AMHPs and Stress

Dolly Stressed Out!

Back in January, Zarathustra posted a link to a survey for AMHPs on stress and burnout. This was for a piece of research being conducted by Janine Hudson, an  AMHP studying for an MSc in Mental Health Social Work at King’s College, London.

AMHPs are Approved Mental Health Professionals who, according to Wikipedia are ‘trained to implement coercive elements of the Mental Health Act (1983) as amended 2007’ so we (because I am one myself) make decisions with requisite recommendations from medical professionals, about whether someone needs to be admitted to hospital and treated without their consent. There are other roles for example in relation to Guardianship and Community Treatment Orders and certain tasks that are reserved for AMHPs legally but we have specific training around Mental Health Legislation and the implementation of it.  It is a role which does demand particular expertise, sensitivity, compassion and intellectual rigour to conduct well.

Janine and Dr Martin Webber who co-authored the study were  generous enough to share with us here (AMHP Survey 2012)  and while I am not entirely surprised by her results, I was saddened that my own gut impressions seemed to be more than just gut impressions.

Over 500 AMHPs responded to the survey and as many as 43% met the threshold for ‘common mental disorder such as stress and anxiety’. The threshold for burnout was much lower but it does raise the question about the amount of support and consideration given to practising within this particular role in local authorities in particular – whose responsibility warranting them (us) remains – but also within employing NHS Trusts. One of the aims of the study was to determine any differential in stress levels experienced by social work AMHPs and non-social work AMHPs but the findings were that there were still very few non-social work AMHPs and there was little differential. Locally, I know that there have been some issues around funding of non-social work AMHPs as it is a duty of the local authorities to provide sufficient AMHPs and as money is stretched, NHS Trusts have seemingly been less keen on sending people to train for a significant period.  It will be interesting to see how that picks up over the years but as the purpose of extending the role to non-social workers in the first place (we used to be Approved Social Workers and it was a reserved role which only social workers could take) was that there were too few AMHPs, it seems that issue hasn’t really resolved itself fully yet, four years after the switch.

71 AMHPs responded that the work as an AMHP had not had an impact on their non-AMHP role, however most of those worked in dedicated AMHP services because for the rest, the issue of managing AMHP and non-AMHP tasks with no workload concession, an increase in unpaid hours and pressure of work were contributing factors to increased stress.

I have certainly found personally that the AMHP work I carry out encroaches substantially on my ‘regular’ work as the amount increases. I am sometimes called out at very short notice to carry out assessments and these assessments take priority over all the other work I do due to the urgency and statutory nature of the tasks.  I have missed and moved visits at short notice and I can’t use any excuses to service users I work with (because obviously I can’t discuss my other work with them) so I apologise profusely and humbly but my stats aren’t as good as my colleagues in the same team and this is challenged. It is an additional pressure but any mention of removing some of my caseload responsibilities are met with a sad and sympathetic sigh. It’s just not happening!

Sadly familiar too, were some of the difficulties raised in terms of working and organising assessments across different services particularly as resources are stretched. Availability of ambulances, doctors and police are all  factors  in trying to manage and organise an assessment and certainly a factor that I recognise however the overriding issue was one of a lack of available beds.

Personally, I have found this to be much more acute as a issue over the last year and is getting increasingly worse. It isn’t wholly unrelated to the local Trust closing down wards to ‘save money’ however it has led to a massive increase in the provision of private beds at higher cost and further distance. This is the kind of ‘strategic decision’ that makes you wonder about the way snap decisions were made.

The impact on the patient is significant but it is also increasing stress levels in members of staff.

Generally, the research study indicates that AMHPs broadly feel unsupported in the role – except (perhaps unsurprisingly) by other AMHPs but in terms of management support/supervision/debriefing, it can vary significantly.

The report concludes that employers should do more to recognise the important and often difficult role that AMHPs take and reward with workload relief and a pay differential that acknowledges how much other professionals are paid for the work too.

My thoughts on reading this survey are that I’m unsurprised. I think it’s hard to explain to someone who is not involved in the role what exactly it entails but there is an enormous amount of responsibility taken  by the AMHP and it does feel to me, personally, that this is not appreciated or understood by my employing organisation. I wonder if there is a general awareness of some of the stresses that can be placed on an AMHP (and I’m absolutely sure every AMHP has been in this situation) when there is a great deal of distress after a decision to admit has been taken and the doctors have gone and we are waiting for the ambulance – maybe with the police, maybe not – but there’s a great deal of responsibility being handed to the AMHP at that point. It’s important that we are given substantial support.

My best support has definitely come from other AMHPs.

Saying that, while I won’t ever say I enjoy the role because depriving someone of their liberty is a very difficult, challenging and distressing process – the learning that I have done as a part of being an AMHP  has been significant – in terms of my understanding of mental illness and in terms of my practical application of the Mental Health Act, Human Rights Act and Mental Capacity Act.

Being an AMHP has made me a better social worker without any doubt and being an AMHP has and does make me reflect constantly on what the ‘system’ does and doesn’t do to those who come through it – and my role within that system.

However benefiting from the knowledge doesn’t mean that we shouldn’t get greater support for the role. That’s clear from this report and thanks to Janine for sharing her research with us. I hope that it will be disseminated widely to all local authorities who engage AMHPs and if you are an AMHP or know one, take it to your next forum meeting and discuss it.

In order to care and plan best for others, we really do need to look after ourselves and our own mental wellbeing.

photo by kelvin255 @ flickr