The new ways of working about developing enhanced and new roles for mental health staff so as to deliver effective, person-centred care in a way that is personally and organisationally sustainable.

New ways of working is about developing enhanced and new roles for mental health staff so as to deliver effective, person-centred care in a way that is personally and organisationally sustainable.

Some of the new roles are already well established and include support, time and recovery workers, community development workers for black and minority ethnic communities, graduate mental health workers and others.

These new staff will be supported by appropriate learning and development.opportunities to help enhance the necessary skills, for example in non-medical prescribing, physical health assessment and psychological therapies.

It will also mean some existing staff changing the way they work to ensure it provides the most benefit to service users and carers - for example, consultant psychiatrists only seeing people when their skills are needed, not just routinely.

Culture change

The changing culture brought by new ways of working.first emerged as a concept in 2003 when two national conferences examined the role of consultant psychiatrists and the problems they faced - including issues concerning responsibility, power and accountability; training in leadership and management skills; and concerns about continuity of care. .

When these problems were examined, it became apparent that other parts of the same system were similarly stressed.

A groundswell of opinion among the Royal College of Psychiatrists, Department of Health and British Medical Association made it clear that it was time to reshape the mental health workforce - there was a need for more flexibility not just within the consultant role but within all roles, and room for new roles too.

A national steering group was set up with two sub-groups (psychiatry and a cross-boundary group) representing all the key professional and related staff groups, including service users and carers. The steering group's work.resulted in the publication of an interim report on new ways of working.for psychiatrists in 2004, followed by a final report in 2005.

What has emerged is a much more flexible approach. For example, we have found that some consultant psychiatrists want to run outpatient clinics, while others don't. Under new ways of working,.both approaches are fine: there are no targets, just a desire to provide effective, responsive care for service users and carers.

In the main, the concept of new ways of based on a team approach that means service users should see the person best suited to meet their particular needs at that time, rather than simply always seeing a consultant psychiatrist, for example. This means staff other than a consultant can take on appointments or can be trained to take on extended roles.

This approach.not only benefits staff in that it shares responsibility between roles and allows those roles to be more flexible, but more.importantly, it benefits service users and carers, who receive a more flexible, more responsive service.

Devon primary care trust

Wellness recovery action planning is a preventive approach for managing stress and maintaining well-being, which can be used as an advanced directive.

This approach is embedded throughout the mental health voluntary and statutory sector in Devon and a version more suitable for use in primary care has been developed.

A training course for primary care staff has begun to address how wellness recovery action planning can support self-management for people with long-term physical health conditions and promote mental health recovery approaches in primary care.

Walsall primary care mental health trust is moving away from using a secondary care model of mental healthcare delivery towards a robust primary care mental health service, grounded in the strengths of primary care.

Walsall has placed its most senior clinicians within frontline primary care; they have been trained in brief assessment techniques (risk and triage) to enable 20-30 minute initial consultations. Outcomes include:

  • increased numbers of people that can be seen
  • reduction in waiting times and in the number of non-attendees
  • faster access for first appointment in a less stigmatising setting
  • early diagnosis and treatment
  • links with specialist mental health services
  • education and training of the primary care team, for example GPs, midwives and health visitors
  • a liaison role between primary and secondary care to discuss cases, and assistance for the primary care team with development and maintenance of a severe mental illness register to meet the quality and outcomes framework.

Roslyn Hope is director of the National Institute for Mental Health in England national workforce programme.