Whose job is it anyway?

Mental Health Nursing,  Jul 2006  by Jones, Steve,  Williams, Barry,  Bayliss, Mark

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The proposed Mental Health Bill (Department of Health 2004) has finally been dropped in favour of an amendment Act to the existing Mental Health Act 1983 (Department of Health 1983). In addition to the challenges via the Human Rights Act 1998 (Department of Health 1998) that are required to ensure compatibility with the current legislation, the government intend to widen the applicant workforce from the current Approved Social Worker (ASW) to include other professionals. We propose that planning and action is presently required in the preparation of the emerging role of the Approved Mental Health Professional (AMHP). This article will explore the current position of the ASW role, examine the proposed role of the AMHP, and propose ways to address the needs of all professional groups so that ground can be gained in anticipation. The authors' experience - historically - has been that differing professions have been slow to respond to the practice implications of introduced legislation. This paper will also endeavour to contrast the current role of the ASW with those of the target contenders for the AMHP role: nurses, social workers, occupational therapists or other professionals, and explore the challenges faced by all disciplines in the emergence of this new generic role.

Introduction

The proposed Mental Health Bill (Department of Health 2004) has fuelled concerns from service-user groups and professional organisations due to its complexity, as evidenced by the sheer volume of written and verbal representations to the Parliamentary Scrutiny Committee (House of Lords/House of Commons, Joint Committee on the Draft Mental Health Bill 2005). The health minister, Rosie Winterton, has finally decided to cancel the 2004 Bill (Department of Health 2004) and replace it with an amendment Bill to update the current Mental Health Act 1983 (Department of Health 1983). The amendment Bill is likely to 'expand the skill base of professionals' in addition to ensuring compatibility following successful challenges via the Human Rights Act 1998 (Department of Health 1998) and, inter alia, introduce community treatment orders and widen the definition of mental disorder.

The 2004 Bill (Department of Health 2004) set out the contemporary role of the Approved Mental Health Practitioner (AMHP), which would have replaced the current responsibilities of both applicants identified in the Mental Health Act 1983 (Department of Health 1983) ,namely the Approved Social Worker (ASW) and Nearest Relative (NR). It is, in the authors' view, likely, that the AMHP role will be largely unchanged in the amendment Act. However the current role and responsibilities of the NR will have to be expanded to include displacement by the patient, to ensure compatibility with the Human Rights Act 1998 following cases such as JT v United Kingdom (2000) and R v Secretary of State for Health (2003).

The role of the ASW has developed from the previous Act's equivalent (Department of Health 1959), namely the Mental Welfare Officer, which required no specialist skills or training. The British Association of Social Workers (BASW), when developing the new role, was keen not to reconstruct the medical model but rather one founded on a welfarist perspective (Bartlett and Sandland 2003).

Workforce

The introduction of the AMHP as a generic practitioner, historically the sole domain of the social work profession, has been argued as being in direct response to an ageing and depleting workforce.

Increasing pressures of statutory duties and the consequent impact on routine work, the emergence of specialist roles within mental health services, access to management positions and the availability of severance and redundancy opportunities, have all contributed to the falling numbers of social workers operating as the ASW.

BASW estimate there are approximately 4500 ASWs in England and Wales, some 900 of which are effectively non-practising since they are no longer in front-line mental health work, and as about 30 per cent are currently over 50 years of age, a further 900 are expected to retire or to move to less stressful work when the revised legislation comes into force.

Huxley et al (2005) cite earlier research by Hatfield and Robinshaw (1994) that only about 40 per cent of assessments lead to compulsory admissions and argue that this 'hidden demand factor' has been ignored in recent estimate accounts for additional staff to implement proposed changes to the role of the AMHP.

The depletion of the ASW workforce, of which the trend is expected to continue, means that the role of the ASW cannot be sustained by social work staff alone as there are presently barely enough ASWs to operate under the present Mental Health Act (Department of Health 1983).

Concerns that the plurality of the AMHP will undermine the core value base and social work perspective of mental distress will, by necessity, be overridden by the essential requirement for trained staff to undertake the role. When considering the current and future shortfalls in approved practitioners it is necessary to consider the workforce implications and establish strategies to meet the demands of the AMHP role.