Changes ahead for mental health workers?

Mental Health Nursing,  Mar 2004  by Hannigan, Ben

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The nature of work and the boundaries between different types of workers have always been subject to change. How will this affect mental health nursing and the services delivered by this group of workers - which itself has changed over a couple of generations. Ben Hannigan looks at the prospects

One of the main planks of the current government's public services 'modernisation' strategy is to make better use of the health and social care workforce. A good indicator of government thinking in this area appeared some four years ago, in the document A health service of all the talents (Department of Health, 2000a). This publication was critical of rigid, highly-demarcated professional practice. In the future, it continued, much greater flexibility in working arrangements would be expected. Practitioners should be better prepared and willing to work across traditional boundaries. Education and training should be focused less on the narrowly-defined requirements of particular occupational groups. Instead, greater emphasis should be placed on multidisciplinary education programmes which aim to prepare practitioners - of whatever ilk -to undertake the necessary work in order that service users' needs be met.

With specific respect to the mental health workforce, A health service of all the talents recognised the problem of understaffing, but also pointed towards changes expected in the future:

'For example, to achieve what we want in mental health services requires more doctors, nurses, social workers and therapists but it also means we need them to work in different ways. [...] Any mental health user knows that psychiatric nurses and social workers must work closely together, but rigid regulatory frameworks make this difficult, and organisational barriers get in the way of good care.'

(Department of Health, 200Oa, p9)

Shortly after the publication of A health service of all the talents, a similar call for greater flexibility in working arrangements came from the Workforce Action Team (WAT). In its final report on the mental health workforce to the Department of Health, this group set out recommendations to tackle under-recruitment and low rates of retention, poor workforce planning, and fragmented education and training (Department of Health, 2001).

As both A health service of all the talents and the final WAT report foresaw - and as many of the articles published in this themed edition of Mental Health Nursing testify - the mental health workforce is now undergoing something of a quiet revolution. England's NHS Plan introduced the idea of recruiting a new type of primary care mental health practitioner (Department of Health, 2000b). Since that time, as David Rushforth has written in this edition, specific plans are being implemented to meet the aim of having 1000 graduate primary care workers in post this year, 'trained in brief therapy techniques of proven effectiveness, [and] employed to help GPs manage and treat common mental health problems in all age groups, including children' (Department of Health, 2003a, p4).

The Department of Health has also produced guidance for another nonprofessionally affiliated group, known as support, time and recovery (STR) workers. It is intended that STR workers 'be flexible in providing the support service users want by giving them time and so aid their recovery' (Department of Health, 2003b, p7). Gateway workers are also being introduced (Department of Health, 2002a). These new community mental health workers, who will be drawn from the ranks of existing occupational groups (including nursing), will have the specific task of helping people with mental health difficulties access care, via entry points such as primary care and emergency services. Around England, innovations are also happening in response to local needs. Most notably, in Southampton, graduates already holding degrees related to health or social care can now follow a two-year postgraduate diploma leading to qualification as (associate) mental health practitioner (University of Southampton, 2003).

Graduate primary care workers, STR workers and (A)MHPs will be joining a 'specialist' mental health workforce which, whilst depleted in terms of actual numbers, is well-provided for in terms of different occupational groups. This highly-complex workforce already comprises, amongst others: hospital and community-based mental health nurses, psychiatrists, clinical psychologists, mental health social workers and occupational therapists. Added to the contribution made by these groups is the mental health work undertaken by: service users themselves, informal carers, non-statutory sector workers, and a vast array of non-mental health specialists such as GPs, practice nurses and other community nurses. Compounding the complexity, mental health care remains a particularly contested field. Within and between occupational groups, different ideas hold sway over favoured approaches to care and treatment, and over what constitutes 'success' in mental health services provision.