Recruitment of Approved Mental Health Practitioners (AMHPs)

Recruitment of Approved Mental Health Practitioners (AMHPs) Lead Executive Author with contact details Responsible Committee/Sub Committee Document approved by & date: Document consultation: Patient and Public Involvement (outline any PPI input into policy and associated impact on service users and carers) What type of document is this (delete as appropriate) Document applicable to (Identify by location and staff groups): If new document, reason for development: Synopsis outlining document aims: Code: MH22 Issue number: 1 Chief Operating Officer Workforce Development Manager/ASW programme Co-ordinator and Workforce Planning and Information Manager Mental Health Act Task & Finish Group Clinical Standards Sub Committee Mental Health Act Task & Finish Group, Clinical Standards Sub Committee, Staff Side, LNC No involvement from PPI other than ex service user representation on MHA Task & Finish Group Policy All services in Health and Social Care responsible for the provision of the AMHP role Mental Health Act 2007 Implementation Date: November 2008 How will the implementation of this document be monitored and reviewed Review Date (default 2 years 1 ): November 2009 Document to be read In conjunction with: Financial resource implications of this document and how these are going to be addressed: Is this document carried out wholly or in part by contractors, or organisations with which the Trust has a service level agreement, and if so state the relevant contractor To assist staff in their duty to work within the Mental Health Act legislation when involved in recruitment of approved Mental Health Practitioners (AMHPs). Monitored and reviewed through the Mental Health Act Network Group, members of which are representatives from Wirral and Cheshire social services. Other MHA policies, Code of Practice (including Code of Practice for Wales where relevant), MHA Guide, Secondary Legislation specifically The Mental Health (Approved Mental Health Professionals) (Approval) (England) Regulations 2008 and GSCC guidance Cheshire Social Services, Wirral Social Services 1 Check with Clinical Governance/Risk Manager to ensure that there is not an external requirement that determines review date Workforce Planning and Information Manager Page 1 of 13 9 January 2009

Document Change History (changes from previous issues of policy (if appropriate) : Issue Number Page Changes made with rationale and impact on practice Date Workforce Planning and Information Manager Page 2 of 13 9 January 2009

CONTENTS SECTION SECTION HEADING PAGE 1 Introduction / background 4 2 Approved mental health practitioners: changes to the new role 5 3 Local Social Services authorities responsibilities 5 4 S75 agreements 8 5 Individual contracts with AMHPS 9 6 Responsibilities for the AMHP service within LSSAS 9 7 Supplementary information 9 8 Appendices Appendix 1 - Training needs analysis Appendix 2 - Equality & diversity / human rights impact assessment 10 12 Workforce Planning and Information Manager Page 3 of 13 9 January 2009

1. Introduction / background The Mental Health Act 2007, which received Royal Assent in July 2007, further developed the Mental Health Act of 1983. Some amendments have been implemented already. The Department of Health has not yet announced a commencement date for the introduction of new professional roles, but advise that for planning purposes implementation on 3 rd November 2008 can be assumed. Councils with Social Services Responsibilities have a range of statutory responsibilities in relation to this Act. The Act has established new roles and responsibilities for people who work with service users subject to compulsion. It has introduced flexibilities which support the wider modernisation agenda incorporated within the New Ways of Working papers issued by the Department of Health. The flexibilities are associated with two new roles; those of the Responsible Clinician and the Approved Mental Health Professional. The issue of other professionals undertaking the Responsible Clinician role is on the agenda for consideration at a future date but priority is currently given to establishing the new AMHP role. The National Institute for Mental Health in England (NIMHE) will publish detailed guidance for Local Social Service Authorities (LSSAs) regarding Approved Mental Health Professionals. This guidance offers information on: Duties As applicant, the AMHP has the authority to take and convey the person to hospital. (6.1) S/he can authorise others to do this. To inform the Nearest Relative (NR) of the application and of the NR s right to seek the patient s discharge s11 (3). Obligation to consult the NR before making application for treatment under S3, or for Guardianship. AMHP may not progress if the NR objects.s11 (4). AMHP has a duty to make application for admission to hospital or guardianship in respect of a patient within the area of their employing authority; if they are satisfied that such an application ought to be made. S13 (1). AMHP must interview the patient in a suitable manner prior to making an application s13 (2). AMHP may make application outside the area of their local authority s13 (3). If requested by the Nearest Relative, the AMHP must consider the case with a view to making an application for admission to hospital. If the AMHP doesn t make the admission s/he must inform the NR in writing. s13 (4). Transition arrangements Currently, in law, practising Approved Social Workers (ASWs) will automatically become AMHPs on the implementation date. However in line with strong recommendations from CSIP/NIMHE, the local training partnership has agreed that all ASWs from member authorities will undertake 2 days transitional training and completion of the ASW to AMHP workbook. 2 days transitional training is currently being provided May to October 2008 by the Cheshire ASW partnership. Completion of the workbook is to be arranged through more groupings within each local authority partner; Selection processes - Refer to section 3.5; Approval and re-approval processes Refer to section 3.5. Workforce Planning and Information Manager Page 4 of 13 9 January 2009

2. Approved mental health practitioners: changes to the new role The role of the Approved Mental Health Practitioner (AMHP) is very similar to that of the Approved Social Worker (ASW). The AMHP, like the ASW, has a central responsibility for: Co-ordinating the assessment process; Considering the need for admission; Pursuing alternatives to the use of compulsion wherever possible; Whilst working in partnership with other professionals, reaching an independent judgement about whether the use of compulsion is necessary and appropriate; They remain the applicant in the process; LSSAs retain responsibility for ensuring that the service is provided but have new powers in enacting flexibilities enabling other suitable trained and qualified professionals to take on the AMHP role. 3. Local social services authority s responsibilities The primary responsibility of the LSSA is to provide the AMHP service and ensure that there are sufficient AMHPs available in their area to provide access to a 24 hour service. It is good practice for LSSAs to provide AMHP skills and knowledge in a number of places and is responsible for the commissioning of AMHP training. Typically AMHPs will be drawn from: Mental Health Services; Learning Disability Services; Adult Care Older Person/ Physical Disability Services; Child & Adolescent Mental Health Services (CAMHS); Emergency duty services. Whenever an AMHP starts an assessment under the Mental Health Act, or carries out a Best Interest Assessment under the Mental Capacity Act, they will be acting on behalf of the LSSA and will need a contractual relationship with that authority. This is particularly important for AMHPs who are not on the payroll or in the employment of the LSSA on whose behalf they act as an AMHP: Types of Contractual Arrangement. Direct employment with local authority In the initial stages of the implementation the majority of AMHPs in Cheshire and Wirral will continue to be Social Workers employed by the local authority and current contractual arrangements will continue. Substantive employment with a Section 75 (s75) (NHS Act 2006) The local LSSA should ensure that the S75 agreement covers all appropriate issues: Provision of the AMHP service - how the daytime service will be configured. Supervision and support arrangements, including access to senior support from within the LSSA where issues related to conflicts of interest arise. Access to legal advice for those staff carrying out Mental Health Act assessments in their role as AMHPs. Agreement to release staff for initial and refresher AMHP training. If warranting panels are situated within trusts, agreement should be included on how they should work, and the relationship between the recommendations of a warranting panel, and the warranting powers of the LSSA. Workforce Planning and Information Manager Page 5 of 13 9 January 2009

Governance issues and the collection of information on AMHP activity should be detailed. When and how this information should be reviewed should also be considered. Mechanisms should be agreed on how and in what circumstances to highlight/ share urgent feedback on issues of concern regarding the service as a whole. For instance, where significant problems or incidents are arising with the Police and Ambulance Services, mechanisms for keeping the responsible directors aware of the issues should be considered. The LSSA has a responsibility to work with other organizations such as the Police Authority and Primary Care Trust, to resolve significant problems occurring during the admission process. LSSAs retain responsibility for the assessment process up to the point when a person is accepted onto the ward. Remuneration for duties. The LSSA should have an agreement with the individual worker, either honorary contract or Zero Hours contract: Honorary contract where no money is involved, LSSAs and AMHPs may enter into honorary contracts that detail the commitments on both sides. Zero hours contracts where the AMHP will be paid extra per session as and when they undertake duties. A zero hours contract that states the obligations plus the reciprocal agreements as above. Substantive Employment with a non S75 Partner LSSAs are free to train and warrant appropriately qualified, skilled and experienced workers from non Section 75 partners, including, for example, private and voluntary sector services. Appropriate issues as above would need to be addressed in these circumstances. Self-employed AMHP or AMHP employed via an employment agency LSSAs may employ AMHPS via employment agencies, in which case a clear contract directly between the LSSA and the AMHP must exist as well as that between the LSSA and the agency LSSAs have a number of key duties in relation to AMHPs who undertake assessments on their behalf, these include: Ensuring that all AMHPs have access to professional supervision and support in their role as AMHPs; A minimum of 18 hours of refresher training each year as determined by the local authority; Responsibility for the health and safety of AMHPs whilst they are undertaking assessments on their behalf; Responsibility for professional competence in their role as AMHP, and for removing or suspending their warrant as necessary; Legal indemnity whilst undertaking the AMHP role; Access to legal advice whilst carrying out AMHP duties. Cheshire and Wirral as the relevant LSSAs agree to take responsibility for the above. LSSAs can enter into arrangements with another organisation to employ an AMHP in their substantive role, and provide a frontline AMHP service (for instance a provider trust), but the LSSA will retain the ultimate legal responsibility for the service. The LSSA should draw up s75 agreements and individual contracts with AMHPs to ensure responsibilities on both sides are met. LSSAs should identify and establish a robust process to ensure that a potential AMHP has successfully undertaken the required professional training and has sufficient knowledge to be approved as an AMHP. Workforce Planning and Information Manager Page 6 of 13 9 January 2009

Training Arrangements Currently AMHP training is provided by the University of Chester in conjunction with the Cheshire Approved Mental Health Practitioner Partnership (previously Cheshire ASW Partnership). This is a long standing partnership of 9 Local Authorities across the North West and North Wales of which both the Local Authorities of Cheshire and Wirral are partners. The Partnership is now actively encouraging a wider membership to include NHS Trusts. The management group of the Partnership is seen as a central focus to promote the workforce needs of employers. The taught programme is run from a Chester base and normally trains approximately 20 ASW / AMHPs per year. Intake is once yearly from November. Nominations are expected in the July preceding. The programme is validated by the University at Masters Level for award of the AMHP qualification: this can be at PG Cert level, PG Diploma level or full Masters. The AMHP qualification is accredited as required by the General Social Care Council. Basic course requirements include six core taught modules with associated academic assignments, a practice placement and demonstration of practice competencies via submission of a portfolio. A consolidation / introductory module is available for those who may need to revisit skills and knowledge in mental health prior to commencement of the course. Eligibility Professional Requirements The professional requirements to be eligible for AMHP training and function are: A social worker registered with the General Social Care Council; A first level nurse, registered in Sub-Part 1 of the Nurses part of the Register maintained under article 5 of the Nursing and Midwifery Order 2001, with the inclusion of an entry indicating their field of practice is mental health or learning disabilities nursing; An occupational therapist registered in Part 6 of the Register; A chartered psychologist who is listed in the British Society s Register of Chartered Psychologists and who holds a relevant practising certificate issued by that Society. Local requirements are that Social Workers will normally have a minimum of 2 years experience in a mental health setting and are deemed by the employing authority to have reached a level of competence and independent practice to fulfil the role as a potential AMHP. In Cheshire they would be expected to have progressed to Grade 9. Employees of Cheshire and Wirral Partnership NHS Foundation Trust will have a local requirement to have a minimum of 2 years experience in a mental health community setting and will have normally progressed to Band 7. Access to AMHP training will also be dependant on the appropriateness of the training to their current role. Eligibility Academic requirements Academically the course is at Masters Level. A number of both Social Workers and Nurses will be qualified at Diploma level i.e. 2 nd Year Degree level, and may not be graduates. In this event, they may still be eligible to do the training but would have to complete a short piece of assessed work to enable the University to form a view about their ability to study at Masters Level. Re-approval An LSSA may approve a person to act as an AMHP for a period of 5 years and this will be adopted as local policy. The process for re-approval is established by the LSSA and may vary slightly between Cheshire and Wirral. Workforce Planning and Information Manager Page 7 of 13 9 January 2009

Conditions of training The LSSAs need to ensure sufficient cover for AMHPs to be available over a 24 hour period and it will be Local Authority policy to maintain the current level of training. LSSAs undertake to fund the costs of the training programme for candidates but see it as the responsibility of the AMHP s employer to fund replacement costs. As a condition of the funding of the training, it is an expectation that following approval as an AMHP by the Local Authority, that the person agrees to undertake rota duties at the frequency required by the locality rota. This would be expected for a minimum 5 year term. Refresher training / maintaining competence AMHPs are required to complete 18 hours of training each year. Local policy is that they should complete 5 days training or equivalent learning. Refresher training days are arranged by the AMHP Partnership based on learning needs identified by AMHPs. Partners in Cheshire and Wirral will be required to establish a warranting panel. Responsibilities of employers Employer s responsibilities will include: Supporting and enabling candidates to do training and to function as an AMHP; Provision of the practice placement; Provision of a suitably trained and experienced Practice Assessor. LSSAs have a responsibility to agree protocols with other agencies, such as Police and Ambulance Service i.e. to cover transport arrangements, use of Places of Safety and roles and responsibilities of such organisations in relation to work under the MHA. Such protocols should include monitoring arrangements and mechanisms for dealing with incidents or significant problems. LSSAs have responsibility for governance including standards for warranting, re-warranting and quality assurance. 4. S75 agreements In order to meet these new obligations LSSAs should ensure that s75 agreements cover the following issues: Provision of the AMHP service - how the daytime service will be configured; Supervision and support arrangements, including access to senior support from within the LSSA where issues related to conflicts of interest arise; Access to legal advice for those staff carrying out Mental Health Act assessments in their role as AMHPs; Agreement to release staff for initial and refresher AMHP training; If warranting panels are situated within trusts, agreement should be included on how they should work, and the relationship between the recommendations of a warranting panel, and the warranting powers of the LSSA; Governance issues and the collection of information on AMHP activity should be detailed. When and how this information should be reviewed should also be considered; Mechanisms should be agreed on how and in what circumstances to highlight/ share urgent feedback on issues of concern regarding the service as a whole. For instance, where significant problems or incidents are arising with the Police and Ambulance Services, mechanisms for keeping the responsible directors aware of the issues should be considered. The LSSA has a responsibility to work with other organizations such as the Police Authority and Primary Care Trust, to resolve significant problems occurring during the admission process. LSSAs retain responsibility for the assessment process up to the point when a person is accepted onto the ward; Workforce Planning and Information Manager Page 8 of 13 9 January 2009

Remuneration for duties (LSSAs need to outline the terms and conditions, including extra allowances for taking on AMHP duties if relevant). 5. Individual contracts with AMHPS In addition to robust s75 agreements Association of Directors of Adult Social Services (ADASS) recommends that LSSAs enter into a contractual arrangement with the individual AMHP. This will cover remuneration, training requirements, disciplinary procedures, access to legal advice and legal indemnity whilst carrying out duties on behalf of he LSSA. The type of contractual arrangement will vary depending on the individual circumstances of the LSSAs but could include: Reciprocal contract- where the s75 partner is paid to provide the AMHP service, including extra finances for taking on the AMHP role, a contract stating the reciprocal agreement between the individual AMHP and the LSSA is still required. LSSAs may employ AMHPs through employment agencies. A clear contract with the AMHP must exist in these instances. LSSAs may wish to train and warrant appropriately qualified, skilled and experienced workers from non-s75 partners including private and voluntary sector services. However, in these cases the LSSA must ensure that appropriate support is available to the AMHP, and that there are no financial or other conflicts of interest that may exist which would undermine their AMHP role. LSSAs without s75 agreements would have to have individual contracts with agreements on what the LSSA will provide in return for example, legal advice. It is important for LSSAs to seek advice from their legal departments on this. 6. Responsibilities for the AMHP service within LSSAs Over the last few years, the formation of partnership arrangements in mental health services has lead to some LSSAs no longer directly employing senior managers with responsibility and knowledge of the ASW / AMHP role. With this in mind, it is recommended that LSSAs maintain at least one directly employed senior manager or officer who has knowledge of the AMHP role and/or service to ensure that AMHPs have access to independent advice and support and to act as a champion to highlight any problems identified by AMHPs, and to protect the role s independence where the source of the problem may be within the substantive employer s control. It is also important for AMHPs in other care groups within the LSSA to have access to champion within their authority. 7. Supplementary information The National Institute for Mental Health in England is soon to publish best practice guidance titled 'The New Ways of Working Guide to the Mental Health Act' that in addition to the guidance provided in this document, also considers conflicts of interest and the overlap between the Mental Health Act and the Mental Capacity Act. Also included is information about the preparatory training which ASWs will need to have before becoming AMHPs, and information about the AC training and competencies. More information can also be found on the NIMHE website http://mhact.csip.org.uk. Workforce Planning and Information Manager Page 9 of 13 9 January 2009

Appendix 1 Training needs analysis for the approved document Please tick as appropriate There is no specific training requirements- awareness for relevant staff required, disseminated via appropriate channels (Do not continue to complete this form-no formal training needs analysis required) There is specific training requirements for staff groups (Please complete the remainder of the form-formal training needs analysis required- link with learning and development department. Staff Group if appropriate Frequency Suggested Delivery Method (traditional/ face to face / e- learning/handout) Is this included in Trustwide essential learning programme for this staff group ( if yes) Career Grade Doctor 3 yearly Face to Face Training Grade Doctors Locum medical staff Inpatient Registered Nurse Inpatient Nonregistered Nurse / Care Assistant Community Registered Nurse Community Non Registered Nurses / Care Assistants Psychologists / Pharmacists One off Face to Face 3 yearly Face to Face 3 yearly Face to Face 3 yearly Face to Face 3 yearly Face to Face 3 yearly Face to Face Therapists 3 yearly Face to Face Clinical bank staff regular worker Clinical bank staff infrequent worker Non-clinical patient contact Non-clinical non patient contact 3 yearly VLE 3 yearly VLE Workforce Planning and Information Manager Page 10 of 13 9 January 2009

Please give any additional information impacting on identified staff group training needs (if applicable) Please give the source that has informed the training requirement outlined within the policy i.e. National Confidential Inquiry/NICE guidance etc. ADDITIONAL INFORMATION FOR CONSIDERATION: NAME DATE. Workforce Planning and Information Manager Page 11 of 13 9 January 2009

Appendix 2 Equality and diversity / human rights impact assessment Does the policy include anything that Eliminates discrimination and/or Promotes equal opportunities (Answer yes, no or N/A for each category listed) IS IT RELEVANT? Is there evidence to believe that groups could be treated differentif so, which groups within each category(e.g. under 16 year olds in age category) HOW RELEVANT IS IT? How much evidence do you have 1. None or a little 2. Some 3. Substantial Is there public concern that the policy is discriminatory 2 (Answer yes, no or N/A for each category listed) Race NO NO N/A N/A Gender NO NO N/A N/A Disability NO NO N/A N/A Age NO NO N/A N/A Sexual orientation Religion or beliefs NO NO N/A N/A NO NO N/A N/A Now evaluate your answers by using the criteria provided and underline which describes your policy Relevance Rationale Monitoring 3 High relevance If there is substantial evidence that indicates that groups could be treated differently because of the policy You need to start monitoring the impact of this policy within a year of it being introduced Medium relevance Low relevance If there is some evidence that indicates that groups could be treated differently because of the policy If there is little/no evidence that indicates that groups could be treated differently because of the policy You need to start monitoring the impact of this policy within 2 years of it being introduced: Impact monitored at least every 3 years 2 Could be gauged from surveys, audit data, complaints etc, 3 Policy Reviews Group working with Equality & Diversity/Human Rights Group must monitor the impact of policies through the following channels: results from the national service user survey, the national mental health and ethnicity census, complaints data, PALS feedback, individual systems within clinical services through which ward and community staff liaise with service users and carers i.e. ward meetings, modern matron meetings 4 This assent will be reviewed by the Equality and Diversity/Human Rights group Workforce Planning and Information Manager Page 12 of 13 9 January 2009

Human Rights When developing any policies, policy writers should ask themselves does the policy engage/restrict anyone s Human Rights? What is the Convention of Human Rights? Where can I get more information about this? What should I do if I suspect my policy affects anyone s Human Rights? There are 16 basic rights in the Human Rights Act, all taken from the European Convention on Human Rights. There are 3 types of rights detailed as follows: Absolute- cannot opt out of Right to life these rights under any Prohibition of torture circumstance- cannot be Prohibition of slavery and forced balanced against any public labour interest No punishment without law Right to free elections Right to marry Limited- these rights are subject to predetermined exceptions Qualified- these rights can be challenged in order to protect the rights of other people Abolition of the death penalty Right to liberty and security Right to a fair trial Respect for private and family life Right to Freedom of thought, conscience and religion Freedom of expression Freedom of assembly and association Prohibition of discrimination Protection of property Right to education More details can be found at the Department of Constitutional Affairs (DCA) http://www.dca.gov.uk/peoples-rights/human-rights/publications.htm Publications DCA (Oct 2006) Human rights: human lives a handbook for public authorities, crown copyright DCA (Oct 2006) Making sense of human rights a short introduction, crown copyright DCA (Oct 2006) A Guide to the Human Rights Act 1998, crown copyright You should forward for discussion at the Trustwide Equality and Diversity and Human Rights Group within the Trust- contact John Short, Chief Operating Officer, executive lead for Equality & Diversity and Human Rights mailto: john.short@cwp.nhs.uk Please tick one of the following The above has been considered and to the best of my knowledge my policy does not affect any of the human rights listed The above has been considered and my policy does affect a human right article(s) but this has been discussed and qualified at Trust Equality and Diversity and Human Rights Group Workforce Planning and Information Manager Page 13 of 13 9 January 2009