A redesign of the mental health support worker role values personal experience and diversity. Siobhan Chadwick and Alison James describe the development

In 2002 a new national role for mental health staff working across health and social care was developed. The result was the support, time and recovery (STR) worker.

Resulting from a partnership between the Modernisation Agency's Changing Workforce Programme mental health team and the Department of Health, the role affords an excellent opportunity for people who may not have considered careers in health and social care.

This opens up opportunities to people who have experienced mental health distress themselves, and also includes carers, people from diverse ethnic backgrounds, and people returning to work after career breaks.

To put the new staff in place, the Changing Workforce mental health team led a large national programme from 2003 to 2006 with local STR worker implementation teams and regional networks facilitated by the Care Services Improvement Partnership.

Keen to dissuade organisations from rebadging existing staff without embracing the necessary service redesign, we faced a number of challenges. The most obvious was that with no new funding available for the roles, it was likely to be difficult to persuade NHS trusts, social services and the voluntary sector to join.

National programme leads were convinced only a genuinely collaborative programme, with staff at all levels in the organisation leading the implementation alongside people who used mental health services, could tackle these challenges.

We wanted to avoid having a token service user on the committee and began to develop effective national and local partnerships with professional organisations, service user groups and trade unions.

Joining in four waves, 74 partnership teams took part, each comprising representatives from the local NHS trust, social services, the voluntary sector, service users, managers, human resources, support workers and professional staff. Early wave teams then supported the later wave teams in their region.

The teams were advised on how to prepare the workforce and organisation for the new role by ensuring training was open to all staff and offering awareness sessions to all teams and managers.

They were also required to report on a monthly basis against very specific objectives that guided them through good practice in retention and recruitment, education and training, role redesign and integration of the role into the organisation.

National and regional learning events were held throughout the programme, where expertise was brought in from our partner organisations on issues such as Agenda for Change, occupational health and service user employment.

Changing attitudes

However, occupational health support varied in each organisation. Some departments were extremely wary of employing people with any history of mental health problems, while others were keen to be involved. Several of the teams reported that there had been negative reactions from occupational health and managers towards existing staff who had developed mental health problems.

Establishing terms and conditions for the role was one of the biggest challenges. Some localities had staff working in the same team with different employers and, as a result, with what appeared to be very different terms and conditions.

We developed guidance to ensure consistency in management and supervision payments, which was essential as STR workers cover different organisations with more than one superviser.

HR departments' capacity to support the local teams was patchy and sometimes poor. This was a problem, as the local programme managers mostly came from clinical or practice backgrounds and had little HR experience.

To help tackle the problem, learning events that included project management skills were set up.

The teams proved to be resourceful and there were a number of examples of innovative practice in recruitment and equal opportunities, for example taster sessions, pre-employment training and non-traditional interviews. Good practice guidance for STR workers' induction was developed and there were specific measures with timeframes for teams to record their progress against.

While the DoH guide on the implementation of STR workers offered a recommended education and training pathway, a number of organisations found this impractical because of cost or availability of courses. This is a particular challenge for rural sites.

Others found that being too prescriptive with the pathway might be excluding the very people the programme was trying to attract, some of whom were not confident in formal education.

We recommended personal development plans with individualised pathways to help overcome this.

The challenge for anyone leading a programme is how to ensure sustainability when the programme ends. We produced practical guidance for the teams well before the end of the programme, advising programme leads of where to find local champions, publicity, and integration into organisational networks. There was also training on the development of business cases and benefits realisation.

The implementation programme measured the percentage of STR workers who told us they had experience of mental health distress. Also measured were numbers leaving and reason for doing so. Performance was measured, monitored and analysed on a monthly basis.

There are many personal testimonies of how the STR worker role has radically changed people's lives. One example is of an individual with a diagnosis of schizophrenia who had never been able to find work. Having established a good record as an STR worker, he has now been accepted for nurse training.

The programme was successful because of three elements: people, partnerships and processes.

STR worker posts in figures

When the programme ended in December 2006, there were 2,298 support, time and reovery workers in posts, 170 in recruitment and 635 funded STR worker posts due to start shortly (awaiting a service reconfiguration) giving a total of 3,103 staff.

Fifty-five per cent of sites were successful in employing 10-100 per cent of new workers who declared that they have experience of mental health distress. A further 18 per cent employed 1-9 per cent.

Eighty-three per cent of sites report that they have had service users involved in an active capacity as part of the local STR worker implementation groups.

Only 0.8 per cent of workers in the new roles had left, the majority to undergo further training, for example nurse training.

Overall the programme was a success, and its progress is mainly down to three key elements: people (collaborative working), partnerships and processes. There are no short cuts to sustainable role redesign.

For more information visit http://www.networks.nhs.uk/