Graduate workers and the MHNA

Mental Health Nursing,  Mar 2004  by Rushforth, David

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This year sees the roll-out of the graduate mental health worker programme including enrolment of students and the commissioning of higher education centres. So how will it look for PCTs, the new graduate workers themselves and the Mental Health Nurses' Association. David Rushforth scans his radar screen for some early indications

The NHS plan for England (DoH, 2000) signalled the emergence of new non-professionally aligned staff to work in primary care mental health. The target of 1000 graduate workers to be in post by 2004 is making good progress. This paper briefly overviews recent developments in building this additional workforce capacity to support the hard pressed mental health professionals. However, many questions with regard to their future require considered debate and discussion and will increasingly involve professional staff organisations, most notably the Mental Health Nurses Association.

The changing face of primary care

The graduate workers are in the forefront of a diverse group of non-professionally aligned workers appointed to complement and expand on existing mental health service provision. Investing in graduate workers aims to reduce pressure on mental health and social care trusts weighed down by the pressures of mounting GP referrals. They have the potential to support the emerging gateway workers of highly experienced link professionals who seek to bring a systematic approach to the interface of primary and secondary care.

The emergence of graduate workers has presented fresh challenges to the key agencies involved. Practical issues around funding, training, recruitment and employment have been to the fore. Local consultation frequently brokered by NIMHE regional development centres has brought together the employing primary care trusts, higher education, user involvement representation and the work force development confederations. Progress has been rapid. The first post-graduate training certificate programmes will enrolled their first students in January. Significantly, the graduate workers will be salaried employees of the primary care trusts prior to commencement of training. During 2004, 24 higher education centres in England will be commissioned, with more in the pipeline.

The graduate worker role

The programme of study will reflect the diversity of local communities arising out of the consultations. Furthermore, the role of the graduate worker will mirror the subtle distinctions in service provision and the local plans for primary care mental health. For example, they will engage in face-to-face assisted self help and guides to mainstream public services and resources for people with common mental health problem, presenting at general practice. This work is viewed as essentially preventative, diverting people away from secondary specialist mental health services. The training will include low intensity interventions including behavioural motivation for people with depression. Certain primary care trusts plan to employ graduate workers to develop community mental health networks and support auditing of local services. Both roles are in the spirit of pioneering mental health initiatives into primary care settings with an often incomplete understanding of the potential value of mental health and how best to deploy new staff.

Recent research published by the Northern Centre for Mental Health (November, 2003) reported the findings of a pilot study conducted in West Yorkshire and Teeside. Preliminary evidence points to the productive involvement of graduate workers in local work place initiatives during the first six months of training. Graduate workers have been positively received by supervisors and their line managers.

Addressing the future

These early findings are welcome. However, they are tempered by uncertainties surrounding their future reported by the graduate workers themselves. Their initial concerns over fixed term contracts can be dispelled. Primary care trusts have recurrent funding to secure their future employment.

Other issues centre on fundamental issues, most notably on accountability to service users and employers and welfare issues including personal safety, employment protection, workloads and inadequate staffing. The rapid pace of change has enhanced the management role of general practitioners who have highly variable and, at times, little management expertise.

Graduate workers express a clear desire for experienced guidance through the plethora of welfare and accountability issues. MHNA has an enviable track record in addressing these key issues and their commitment to embracing a wider membership demonstrates their willingness to embrace the multi-agency approach to improving user and carer services.

Mental health nurses make up half of the current workforce of 76,000 staff while nonaligned workers, including health and social care assistants account for a quarter of the entire mental health workforce in England and the numbers of staff are set to increase. The emergence of graduate workers will inevitably forge closer contact with mental health nurses most notably through supporting clinical supervision and developing their nascent case management skills. The MHNA allegiance with primary care is long-standing. The practice expertise amongst the membership and close organisational links with the CPHVA place them in a unique position to take forward the debate and explore the potential for graduate worker contribution to the growth of the MHNA.