Care Quality Commission
Wide variation uncovered in how NHS and local authorities work together when applying the Mental Health Act
People might not be getting the specialist mental healthcare they need and when they need it most because of disparity in how approved mental health professional services are provided across the country.
Approved mental health professionals (AMHPs) are typically social workers who work on behalf of local authorities to – amongst delivering other responsibilities – assess people to decide whether or not applications should be made to detain them under the Mental Health Act following medical recommendation.
AMHPs play a vital role in ensuring that people are detained in hospital only when there is no other option. Where possible, they help to identify alternatives to people being legally detained under the Act so that people do not receive healthcare that is unnecessarily restrictive.
In the ten year period between 2005/06 and 2015/16, the number of detentions under the Mental Health Act increased by 40% – from 45,484 to 63,622. AMHP services would have been involved in considering the majority of these applications.
As part of our commitment to make sure people get safe, high-quality and compassionate mental healthcare and to encourage improvement, we have reviewed how AMHP services are being provided across England.
Yesterday (Tuesday 27 March), we published a briefing paper that sets out our key findings around what is working well and what the barriers are to these services running as well as they should be.
In it, we have concluded that while there are examples of good practice, further work is needed support local AMHP services to deliver their roles effectively. In particular; AMHPs told us that:
- There are difficulties with recruiting and retaining AMHPs.
- In some parts of the country, there are often delays in admitting patients to hospital because mental health beds are fully occupied.
- There is variation in the extent to which health and social care services are integrated and work together.
- They were concerned about limited access to low level prevention resources (e.g. in the community) and limited funding across adult social care commissioned services that might have supported people so that they did not need to be detained or admitted to hospital.
We have shared our paper with the Department of Health and Social Care so that it can inform the ongoing independent review of the Mental Health Act, led by Prof Sir Simon Wessley.
Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said:
“Local authorities, through their approved mental health professional services, have a crucial role to play in working with the NHS to ensure that people with serious mental health problems get the care and support they need. Although this includes ensuring that every attempt is made to find less restrictive alternatives to detaining people in hospital under the Mental Health Act, it also means being able to admit a person promptly when that is in their best interests.
“We have found that where AMHP services work well, they are underpinned by good leadership, that their role and contribution is recognised locally, and that there is solid partnership working across the system which allows innovative practice to be shared.
“Also, AMHPs we spoke to told us that particular forms of community provision can sometimes prevent the need to detain a person in hospital under the Mental Health Act. These alternatives to admission include intensive support to the person in their own home, or in another safe place, and in crisis cafes.
“However, not all parts of the country achieve this vision of integrated care that minimises the restrictions placed on people with severe mental health problems, while ensuring they can be admitted to hospital promptly when this is unavoidable. The barriers include reduced bed capacity in specialist services, difficulties in recruiting and retaining AMHPs, variation in how health and social care providers and commissioners integrate across areas and the unavailability of services that might provide an alternative to admission.
“The Government’s independent review of mental health legislation that is being led by Prof Simon Wessley is a ‘once in a generation’ opportunity to get to the bottom of the concerns we have raised about the use of the Mental Health Act and in particular, the ongoing rise in detentions. The role of AMHPs will be very important in understanding and addressing this.”
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