Primary Mental Health Workers Research Articles

GP perceptions of community-based children's mental health services in Pennine Lancashire: a qualitative study.

BackgroundGP satisfaction with specialist Child & Adolescent Mental Health Services (CAMHS) is often reported as low in the UK, and internationally.AimTo explore GP perceptions of local children’s mental health services and to understand their experiences of a novel GP-attached Primary Mental Health Worker (PMHW) service.Design & settingQualitative research involving GPs in Pennine Lancashire.MethodSemi-structured face-to-face interviews of GPs (n = 9) were carried out. Thematic analysis was undertaken.ResultsThemes identified included: 1) The role of the GP: most GPs perceived their role to be signposting and referring patients with mental health issues to specialist services, rather than offering care directly; 2) Clarity on help available: GPs were unclear about specialist CAMHS referral criteria and alternative resources available. GPs experienced communication challenges with specialist CAMHS; 3) Getting advice and support: PMHWs enabled GPs to have informal discussions, and to seek advice about children. Some GPs felt they could recognise problems earlier and were able to access help more quickly; and 4) Development needs: some GPs felt they required increased training in supporting children with mental health problems, and identified a need for further collaboration with schools and specialist CAMHS.ConclusionThe study identified challenges that GPs face with accessing and utilising specialist CAMHS. GPs who had PMHWs based in their practices expressed increased satisfaction with these services. GP-attached PMHWs can potentially reduce the challenges faced by GPs in primary care by offering timely and accessible advice, and improving access to specialist CAMHS.

Computerised cognitive-behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study.

Computerised cognitive-behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this. This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579). The trial ran within community and clinical settings. Adolescents (aged 12-18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group. There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately. CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.

G226(P) Why Do We Review Children?

BackgroundThe waiting list for review appointments in our Community Paediatric clinics is getting longer. We get frequent calls from parents and other professionals regarding delayed appointments. This audit was undertaken...

Developing the Primary Mental Health Worker Role in England.

The Primary Mental Health Worker (PMHW) interface role was introduced in England 13 years ago. This study evaluated the development of the role. 415 English PMHWs (64% of workforce) completed a survey about the services they provide, management organisation, training and development, and job satisfaction. PMHWs perceive their role to involve successful collaboration with primary care staff, offering improved access to mental health services, and being supported by a generally good infrastructure; although training opportunities remain an area of need. The workforce development policy appears, from the PMHWs' perspective, to be successful although training opportunities need consideration.

The role of primary mental health workers in child and adolescent mental health services in Scotland

It is estimated that approximately 10% of children and young people in Scotland have mental health problems (Scottish Government, 2008), resulting in a rapidly increasing need for child and adolescent mental health services (CAMHS). Primary mental health workers (PMHW) have been identified as one of the key professional groups within a multidisciplinary CAMHS team to progress the agenda of early intervention and identification of mental health problems among children and young people. One discrete aspect of the PMHW role is the facilitation and delivery of consultation services to a wide range of agencies. Consultation, in this context, is understood as a community activity for disseminating knowledge, creating understanding and facilitating non‐CAMH professionals to support children and young people with psychological difficulties (Scottish Executive, 2005). This paper discusses a smallscale study that aims to deconstruct the concept of consultation and explore the professional expertise and service requirements necessary for effective delivery. It concludes that complex and multifaceted skills are required if a consultation is to be meaningful and effective. Consequently, and despite competing discourse, there remains a strong debate for retaining the role of the PMHW, specifically for the delivery of early intervention and health promotion activities, such as consultation. The study took place in Scotland, but UK‐wide data is drawn on to provide a more comprehensive picture.

Improving communication between health visitors and primary mental health workers

This audit aimed to open and improve communication between health visitors in Kirklees and the primary mental health workers in the child and adolescent mental health services at Calderdale and Huddersfield NHS Foundation Trust. This was deemed to be important for the establishment of best working practices and the need for multidisciplinary, multi-agency collaboration in the interests and wellbeing of the children, young people and families who use this service. It was hoped the audit would establish health visitors' knowledge of the local primary mental health worker service so that its effectiveness and relevance could be determined. In essence, the audit was intended to find out if the service provided what the service users needed and wanted. The audit demonstrated that about half of the health visitors were satisfied with the service provided and believed that their concerns or queries were dealt with appropriately. Two thirds of respondents, however, believed that they had insufficient knowledge about the role of the primary mental health worker.

Improving communication between health visitors and primary mental health workers

Improving communication between health visitors and primary mental health workers

An educational evaluation of supervisor and mentor experiences when supporting Primary Care Graduate Mental Health Workers

This paper reports on the findings of a postal survey used to enhance understanding into the backgrounds, experiences and support offered to supervisors and mentors of Primary Care Graduate Mental Health Workers (PCGMHWs). A postal questionnaire was sent to the total population of supervisors and mentors who had supported PCGMHW students from three universities in the Northwest of England, during the period of their introduction 2004-2006. Most supervisors and mentors had previous experience of supervision and mentorship with other types of students but not PCGMHWs. Data suggest that there were difficulties due limited understanding of the role of PCGMHWs and how it was to be operationalized. Respondents reported staff shortages, time constraints and competing commitments, which limited support available to students. The lack of organizational readiness and infrastructure to support the role was widely reported. However, the role has developed and is generally well received. The implications for future development of the PCGMHW and the preparation and support of supervisors and mentors are discussed.

The road to self‐efficacy: a discussion of generic training in mental health competencies for educational professionals

This discussion aims to consider the value of training educational professionals in mental health competencies. Primary Mental Health Workers working in the Child and Adolescent Mental Health Service have traditionally used a consultation model when working with schools. In this article I consider moving the emphasis away from consultancy work, instead putting training at the cornerstone of improving mental health in schools. I believe that local practices using consultation can create a ‘dependency’ culture, inhibiting the development of self‐efficacy in those involved in pastoral care in educational settings. Instead, an alternative method of improving confidence and self‐efficacy amongst educational practitioners is by delivering a comprehensive training course, which aims to provide a range of competencies in mental health. Training, which provides skills in low‐level therapeutic approaches for pupils and students, in conjunction with a broad understanding of mental illness and mental health issues, could be a highly effective method of responding to the maxim ‘mental health is everyone’s business’.

On-site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers.

Mental health problems are common in primary care and mental health workers (MHWs) are increasingly working in this setting delivering psychological therapy and psychosocial interventions to patients. In addition to treating patients directly, the introduction of on-site MHWs represents an organisational change that may lead to changes in the clinical behaviour of primary care providers (PCPs). To assess the effects of on-site MHWs delivering psychological therapy and psychosocial interventions in primary care on the clinical behaviour of primary care providers (PCPs). The following sources were searched in 1998: the Cochrane Effective Practice and Organisation of Care Group Specialised Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, PsycINFO, CounselLit, NPCRDC skill-mix in primary care bibliography, and reference lists of articles. Additional searches were conducted in February 2007 using the following sources: MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Clinical Trials (CENTRAL) (The Cochrane Library). Randomised trials, controlled before and after studies, and interrupted time series analyses of MHWs working alongside PCPs in primary care settings. The outcomes included objective measures of PCP behaviours such as consultation rates, prescribing, and referral. Two review authors independently extracted data and assessed study quality. Forty-two studies were included in the review. There was evidence that MHWs caused significant reductions in PCP consultations (standardised mean difference -0.17, 95% CI -0.30 to -0.05), psychotropic prescribing (relative risk 0.67, 95% CI 0.56 to 0.79), prescribing costs (standardised mean difference -0.22, 95% CI -0.38 to -0.07), and rates of mental health referral (relative risk 0.13, 95% CI 0.09 to 0.20) for the patients they were seeing. In controlled before and after studies, the addition of MHWs to a practice did not affect prescribing behaviour towards the wider practice population and there was no consistent pattern to the impact on referrals in the wider patient population. This review provides some evidence that MHWs working in primary care to deliver psychological therapy and psychosocial interventions cause a significant reduction in PCP behaviours such as consultations, prescribing, and referrals to specialist care. However, the changes are modest in magnitude, inconsistent, do not generalise to the wider patient population, and their clinical or economic significance is unclear.

What Makes a Good CAMHS Primary Mental Health Worker?

Background: The role of primary mental health worker (PMHW) in CAMHS was established in 1995 although comparatively little research has explored the attributes required to successfully undertake this role.Method: Qualitative interviews with PMHWs and staff working in primary care were conducted and thematic analysis was performed.Results: In addition to clinical skills and mental health knowledge all respondents consistently emphasised the importance of inter‐personal attributes such as general accessibility, flexibility, and self‐motivation.Conclusions: Both professional competencies and inter‐personal skills are perceived as important characteristics for PMHWs. It therefore seems appropriate for these to be made more explicit in competency frameworks.

Postgraduate Diploma in Child and Adolescent Mental Health

It is designed for social workers, nurses, special needs teachers, GP practice counsellors, primary child mental health workers, psychologists, and psychiatrists who work with children or adolescents with mental health problems. It may be of particular interest to recent graduates of social or behavioural sciences by providing a sound knowledge base and professional training in the area of child and adolescent mental health. I did it in 2004-5, part time over two years, one day a week. The timing of the taught sessions is ideal for those working full time as classes are held from 3 …

Is there an optimum model of practice for the newly developed child and adolescent primary mental health worker posts?

The role of the primary mental health worker (PMHW) is relatively new within child and adolescent mental health services (CAMHS). Different organisational structures have emerged and it is important to study the advantages and disadvantages associated with different PMHW practice models. The current study uses a large, representative sample of PMHWs and operationalises practice models according to the PMHWs' self‐reported location and team alignment thus identifying three models (namely CAMHS outreach, primary care based, and dedicated PMHW team). Comparisons between the models are made in relation to organisation and management, inter‐agency links, and job satisfaction with the aim of exploring the strengths and weaknesses of each model. The results suggest that each model meets the aims of the role and there is greater similarity than dissimilarity between models. However, it also indicates that attention should be paid to improving the working environments and training and development opportunities for...

Evaluation of outreach services for primary care and mental health; assessing the impact

This paper reports an evaluation, carried out for London Health Libraries, of the impact of outreach services to primary care and mental health workers in 13 different settings. The main aims of the project were to identify the impact being made by the service, and to produce best-practice guidelines for outreach services in this kind of community setting. Analysis of documents, analysis of any evaluation already carried out, interviews with outreach librarians, survey of a representative sample of users (eight services). The services evaluated were very diverse in terms of setting, structure, functions and activities. The evaluation was therefore largely qualitative. Emphasis was placed on trying to identify critical incidents, where it could be shown unambiguously that the outreach services made a difference to practice. Service recipients felt better informed, more up to date, more aware of resources, more confident and supported in their work, and saved time. Direct impacts, such as improved patient care, cost savings, etc., were more difficult to establish. The study identified the main areas of impact, and the main factors which affected this. Recommendations for good practice in such outreach services are made. Lessons of this evaluation for impact studies in general are presented, in particular the difficulty of assessing 'direct' impacts.

“Joined on rather than joined up?” Primary mental health work in Scottish schools

PurposePrimary mental health workers have been based in West Lothian schools since 2003 to act as links between the community and hospital‐based services. The research programme this paper describes aimed to examine how this model worked and its impact for children and their families.Design/methodology/approachThis paper reports on interviews with secondary school staff, the link workers and comparative post‐holders. The research study was qualitative and the research question was “What is the perceived impact of Mental Health Link Workers in West Lothian schools?”.FindingsThe paper finds that Primary mental health workers felt that their main contribution was building capacity in the community to support children with mental health problems, and identified four strands to this: space, relationships, skills and containment. Two described direct access for children and their families as the main gain. Secondary school staff considered that the greatest impact was for children at the onset of mental illness, and their own knowledge and skills.Practical implicationsPrimary mental health work in the community is fairly new in Scotland. This study suggested that it speeded up and improved access to services for children in need of mental health assessments and services. It was based on temporary contracts and short‐term funding. Sustainability within schools may only take place when the work becomes well resourced.Originality/valueThe paper is a detailed look at the views of Primary Mental Health Workers based in schools and school staff.

Impact of graduate mental health workers upon primary care mental health: a qualitative study

The role of the primary care graduate mental health worker (GMHW) was developed to improve the availability of mental health services within primary care. However, little is known concerning the impact of the role upon primary care mental health. Semistructured interviews were undertaken with 27 key stakeholders (12 clients, 10 managers/supervisors, 5 general practitioners) who had experience of the GMHW role and activities provided. Thematic analysis of interview transcripts highlighted four main themes: Access to primary care mental health, Inappropriate referrals, GMHW characteristics, and Role developments. All participant groups highlighted a range of ways in which the GMHW role was making significant contributions to primary care mental health. Many of these were associated with increasing access to mental health services afforded by the range of interventions provided. Benefits, however, may exclude working clients who expressed concerns about a lack of flexibility in the appointment times offered. Concerns arise as a consequence of inappropriate referrals made by some general practitioners. Such referrals were, in part, motivated by a belief that developments in primary care mental health should have been directed towards clients with more severe difficulties. In conclusion, this study suggests that the GMHW role is having a significant impact upon primary care mental health. Attempts to improve primary care mental health through the incorporation of the GMHW role within stepped care models of mental health service delivery should be encouraged.

Workforce, volume and access: graduate workers' contribution to primary care child and adolescent mental health services

This paper provides initial findings from a pilot to introduce graduate mental health workers into primary care, child and adolescent mental health services (CAMHS) across three localities in the north west of England in the UK. The progress of the pilot was monitored by gathering information from students, managers, supervisors and mentors regularly throughout the 12 month period, during which the pilot cohort were being formally trained. The potential of the new role of primary care graduate mental health workers to address problems of volume and access to services, particularly how the role might contribute to developing nonspecialist primary care services, is considered.

Evaluation of a CAMHS in Primary Care Service for General Practice.

Many CAMH Services have Tier 2 provision in primary care, but there has been little published evaluation. In a service aimed at general practice, this study examined: 1) the clinical activities of the primary mental health workers; 2) the effect of the service on referrals to specialist CAMHS; and 3) the utilisation and perceived usefulness of the service. clinical activity data collection, evaluation of referral patterns, and a postal questionnaire. Informal (unstructured) consultation-liaison was used more than formal consultation. Referrals to specialist CAMHS increased from practices using the service. The service was perceived as helpful and accessible. The service supported primary care staff in their work with child and adolescent mental health issues. Referrals to Tier 3 may increase as a result of the service.

Stretching the Boundaries: Schools as Therapeutic Agents in Mental Health. Is it a Realistic Proposition?

It seems self-evident to suggest that our schools should play a part in the identification and the response to school-age pupils with mental health problems/mental illness. Schools have a number of unique advantages as both preventative and curative agents in the mental health discourse. The notion of schools playing an extended role in the health, mental health and safety of children, enshrined in the UK Children Act, 2004, has resulted in further demands on educational professionals to meet a broader care agenda. The school as a site for mental health work appears to be an enlightened rather than radical proposition, yet often there are cultural and systemic barriers to implementation. This article aims to highlight some of the main obstacles to the promotion of therapeutic interventions in schools and proposes that there is a considerable gap between the rhetoric of joint-agency cooperation and the reality of applying mental health strategies in an educational setting. A number of recent UK government programmes have reflected a shift in thinking towards adopting more therapeutic interventions and this is particularly evident in the primary school strategies to improve behaviour and attendance. In tandem, Child and Adolescent Mental Health Services have, through training initiatives and the use of primary mental health workers, actively promoted mental health issues in schools. Yet, despite these initiatives, it is arguable that many schools remain ill-equipped to recognize and respond to mental health problems in school-age children. I believe that schools have a pivotal role to play, but there must be fundamental changes before effective change can take place.

The management and work roles of primary mental health workers in child and adolescent Tier 2 services in the North

This article describes a survey of the roles and management of primary mental health workers in children’s services. We found various roles and management arrangements, with most practitioners taking a mixed role of casework and non-case work.