AMHPs lack time for ‘extremely important’ pre-assessment work with people in crisis, finds survey

Approved mental health professionals (AMHPs) lack time to carry out “extremely important” pre-assessment work that would likely improve outcomes for people in mental health crisis.

That was among the findings from a recent survey of 118 AMHPs – the vast majority still in practice – in relation to working with people prior to an assessment of whether the person should be detained under the Mental Health Act 1983.

While the AMHP role involves assessing whether people meet the criteria for detention under the MHA and this is necessary for their treatment, they are also required to “consider the patient’s case” on behalf of the relevant council.

Practitioners see this as involving work prior to assessment that could support less restrictive alternatives to the person being sectioned.

Howver, there are longstanding concerns that this frequently gets squeezed out because of the severe pressures on services.

This was borne out in the results of the survey, carried out by Nick Perry, an AMHP from East Sussex council and visiting lecturer on the AMHP training course at Brighton University.

AMHPs lack time for ‘extremely important’ work

Almost nine in 10 said pre-assessment contact was ‘extremely important’ (45%) or ‘somewhat important (43%) in building rapport with people due to be assessed under the MHA, while 70% said a pre-assessment interview was likely to help improve outcomes.

However, just 18% of those currently practising said they had enough time to devote to pre-assessment interviews, with 43% saying they rarely had any time and 39% that they had a small amount of time.

The AMHP Leads Network said the research highlighted the value of practitioners’ consideration role under section 13(1), which it described as “the foundation for good AMHP practice”, and “an essential component of the prevention work AMHPs are dedicated to providing”.

“Pre-interview contact with the individual, their family, carers and any other support staff forms one part of a quality consideration,” it said.

“This is alongside a range of other work such as a review of records, risk assessments and an interrogation of the information provided using a social and human rights perspective to ensure the context of the crisis is considered in order to reveal alternative ways to manage it.”

While data was not collected nationally on the impact of consideration work, areas that had analysed it had found that it prevented about 20% of referrals progressing to the assessment stage, the network added.

Practitioners ‘stretched beyond capacity’

However, it warned: “AMHPs up and down the country are stretched beyond capacity and report having little time to dedicate to consideration, as well as other essential preventative work such as availability for professional consultation, attendance at multi-agency reviews and forums and service development work.”

The network’s concerns follow warnings it issued earlier this year of “severe” delays to MHA assessments, due to a lack of beds, doctors and transport.

It said these were increasing risks to people in crisis and their families, and putting added pressures on AMHP workloads, because they often had to spend hours waiting with people – in homes, police stations and A&E departments – for other services.

This is against the backdrop of a 3% fall in the size of the AMHP workforce from 2020-22.

The network called for action from all those involved with Mental Health Act services to build capacity so that AMHPs could “offer their expertise to the whole system, not simply to be available for the making of applications”.

Enhancing AMHP training courses

Perry’s survey also focused on how far AMHP training courses provided practitioners with the skills to carry out pre-assessment work. It found that:

• 74% of respondents believed pre-assessment interviews could be put to more therapeutic effect if there was more focus on them in training courses.
• While 23% felt courses equipped AMHPs for pre-assessment contact ‘very effectively’ or ‘somewhat effectively’, 53% said they did so ‘not very effectively’ or ‘not at all effectively’.
• 27% felt that providing additional training in this area would ‘definitely’ have a positive impact on AMHP wellbeing and retention, with 31% saying this was ‘quite likely’ to be the case.

The research is designed to help shape forthcoming Social Work England guidance for AMHP education providers on meeting the regulator’s standards for courses, which were agreed last year, specifically standard 3 on course curricula.

This states, among other things, that courses should be designed in accordance with the principles of anti-discriminatory, anti-oppressive or anti-racist practice, with content updated in line with research, best practice, policy and legislation, with the purpose of enabling students to “demonstrate an evidence-informed approach”.

Promoting therapeutic approaches

Perry carried out the survey after co-authoring an article* on the value of AMHPs using solution-focused, therapeutic approaches in identifying less restrictive options to detention with people in crisis.

He said he wanted to ensure that the “development of therapeutic intervention skills forms part of the offer from AMHP training programmes, as well as in the ongoing CPD of warranted AMHPs”, though the latter is outside the remit of Social Work England’s standards.

It is not clear how far Social Work England will go in specifying course content, but the regulator said it welcomed the research and would consider it in developing the guidance.

*The article, Solution-focused practice and the role of the approved mental health professional, was co-authored by David Watson, principal lecturer at Brighton University, and published in the Journal of Ethics and Social Welfare (Taylor & Francis).