Delivering care in the community

Graduate workers are wanted for a new NHS post that helps patients with mental health problems. Grace McCann reports

Not many job specifications list a history of mental illness in the "desirable experience" section. But the outline of a new NHS post - that of graduate mental health worker in primary care - does exactly that.

The Health Service is trying to fill 1,000 of these jobs around the country to address the severe shortage of support for people with common mental health problems, such as mild to moderate depression and anxiety.

Mental health conditions account for one in four visits to GPs, but doctors do not have the resources to deal with them effectively. "Patients can be left untreated, put onto medication or referred for secondary treatment that is not appropriate," says Harrison Riley, the senior commissioning manager for mental health and community services in the Heart of Birmingham Teaching Primary Care Trust (PCT). "Someone who has suffered a bereavement may be put onto antidepressants when what they need is specialist counselling."

The Government has issued an outline of the type of person it wants to recruit for the roles. They should ideally be graduates in a relevant discipline, and recruiters will be looking for knowledge of "human development, theories of abnormal behaviour and the effects of disease and disorder on thinking and feeling". The Government would also like applicants to have recovered from mental illness themselves.

Despite this Whitehall wish-list, it is up to local trusts to come up with "people specifications" based on the needs of their community. Some parts of Riley's catchment area have a 90 per cent non-white population, so an understanding of ethnic-minority mental health issues would be advantageous for one of his posts.

A typical day for a graduate worker in one trust could well be unrecognisable to that of a worker in another. As with the people specifications, the Government has asked local trusts to define job descriptions for the new workers to recognise the different priorities and structures of trusts across the country.

Portsmouth's trust, for example, is more advanced than some in that it employs Dr Lisa Butler, a clinical psychologist responsible for primary care psychological therapy. Portsmouth's three graduate workers will therefore have the chance to do some hands-on therapy with patients, under supervision from Dr Butler. "Because my role existed, we wanted to use graduates to complement what I do," she says.

The graduate workers will each be attached to GPs' surgeries in Portsmouth, where they will run self-help clinics for patients with mild to moderate mental health problems. "Our large research base shows that supported self-help can be very effective in treating conditions like

bulimia," says Helen Courtney, one of the graduates. "We are also adopting the same approach for people with anxiety and stress-related problems."

But graduates joining other trusts may not be working in therapeutic roles. Some will be conducting research into patients' needs, while others may be given administrative projects. These could include the compilation of directories of useful voluntary services, like eating disorder support groups.

The posts are full-time and the salaries are based on pay scales for psychology assistants. Courtney works 37.5 hours a week and earns £15,000. Most of the graduates will have the opportunity to study for a postgraduate certificate in mental health while they are on the job.

Bosses at both the Portsmouth and Birmingham trusts are pleased with their graduates so far. This will be encouraging for the Government, particularly as some mental health experts initially expressed reservations about the scheme. Some were concerned that graduate workers with limited training would have responsibility for assessing patients, but Dr Butler emphasises that this job is still done by GPs.

The only major drawback appears to be the lack of a defined career progression for the graduates. Courtney sees her job as a stepping stone to training as a clinical psychologist, and the Heart of Birmingham Teaching trust has already lost graduates to this branch of the profession.

For this reason, Riley's team has tweaked its recruitment policy to allow non-psychology graduates to apply, in the hope that they will be more likely to stick around.

"We are also trying to define a more senior graduate worker role," he says. "We need to create at least a second tier so that the workers can move up to more responsible work."