Mental Health Practitioners (MHPs)

Mental Health Practitioners (MHPs)

Slide

Read our Toolkit:
The page below serves as a starting point; for more information, please read our Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care.

Questions?
Please contact our Mental Health Profession Lead, Amy Chrzanowski, at amy.chrzanowski1@nhs.net.

Read Toolkit
Contact Amy

Read our Toolkit:
The page below serves as a starting point, but for more information, please read our Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care.

Questions?
Please contact our Mental Health Profession Lead, Amy Chrzanowski, at amy.chrzanowski1@nhs.net.

Read Toolkit
Contact Amy

Read our Toolkit:
The page below serves as a starting point, but for more information, please read our Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care.

Questions?
Please contact our Mental Health Profession Lead, Amy Chrzanowski, at amy.chrzanowski1@nhs.net.

Read Toolkit
Contact Amy
Slide

Read our Toolkit:
The page below serves as a starting point; for more information, please read our Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care.

Questions?
Please contact our Mental Health Profession Lead, Amy Chrzanowski, at amy.chrzanowski1@nhs.net.

Read Toolkit
Contact Amy

Read our Toolkit:
The page below serves as a starting point, but for more information, please read our Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care.

Questions?
Please contact our Mental Health Profession Lead, Amy Chrzanowski, at amy.chrzanowski1@nhs.net.

Read Toolkit
Contact Amy

Read our Toolkit:
The page below serves as a starting point, but for more information, please read our Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care.

Questions?
Please contact our Mental Health Profession Lead, Amy Chrzanowski, at amy.chrzanowski1@nhs.net.

Read Toolkit
Contact Amy
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Why include them in your MDT?

What are they?

What are the benefits?

How do you employ a mental health practitioner?

What employment models are there?

What characteristics, training / qualifications, and competencies should they have?

Any example job descriptions?

Any sample interview questions?

What are Mental Health Practitioners (MHPs)?

Mental Health Practitioners (MHPs) contribute to the NHS Long Term Plan ambition to develop new and integrated models of primary and community mental health care, offering patients access to specialist support and providing guidance to other clinicians working in the general practice multidisciplinary team (MDT). Practices can employ them as jointly funded ARRS MHPs – in collaboration with Avon & Wiltshire Mental Health Partnership (AWP), through the Additional Roles Reimbursement Scheme (ARRS) – or as independently employed MHPs (IEMHPs) — please note that the method of employment can impact their core functions.

For more information, please expand the boxes below.

For jointly funded ARRS MHPs:

Through the Additional Roles Reimbursement Scheme (ARRS), MHPs can be jointly employed and funded by a PCN and local community mental health service provider (in BNSSG’s case, Avon & Wiltshire Mental Health Partnership (AWP)). A local service agreement will confirm this arrangement. This jointly funded ARRS MHP role can be taken on by any registered clinician working at Band 5 or above, such as:

  • Community Mental Health Nurses
  • Social Workers
  • Mental Health Occupational Therapists

Main functions of the jointly funded ARRS role:

  • No exclusion criteria other than under 18 years old and dementia
  • Combined consultation, advice, triage and liaison function, supported by the local community mental health provider
  • Working with patients to support shared decision-making about self-management; facilitate onward access to treatment services; provide brief psychological interventions, where qualified to do so and where appropriate and work closely with the PCN MDT to help address wider patient needs
  • Operating without the need for formal referral from GPs
  • Being supported through the local community mental health services provider by robust clinical governance structures to maintain quality and safety, including supervision

For independently employed MHPs (IEMHPs):

Practices may choose to employ their own MHPs to allow greater freedom in adapting the role to better fit practice and patient population needs. However, the general concept of the IEMHP role will remain much the same:

  • Combined triage, consultation, advice, and liaison function
  • Working with patients to support shared decision making around self-management, and to facilitate onward access to treatment services
  • Provide brief psychological interventions where qualified to do so and where appropriate
  • Prescribing and reviewing medication where indicated, and if appropriately qualified to do so
  • Support with QoF
  • Exclusion criteria dependent on practice and individual practitioners

It is recommended that MHPs have 2– 5 years‘ experience working in mental health before joining the primary care sector, due to the level of autonomy associated with the role.

Additionally, due to the nature of the role and career progression, it is recommended that Band 6+ or equivalent roles – ideally a Mental Health Nurse – are employed in this capacity.

What benefits can Mental Health Practitioners (MHPs) bring?

Mental Health Practitioners (MHPs) can offer a wide range of benefits to patients, practices, and primary care networks (PCNs), though they can differ depending on whether MHP(s) are employed through the Additional Roles Reimbursement Scheme (ARRS) or independently. Further details can be found below.

For more information, please expand the boxes below.

For jointly funded ARRS MHPs:

Benefits for patients:

  • MHPs can help with reducing waiting times
  • They can help to prevent referral into secondary care
  • They provide an integrated pathway for patients
  • They provide access to specialist mental health support
  • Patients typically report positive experiences with MHPs
  • Integrated pathways for patients
  • Access to specialist mental health support
  • Reduced waiting times
  • Prevention of referral into secondary care
  • Positive patient experience

Benefits for PCNs:

  • MHPs can integrate into and work as part of the multidisciplinary team, in line with the community mental health framework
  • They can teach other clinicians new skills around managing mental health
  • They provide a bridge between primary care and specialist mental health providers
  • Through MHPs, PCNs can draw on a range of mental health service providers
  • When employed through ARRS, PCNs don’t need to be involved in the recruitment process for MHPs
  • They’re employed through an innovative model of shared employment
  • No formal referral process is required

For independently employed MHPs (IEMHPs):

Benefits for patients:

  • Access to specialist mental health support
  • Patients typically report positive experiences with MHPs
  • Patients can have longer appointments for assessing and formulating a treatment plan
  • Reduced waiting times

Benefits for PCNs:

  • MHPs can integrate into and work as part of the multidisciplinary team, in line with the community mental health framework
  • They can teach other clinicians new skills around managing mental health
  • They can help to free up GPs’ time
  • When employed independently, PCNs have full control over the recruitment process
    • PCNs can, consequently, develop the role according to their particular patient population and practice needs
What supervision do Mental Health Practitioners (MHPs) need?

Supervision arrangements for Mental Health Practitioners (MHPs) can differ depending on which employment model they’re hired through.

For more information, please expand the boxes below.

For jointly funded ARRS MHPs:

If employed through the Additional Roles Reimbursement Scheme (ARRS), then MHPs will receive line management and clinical supervision through Avon & Wiltshire Mental Health Partnership (AWP).

  • AWP will also offer lunchtime check-ins with peers from across BNSSG, twice a week
  • Monthly team meetings will be held by AWP, too
  • PCNs should still identify a GP Mentor to work with MHPs, however
    • For more information on the role of a GP Mentor, please click here.

For independently employed MHPs (IEMHPs):

If employed independently, then line management and clinical supervision for MHPs should be provided by a…

  • GP (a mental health lead would be ideal)
  • Senior Mental Health Practitioner
  • Or Nurse Manager

…with the frequency of supervision should be agreed with individual practitioners.

Peer supervision with other MHPs in primary should be encouraged, too, as a means of sharing best practice and supporting retention.

What employment models are there for Mental Health Practitioners (MHPs)?

Mental Health Practitioners (MHPs) can either be employed independently at a practice surgery, in which case the practice will fully fund and oversee the recruitment process; otherwise, they can be employed as a jointly funded ARRS role in collaboration with Avon & Wiltshire Mental Health Partnership (AWP) through the Additional Roles Reimbursement Scheme (ARRS).

Employed through either model, MHPs are a valuable addition to any MDT. You can see the benefits of each model under What are the benefits?

To employ an MHP through ARRS, there are certain criteria that must be met. For instance, as stated the Network Contract Directed Enhanced Service (DES) contract specification 2023 / 2024:

  • “B14.2. Where a PCN engages one or more Mental Health Practitioners under the Additional Roles Reimbursement Scheme, the PCN must ensure that each Mental Health Practitioner provides the following functions depending on local context, supervision and appropriate clinical governance:
    • a. mental health advice, support, consultation, and liaison across the wider local health and social care system, including acting as a first point of contact in primary care for patients whose care needs are not suitable for Talking Therapies services;
    • b. facilitation of onward access to mental and physical health, well-being, and biopsychosocial interventions;
    • c. provision of brief psychological interventions, where qualified to do so and where appropriate;
    • d. work closely with other PCN-based roles to help address the potential range of biopsychosocial needs of patients with mental health problems. This will include the PCN’s MDT, including, for example, PCN clinical pharmacists for medication reviews, and social prescribing link workers for access to community-based support; and
    • e. may operate without the need for formal referral from GPs, including accepting some direct bookings where appropriate, subject to agreement on volumes and the mechanism of booking between the PCN and the provider.”
  • “B14.3. A PCN must ensure that the postholder is supported through the local community mental health services provider (or by the employer of the postholder, where the local community mental health services provider has subcontracted the service to another organisation) by robust clinical governance structures to maintain quality and safety, including supervision where appropriate.”
What characteristics and training / qualifications should Mental Health Practitioners (MHPs) have?

Please find information on what you should look out for when employing an MHP below:

Personal Characteristics

The Avon & Wiltshire Mental Health Partnership (AWP) suggests that MHPs should have the following personal characteristics:

  • Ability to diplomatically challenge inaccurate assumptions and perceptions
  • Comprehensive experience in educating and training the mainstream workforce, particularly non-specialist mental health workers
  • Effective active listening skills, enabling the reframing and testing of understanding
  • Effective verbal communication skills, which can be put to use with people at all levels (even when an assertive approach is needed)
  • Effective written communication skills, with experience of compiling and sorting notes and reports, establishing statistical data, and analysing information
  • In-depth working knowledge of secondary specialist mental health services, the wider health and social care community, and the third sector
  • Possesses a detailed understanding of the relevant legal frameworks / legislation, including CPA process, the Mental Health Act, the Mental Capacity Act, and safeguarding
  • Substantial experience in assessing risk and producing risk management strategies
  • Well-versed with Microsoft Office, and willing to embrace new technology and processes
  • Well-versed with national drivers and policies, and with legislation affecting patients and service users

Please note: the above information is drawn from AWP‘s job description for a Band 6 mental health practitioner — it should, therefore, not be considered an exhaustive list, for all situations.

For further information, please consult NHS Health Careers‘ guidance on required personal characteristics and skills by clicking here.

Training and Qualifications

It is recommended that MHPs have significant post-qualification experience of working in mental health field prior to join the primary care sector. Available job descriptions suggest between 2 – 5 years‘ of experience, on account of the level of autonomy associated with the MHP role in primary care.

The Avon & Wiltshire Mental Health Partnership (AWP) suggests that MHPs should have the following training and educational qualifications:

  • A professional qualification in mental health, equivalent to a registered RMN (mental health nurse), registered social worker, or registered therapist.
  • In-depth working knowledge of secondary specialist mental health services and the wider health and social care community, as well as the third sector.
  • Comprehensive experience in educating and training the mainstream workforce, particularly non-specialist mental health workers.
  • Substantial experience with assessing risk and producing risk management strategies.
  • Current registration with a professional body (ideally the Nursing and Midwifery Council (NMC)), and a commitment to CPD

If you wish to employ through the Additional Roles Reimbursement Scheme (ARRS), any registered clinician working at Band 5 or above can take on the role, including:

What can a Mental Health Support Worker do?

The Specialist Mental Health Practitioner role will help people over 18 years old, who are accessing support through primary care, to define achievable goals and access local community resources.  Areas of focus will include:

  • Those with mental health needs that do not meet the access criteria for IAPT (Improving Access to Psychological Therapies provided through Vita Health) and do not meet the access criteria for secondary care.
  • People with serious or significant mental illness (SMI) who are supported within recovery services and relatively stable in secondary care mental health services, who could be cared for within primary care.
  • Those diagnosed with, or presenting with traits of, personality disorder who will benefit from being signposted to services who can best meet their needs
  • Younger adults with SMI (17-25years) particularly those transitioning between children’s and adult services
  • Older adults with complex presenting issues
  • First contact with primary care

MH Job description Outline Doc

The above information was sourced from the following:

 

Band 6 Mental Health Practitioner (ARRS BNSSG) AGREED 04.08.21

What is their scope of practice?

While the exact scope of the role and job description should be agreed between the mental health support worker and their PCN, broadly speaking, the role is qualified to:

  • Engage in shared decision making and support patients to make decisions about self-management
  • Support patients in accessing treatment services
  • Provide brief evidence-based psychological interventions for patients ineligible for IAPT, where such interventions can be safely offered outside of a multidisciplinary mental health team
  • Work closely with other PCN-based roles to address wider patient needs (e.g., PCN clinical pharmacists for medication reviews, and social prescribing link workers for access to community-based support)
  • Operate without the need for formal referral from GPs (including accepting direct bookings where appropriate, subject to agreement on volume and booking mechanism between the practitioner and PCN)
  • Fulfil a consultation, advice, triage, and liaison function, backed by the local community mental health provider through robust clinical governance structures, maintaining quality and safety standards

As stated above, this should not be considered an exhaustive list.

For more information on the scope of practice of this profession, please consult AWP’s job description below:

AWP's Job Description

Provided by AWP, this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

Is funding available for them?

From April 2021 onward, mental health support workers can be employed through the Additional Roles Reimbursement Scheme (ARRS). 50% of the funding will be provided by the local provider of community mental health services, and 50% by the PCN itself (this amount can be reimbursed through the ARRS, however).

The maximum reimbursable amount is still to be decided, however. We hope to have more information over the coming months.

For more information:

BMA's Supporting General Practices in 2021 / 22 update

Hosted by the British Medical Association (BMA), this document from January 2021 provides an update on expansions to the Additional Roles Reimbursement Scheme (ARRS), including the provision of mental health support workers.

To read it, please click here.

Are there any requirements to receive ARRS funding?

As noted under ‘Is funding available for them?‘, mental health support workers (MHSWs) can be reimbursed via the Additional Roles Reimbursement Scheme (ARRS). However, to be eligible for this funding, there are requirements that MHSWs must adhere to.

For instance, as stated in Annex B of the Network Contract Directed Enhanced Service contract specification 2021 / 22:

  • “B14.2. Where a PCN engages one or more Mental Health Practitioners under the Additional Roles Reimbursement Scheme, the PCN must ensure that each Mental Health Practitioner has the following key responsibilities, in delivering health services:
    • provide a combined consultation, advice, triage and liaison function, supported by the local community mental health provider;
    • work with patients to:
      i. support shared decision-making about self-management;
      ii. facilitate onward access to treatment services; and
      iii. provide brief psychological interventions, where qualified to do so and
      where appropriate;
    • work closely with other PCN-based roles to help address the potential range of biopsychosocial needs of patients with mental health problems. This will include the PCN’s MDT, including, for example, PCN clinical pharmacists for medication reviews, and social prescribing link workers for access to community-based support; and
    • may operate without the need for formal referral from GPs, including accepting some direct bookings where appropriate, subject to agreement on volumes and the mechanism of booking between the PCN and the provider.

For more information:

Network Contract DES contract specification 2021 / 22

Provided by NHSE / I, this document outlines the Network Contract Directed Enhanced Service (DES) for 2021 / 22.

To read it, please click here.

Any example job descriptions?

Please find below two example job descriptions, one for jointly funded ARRS MHPs and one for independently employed MHPs (IEMHPs).

For jointly funded ARRS MHPs:

Provided by Avon & WiltshireMental Health Partnership (AWP), this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

For independently employed MHPs (IEMHPs):

Produced by Amy Chrzanowski, our Mental Health Profession Lead, this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

Any sample interview questions?

Below is a set of sample interview questions:

  • “What skills can you bring to this role?”
  • “How would you assess a patient’s needs?”
  • “How would you risk assess and safety plan with a patient who is experiencing thoughts of self-harm and suicide?”
  • “Appointment times are shorter in primary care: how do you envisage you will adapt to this?”
  • “What challenges do you think you may encounter coming from secondary care into primary care?”
  • How do you look after your own wellbeing?
Finance & DES-supported roles

Overview of the role

  • AfC TBC 2021/22
  • TBC 2021/22

Mental Health Practitioners – including Improving Access to Psychological Therapy (IAPT) – to be included in the scheme from April 2021 – Awaiting further advice and guidance.

E-learning for health link

The above info on financing of the MHSW role can be found on the e-learning for health website:

https://www.e-lfh.org.uk/programmes/new-roles-in-primary-care/

The DES Role Descriptors

The following information concerns the DES role requirements for Mental Health Support Workers, and full details can be found in the Network Contract DES link below.

 

B.14. Mental Health Practitioners
B14.1. The mental health practitioner role may be undertaken by any registered
clinical role operating at Agenda for Change Band 5 or above including, but
not limited to, a Community Psychiatric Nurse, Clinical Psychologist, Mental
Health Occupational Therapist or other clinical registered role, as agreed
between the PCN and community mental health service provider.

B14.2. Where a PCN engages one or more Mental Health Practitioners under the
Additional Roles Reimbursement Scheme, the PCN must ensure that each
Mental Health Practitioner has the following key responsibilities, in delivering
health services:
a. provide a combined consultation, advice, triage and liaison function,
supported by the local community mental health provider;
b. work with patients to:
i. support shared decision-making about self-management;
ii. facilitate onward access to treatment services; and
iii. provide brief psychological interventions, where qualified to do so and
where appropriate;
c. work closely with other PCN-based roles to help address the potential
range of biopsychosocial needs of patients with mental health problems.
This will include the PCN’s MDT, including, for example, PCN clinical
pharmacists for medication reviews, and social prescribing link workers for
access to community-based support; and
d. may operate without the need for formal referral from GPs, including
accepting some direct bookings where appropriate, subject to agreement
on volumes and the mechanism of booking between the PCN and the
provider.
B14.3. A PCN must ensure that the postholder is supported through the local
community mental health services provider by robust clinical governance
structures to maintain quality and safety, including supervision where
appropriate

Network Contract DES document

More can be read on the MHSW role des on page 93 of the following document:

B0431-network-contract-des-specification-pcn-requirements-and-entitlements-21-22

Supporting Documents

Network Contract DES document

B0431-network-contract-des-specification-pcn-requirements-and-entitlements-21-22

Mental Health Support Worker Job Description

14.07.21 Band 6 Mental Health Practitioner (ARRS BNSSG) JD

MHP FAQs

220210415 MHP FAQs_FINAL 190421

ARRS Resource Booklet

ARRS Resource Booklet 1 April 2021o

BMA PCN Handbook

B0431-network-contract-des-specification-pcn-requirements-and-entitlements-21-22bma-pcn-handbook-march-2020

Community MH Framework Older Adults

community-mental-health-framework-for-adults-and-older-adults

SW Regional Operating Plan

community-mental-health-framework-for-adults-and-older-adultsHEE South West Regional Operating Plan 2020-21_1

Innovative Employment Models

community-mental-health-framework-for-adults-and-older-adultsHEE South West Regional Operating Plan 2020-21_1Innovative_Employment_Models_FINAL

Mental Health Practitioners ARRS

Mental-health-practitioners_ARRS

Further Reading

Toolkit for Embedding Mental Health Practitioners (MHPs) in Primary Care

Compiled by Amy Chrzanowski, our Mental Health Profession Lead, in collaboration with Avon & Wiltshire Mental Health Partnership (AWP), this toolkit is intended to support practices in embedding Mental Health Practitioners (MHPs) into their multidisciplinary team (MDT).

To read it, please click here.

AWP Job Description

Provided by Avon & Wiltshire Mental Health Partnership (AWP), this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

IEMHP Job Description

Produced by Amy Chrzanowski, our Mental Health Profession Lead, this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

GP Mentor / Liaison summary

This document outlines the role of a GP Mentor / Liaison for jointly funded ARRS MHPs.

To read it, please click here.

NHS Health Careers Personal Characteristics guidance

This document, provided by NHS Health Careers, offers further guidance on the required personal characteristics and skills of MHPs.

To read it, please click here.

Supervision Requirements for Mental Health Practitioners (MHPs) in Primary Care

 

Compiled by Amy Chrzanowski, our Mental Health Profession Lead, in collaboration with Avon & Wiltshire Mental Health Partnership (AWP), this toolkit is intended to support practices in embedding Mental Health Practitioners (MHPs) into their multidisciplinary team (MDT).

To read it, please click here.

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