Social workers and other professionals are being encouraged to
undergo specialist training as primary mental health workers to
improve child and adolescent mental health services. The new role
aims to bridge the gap between mainstream children and families’
services and specialist Camhs. This follows government, research
(1) and campaigns by charity YoungMinds and Community Care that
highlighted the urgent need for improved Camhs.
These new postgraduate courses have been developed with the
Department of Health as it seeks to achieve a comprehensive Camhs
by 2006. But there are concerns that the expansion of the Camhs
workforce is going to place unrealistic expectations on primary
mental health staff.
Courses for the new role are unlikely to attract enough students
to begin to address the shortfall in numbers already
highlighted.(2) It has been estimated that as many as 900 primary
mental health workers are needed in England to achieve a minimum of
four in each local Camhs in England by 2006.3 No reliable evidence
has been used to substantiate this number. Previous studies have
showed that existing Camhs were understaffed in health authorities,
although the level of demand was a fraction of the actual need for
services in the community.
Existing Camhs staff who are eligible to become primary mental
health workers are usually already well-qualified. For them there
is little incentive in undertaking post-graduate training.
The number of staff with the required experience – plus a degree
– is likely to be smaller than the number needed to hit the 2006
target. Also there is no formal national accreditation or career
structure for primary mental health worker roles. This means
individual universities can vary the content of their courses or
build on existing ones, while employers in primary care trusts or
social services can design their own job descriptions. The result
will be uneven national service development especially as Scotland
and Northern Ireland have not been covered by this programme.
Expectations being placed upon the new role seem unrealistic.
The National Camh Support Service (NCSS) set up to help develop
better services has produced guidance and a definition of the role
of the primary mental health worker. There are seven key components
to the role:
Liaison: The liaison role anticipates the
primary mental health worker “facilitating collaboration between
all agencies… to enable the definition of the best approach to
meet the mental health needs of the child”.
Words in the guidance such as “networking” and “being a
catalyst” are used without much explanation of their meaning, or
how much of the practitioner’s time is expected to be devoted to
this and the other six roles.
Consultation: The role of consultation is also
poorly defined and replicates some of the tasks mentioned in the
roles of supervision and intervention.
The term consultation is open to multiple interpretations and
will mean different things to different professional staff.
The potential for tension or confusion or both being generated
between line managers and primary mental health workers seeking to
offer advice and support is high, particularly where there are
child protection concerns.
Training: The training role is likely to become
a focal point of pressure given the predicted shortfall in
workforce numbers. The guidance from the NCSS suggests “regular
multi-agency training programmes should be offered to the range of
professionals working with children… enabling them to recognise
and manage child mental health problems at an early stage”.
So how are primary mental health workers going to be trained to
train others and what controls will be in place to measure the
effectiveness of this training. There are staff eligible for
undertaking the job of primary mental health worker who may be put
off undertaking training if by doing so they are going to feel
burdened with unwanted extra responsibilities and work.
Supervision: The aim of the supervision role is
to “improve tier one staff skills and knowledge base to achieve
early intervention, preventive work and aid assessment”. Yet the
skills of supervision are complex, with different models. There
will be a lack of fit between individual primary mental health
workers’ supervision experiences and methods of working, and
between the various professionals at tier one.
Intervention: The guidance states that the
intervention role can be provided on two levels – through joint
work with tier one staff or direct work with children and families.
Each of these tasks is labour intensive. Joint work requires time
and planning, the building of trusting relationships and
negotiation of roles and appreciation of different working
practices. In addition with the enormous waiting lists in tier
three together with demand in the community it is expected that
primary mental health workers will initially be subjected to
considerable pressure to undertake large volumes of work.
Strategic planning: The guidance suggests that
strategic planning “includes the development and agreement of joint
agency protocols for pathways of intervention, treatment or care…
and contribution to the development of inter-agency structures to
ensure joint planning and collaborative working relationships”.
These strategic, time-consuming tasks will be unattractive to
many prospective primary mental health workers.
Research and development: Finally, the role of
research and development envisages “identifying service needs and
gaps across agencies with regards to children’s mental health and
obtaining users’ views and involving users in the design and
delivery of accessible Camhs provision”.
The implications of this are profound. Needs assessment and
analysis are notoriously difficult to implement but produce
statistically robust data. Involving children in service
development is also difficult as it raises tricky ethical
There is anecdotal evidence that new posts are being filled by
poaching staff working at tier 3 who face the stress of long
waiting lists and entrenched complex caseloads.
The prospect of moving to tier 2 with a light touch preventive
role is attractive especially as many staff will earn the same
money. In the short-term there will be no overall net increase in
the workforce just re-badging of existing staff.
The aim of building workforce capacity and improving the quality
of Camhs over the next two years as specified in the children’s NSF
is looking more unrealistic.
The National Service Framework for Children has specified
improvements in staffing child and adolescent mental health
services. New primary mental health worker posts are proving
attractive to social workers seeking to develop their special
interest in child and adolescent mental health. This article sets
out some of the prospects and problems for these new jobs and
suggests they carry an unrealistic burden of expectation.
- S Walker, Social Work and Child and Adolescent Mental Health,
Russell House, 2003
- YoungMinds, Briefing on the National Service Framework for
Mental Health, YoungMinds, 2001
- DfES/DoH, NSF for Children, Young People and Maternity
Services, HMSO, 2004
Contact the Author
Steven Walker has worked in child protection and child
and adolescent mental health services. He is currently Camh
programme leader at Anglia Polytechnic University and is the author
of Social Work and Child and Adolescent Mental Health, and Working
Together for Healthy Young Minds, Russell House