Research shows significant spike in mental distress and the effects on AMHP services

New research commissioned by BASW England and the Department of Health and Social Care reveals a significant increase in people accessing mental health services during the first lockdown.

The Impact of Covid-19 on AMHP services survey is the first to provide significant information on the role of Approved Mental Health Professionals (AMHP) during the pandemic and the changing pressures on the service.

Around three-quarters of England’s local authorities were surveyed, with 96% of them reporting an increase in number of first-time presentations of people suffering mental distress/ill-health who had not been previously known to mental health services.

Steve Chamberlain, Chair of AMHP Leads Network and author of the report, said: “The reality is that AMHPs only see people who are in a mental health crisis – most people don’t reach that point.

“Therefore, the increase in those numbers strongly suggests that this is just the tip of the iceberg and that the pandemic has caused considerable mental distress for a great many people.”

The survey also asked a variety of questions regarding changes in demand for Mental Health Act (MHA) assessments both during the first lockdown and following the easing of restrictions, the possible reasons for the changes and the impact of the pandemic and the resulting restrictions on staff.

Feedback from over 100 AMHPs revealed an increase of MHA assessments during the lockdown period and into the post-lockdown period in summer, amounting to a higher level of demand than prior to the pandemic.

The survey found that since lockdown eased at the end of July, 60% of respondents said the level of demand for mental health services was above pre lockdown levels, while 28% said they returned to the same levels.

Another major finding was the mixed picture regarding the use of s136 – where a person can be detained for safety reasons – during the lockdown period. Approximately 60% of respondents identified a change, but almost 40% of those reported a reduction, with the rest identifying an increase.

There was significant level of concern expressed from AMHP respondents that withdrawal of face-to-face visits and monitoring by community services, and reduction of contact to telephone only, led to requests for MHA assessments which would not otherwise have been made and which did not warrant consideration of detention in hospital.

Responding to the survey, an AMHP said “[I] do not feel remote MHAA assessments are appropriate given the magnitude of the potential outcome”

Among many recommendations for the ongoing handling of the pandemic and any future virus-related pandemics is better understanding of the AMHP role, especially regarding PPE.

Many respondents highlighted the ineffectiveness of wearing masks in a role working with people potentially suffering from a range of serious mental illnesses, where face to face communication is vital.

The use of see-through face masks or reusable face shields was mentioned to address the concerns over the impact of PPE on the assessment process.

“Given that AMHPs across the country were one of the few front line staff continuing to work face to face, it would have been helpful if that role had been recognised in PPE guidance as none of it seemed to cover the unique sort of role AMHPs have,” said one AMHP.

Joint-Chief Social Worker for England, Mark Harvey, said: “AMHPs have carried on with face to face interactions with people in mental health crisis and they have adapted to the challenges experienced by partner agencies while also dealing with a rise in requests for mental health act assessments – including people new to mental health services. This report will help government, local authorities and NHS colleagues to work together to improve support for AMHP services and implement lessons learnt from pandemic.”

Maris Stratulis, BASW England national director, said: “AMHPs have played a pivotal role throughout the pandemic and have worked incredibly hard to maintain and deliver essential services to people experiencing distress and mental health crisis.

“We need to consider if and why AMHP services were fulfilling a function normally undertaken by community mental health services and question inequalities of access to support services and the impact of PPE and health and safety of the workforce.
“We look forward to working in partnership with AMHPs, people with lived experience, DHSC and other key partners in taking forward the report recommendations.”