AMHP workforce faces squeeze with third over 55, warnings over lack of trainees and increased workload

The approved mental health professional (AMHP)  workforce faces a significant squeeze, with one-third aged 55 or over, government reforms heralding a need for increased numbers and warnings over a lack of trainees.

In a government-commissioned workforce briefing, published this week, Skills for Care estimated that of the 3,900 AMHPs in England in 2020, 33% were over 55, compared with 23% of all social workers.

The findings come at a time when government reforms to the Mental Health Act suggest the AMHP workforce would need to grow by 7% above current estimates by 2023-24. In addition, AMHPs are due to take on a new role in May referring people in mental health crisis treatment to have a moratorium placed on certain debts while their treatment continues.

However, AMHP leads network lead Steve Chamberlain warned that local authorities and NHS trusts were struggling to put practitioners forward for training because of the challenge of backfilling their roles.

The data revealed the AMHP workforce had grown by 1% since 2019, from 3,850 to 3,900. Last year’s briefing estimated the workforce had shrunk by 4% since 2018, but Skills for Care has now determined this to be incorrect and estimated it had decreased by just 1%.

Similarly to 2019, the 2020 briefing showed that 65% of AMHPs combined their role with another and 11% were not primarily working as an AMHP or regularly on the AMHP rota. Just 24% of AMHPs solely performed that role.

Ageing workforce ‘a constant anxiety’

Chamberlain said while the data around the ageing workforce was not surprising, it was a “constant anxiety to a certain extent”.

He said it was inherently challenging to train AMHPs as they required two years of post-qualifying experience, while training courses then ranged from six months full-time to one-two years part-time.

However, he added that employers were increasingly struggling to send people on training because of the challenge of backfilling their roles.

“If you release staff for a major piece of training, who’s going to take on their work? Once upon a time you were backfilled routinely, now you aren’t and a lot of places will only release one person per year for training for example, so that struggles to maintain the numbers,” he said.

Chamberlain added: “If you want to increase numbers you’re going to have to send a group of people, which will increase pressure on the whole service because they are going to be away for their day-to-day work for three or four months.”

The Skills for Care briefing highlighted the challenge of recruiting AMHPs from the other eligible professions – nursing, occupational therapy and psychology – with social workers accounting for 95% of staff performing the role.

Another challenge highlighted by the research was that the pay premium for social workers in being an AMHP had declined, from £3,500 in 2018 to £2,700 in 2020.

Demand ‘constantly increasing’

While Chamberlain said it was positive the AMHP workforce wasn’t shrinking, as previously thought, demand was “constantly increasing”, an issue exacerbated by the pandemic, which had affected both the numbers of AMHPs available and the scale of demand.

He said the other concern was the potential changes to the Mental Health Act, currently out for consultation, which could see the AMHP role expanded.

The White Paper proposals would involve an increased workload for AMHPs, particularly through more involvement in renewals of community treatment orders, and also moots a new role for AMHPs in managing transfers of people from prisons or immigration removal centres to hospitals.

The impact assessment on the White Paper states that, by 2023-24, the full-time equivalent AMHP workforce would need to grow by 7% above current projections to take on their proposed responsibilities, excluding the suggested prison transfer role.

AMHPs are already due to take on a new role later this year, assessing people receiving mental health crisis services who are in debt so they can gain access to a freeze on their debt repayments and any enforcement action for the duration of their treatment plus a month.

‘Even greater pressure’

“Local authorities are already struggling in terms of staffing and responding to demand is going to be an even greater pressure,” Chamberlain said.

Under the Mental Health Act code of practice, local authorities are required to ensure that sufficient numbers of AMHPs are available to carry out their roles under the act.

The government’s 2019 national workforce plan for AMHPs stated that councils should monitor, among other issues:

  • the number of AMHPs required to provide a service across 24 hours;
  • the workforce and succession planning needed to ensure the ongoing sufficiency of AMHPs;
  • the pressures on the AMHP role, including out of hours;
  • regional differences in pay or conditions affecting recruitment or retention.

It also said that Social Work England, which is responsibility for monitoring AMHP training, should “consider the reform and development of AMHP training courses to ensure improved accessibility whilst quality is maintained”.