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

Exploring the value of mental health nurses working in primary care in England: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Primary care and, in particular, general practice (GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service (PCLS), developed in 2011 in inner London. The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary. Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness.

ABSTRACT

Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area.

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

BACKGROUND

Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice.

AIM

To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK.

DESIGN AND SETTING

Realist review in general practice.

METHOD

A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses.

RESULTS

Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship.

CONCLUSION

Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction.

The Mental Health Nurse Incentive Program: the benefits from a client perspective

It is now acknowledged that a substantial proportion of the Australian population will experience a mental health condition at some time during their lives. Only a small proportion will access care and treatment for these conditions, and those who do are more likely to access general medical practitioners than specialist mental health providers. The Mental Health Nurse Incentive Program (MHNIP) was introduced by the Commonwealth Government to enhance access to mental health care by engaging mental health nurses in collaboration with general practitioners and private psychiatrists. The aim of the current study was to explore the experiences and opinions of clients utilising these services. A qualitative exploratory approach involving in-depth semi-structured interviews was utilised to enhance understanding of the client perspective. Interviews were conducted with 14 clients. Data were analysed using NVivo to assist with the identification of major themes. The findings revealed the major themes to be: initial reactions; a comfortable setting; flexibility; holistic care; and affordable care. These findings suggest that clients perceive the MHNIP as a valuable intervention that met the mental health needs of clients to a greater extent than had previously been possible.

Mental health policy to practice; too much loose change?

Mental health, cancer care and coronary heart disease were identified as the three priorities for the National Health Service, and National Service Frameworks were developed for each area. This prioritisation was reinforced when the NHS Plan was published and a programme of systemic change in the National Health Service was embarked upon to support this new agenda. This paper describes the major policy decisions and systemic changes and how they affected mental health care. The end of the 10-year National Service Framework programme provides an opportune time to review and reflect on the changes, successes and areas for on-going improvement in the years ahead. Clearly there have been significant developments, and perhaps the successes of the last 10 years have been lost in the clutter that often results as a consequence of major change.

Guided self-help supported by paraprofessional mental health workers: an uncontrolled before--after cohort study

There has been considerable development of guided self-help clinics within primary care. This uncontrolled before-after cohort study examines efficiency and effectiveness of these clinics when supported by paraprofessional mental health workers having little mental health training and experience. Data were collected by seven Graduate Mental Health Workers (GMHW) located in South-west England. Alongside an analysis of clinic attendance and dropout, efficiency was measured with respect to the number and length of sessions to support patients with the effectiveness of the interventions examined with respect to problem severity. Over a 15-month period, 1162 patients were referred to the GMHW clinics with 658 adopting guided self-help. Patients using guided self-help received an average input per patient, excluding assessment, of four sessions of 40 minutes. Dropout rate was comparable to other primary-care-based mental health clinics supported by experienced mental health professionals with 458 patients completing all support sessions. However, only 233 patients went on to attend the 3 months of follow-up session. Effectiveness of guided self-help clinics supported by paraprofessional mental health workers was comparable to that supported by an experienced mental health nurse. Improvements in problem severity were statistically significant, with 55% and 58% (final support session) and 63% and 62% (3 months of follow-up) of patients experiencing clinically significant and reliable change for anxiety and depression, respectively. However, concerns exist over the efficiency of the GMHW clinic especially with respect to the use of longer support sessions and high dropout rate at the 3 months of follow-up session. The paper concludes by highlighting the effectiveness of guided self-help when supported by paraprofessional mental health workers, but questions the utility of the two-plus-one model of service delivery proposing a collaborative care approach as an alternative.