meet our needs, protecting our rights and ensuring that we are only detained when we are acutely mentally ill if necessary, which has in part led to this reduction," said ADASS's joint chief executive, Cathie Williams.
“But there is a growing need for support for mental illness and it’s hard to see that the lack of availability of local, specialist acute hospital care isn’t impacting on social work and health professional decision making."
Meanwhile, Mental Health Network chief executive Sean Duggan said: “Mental health leaders will be cautious about celebrating a drop in detention as these are actually likely to hide a level of unmet need due to the sector facing huge increases in demand since the pandemic against little additional funding."Calls for better AMHP data
All three bodies called for data to be collected on demand for AMHP services and on practitioners' activity, in order to improve planning of mental health provision.Cheney said: "In order to learn more about trends in mental health need and our services response to it, we must gain a full picture of the work going on under the Mental Health Act, not just a record of times when detention has been used – this is less than half the picture.
"The network is working to support proposals to develop and implement a national AMHP data set and we need support from government to ensure this is achieved."
This was echoed by Duggan, who added: “To more accurately gauge the level of demand services are facing across different parts of the system we would need wider data to show the number of requests for detention made by approved mental health professionals (AMHP)."
Williams said that ADASS was "actively working with Department of Health and Social Care colleagues in the hope that this ‘missing data’ can be made available at a local and national level in the future".
30% workforce gap
The calls come with the AMHP workforce in England having remained stable since 2018, with between 3,800 and 3,900 practitioners in post, according to successive surveys of local authorities carried out by Skills for Care.However, in its 2023 survey, the workforce development body found that councils would need to increase the number of full-time equivalent AMHPs by 30% to fully staff their services.
There are also concerns about the impact on health and social care services of a new national policy for the police to only attend mental health incidents when there is a suspected crime or significant safety risk.
The AMHP Leads Network, charity Mind, the Local Government Association and the Royal College of Psychiatrists are among those to have voiced concerns that Right Care, Right Person is being implemented too quickly for mental health services to respond to the ensuing increase in demand.
