‘ While there ’ s still work to do to improve links between mental health and drug and alcohol services it can be life-changing ... It ’ s having a profound impact on people who use our services .’ |
KIERAN DOHERTY
continues . ‘ It might be sufficient for their needs , or it might get them to a point of stability where they are then able to access mental health services . Even with Vincent , we ’ re a small psychology resource , but addictions services have to do some mental health work . Sending everyone to mental health services is unrealistic and service users won ’ t go . Mental health services should be equally pragmatic .’
INCLUSION ‘ Inclusion ’, part of Midlands Partnership University NHS Foundation Trust , deliver services across the UK and took on a number of MHWP trainees as part of the drug and alcohol pilot . Kieran Doherty , head of quality and governance , states ‘ I very much see the value of talking therapies within drug and alcohol services . There have been challenges accessing talking therapies for people who use our services who may need clear , structured interventions to help with their mental health needs . We were taking a financial risk with this project as there were start-up costs , supervisory costs and the need to make workforce changes , but it had strong support from Inclusion ’ s
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leadership team . We recognised that we need to build people with these skills into our workforce . Developing supervisory networks was possible internally because we already deliver talking therapy services . It ’ s our aim that MHWPs become part of the mixed treatment economy within our services .’
While there ’ s still work to do to improve links between mental health and drug and alcohol services it can be lifechanging , says Kieran . ‘ People who wouldn ’ t have received a talking therapies intervention are now getting one . It ’ s having a profound impact on people who use our services .’
Debbie Hart and Karina Cichocka both qualified in the first trial cohort at different Inclusion drug and alcohol services . ‘ The focus of our sessions is mental health ,’ says Karina . ‘ Recovery workers also work within a CBT model , but the tools that we use are very different , and the goals that we work on are very different . We work in parallel for joint outcomes for the client , focusing on different areas that the client is struggling with . My line manager has been very specific about protecting my job role and not getting it confused with the recovery worker ’ s role .’
‘ At the start it was a struggle for everybody to understand where we fit within the service , as the role was so new ,’ adds Debbie . ‘ Now I feel like we ’ re embedded . We ’ re getting more referrals from recovery workers who understand more about what our role is .’
GAMBLING HARMS The West Midlands Gambling Harms clinic , also delivered by Inclusion , offers self-referral with rapid access to a formulationbased assessment process . Clients are allocated to one of three pathways : ten-week group , one to one , or an online / blended support programme . Elective psychological therapies are offered in parallel based on need , and this is where trainee MHWP Ela Osei Williams comes in .
‘ I assess purely mental health and wellbeing ,’ says Ela . My
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role is fluid ; I might come in at the beginning of someone ’ s treatment journey , or midway , when low mood , depression or anxiety are an issue , to do some structured work . There ’ s a benefit in having an MHWP who solely focuses on mental health support . The rest of the team can focus on the gambling treatment .’
LEARNING CURVE Operations manager Andy Ryan states ‘ We rely on the insight of therapists working on the gambling side to bring Ela in when mental health issues arise . Ela ’ s interventions are invaluable in supporting people and keeping them engaged . We can build a scaffold around the person , drawing on the multidisciplinary team . We ’ re one of 15 gambling clinics , and we are all experimenting with different methods and care pathways . We ’ re on such a learning curve .’
Dr Sarah Stacey , consultant clinical psychologist and professional lead for psychology at Inclusion , has been leading the pilot cohort of MHWPs in prisons , which commenced in April 2024 .
‘ We started having conversations about the feasibility of this in autumn 2022 ,’ she says . ‘ Our leadership team already had experience from the drug and alcohol pilot , and insights that practitioners like Karina and Debbie helped us think about how this might work in prisons . Inclusion run psychosocial substance use services in over 20 prisons .
‘ We decided to pilot the roles in prisons where we ’ ve got integrated mental health and substance use teams , so that the practitioners could have the experience of working with substance use , but could also be part of an established mental health team where they ’ d have support from senior practitioners . We chose sites with practitioner psychologists in post too – it ’ s a really nice fit .’
In the trainee ’ s sites , there ’ s an integrated primary and secondary care mental health service while for the secondary care population , there ’ s been a treatment gap with psychological
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interventions , and the MHWPs ‘ slot in really nicely ’, she says . ‘ The interventions they ’ re being trained to provide will definitely meet a need . It ’ s early days , but our hope is that we can provide interventions that support people to manage distress and difficulty in prison . They can get on with doing other things in prison that will give them a better chance of the life that they want on release .’
MAKING A DIFFERENCE Across these three settings , MHWPs are clearly making a difference and improving mental wellbeing . Inclusion and SLaM both deliver mental health services , bringing existing governance infrastructure for supervision and appropriate clinical escalation which have been vital to these new roles .
So what can we take away from the mental health and wellbeing practitioner pilots so far ? NHS England ’ s Workforce , Training and Education Directorate are currently finalising their evaluation , but early indications seem positive . A challenge will be to navigate the frequent tendering and remodelling of services through commissioning cycles , often moving from NHS to third sector provision , and vice versa . NHS innovation within the psychological professions workforce must be recognised and understood by commissioners , with the value of MHWP and similar roles built into service specifications . Psychological interventions work , as demonstrated by a body of evidence .
MHWPs – and potentially other new roles emerging within the psychological professions ’ taxonomy – represent a move towards designated psychological practice capacity for mental health and wellbeing within drug and alcohol services , as well as gambling , prison healthcare , and other specialist settings .
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James Varty is programme manager , Psychological Professions Network ( Midlands )
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