Mental health and wellbeing practitioners (MHWP) can play a significant – and vital – role in addictions treatment, says James Varty.
In recent years the psychological professions have seen significant change. The NHS Long Term Plan set out ambitious proposals to rapidly expand access to psychological therapies and interventions in England. This transformation required significant workforce expansion, leading to a psychological professions workforce growth of 65 per cent between March 2020 and December 2023. Growth ambitions continue, with a further 24,000-26,000 posts projected by 2037, almost doubling the size of the current workforce.
This transformation has included the creation of a variety of new roles across the three workforce groupings (psychologist, psychological therapist and psychological practitioner) designed to deliver different levels of treatment intensity and psychologically informed interventions in a range of settings.
Mental health and wellbeing practitioner (MHWP) is one new ‘practitioner’ role, introduced in 2022. Although intended to work in secondary care adult community mental health services as part of the national Community Mental Health Transformation programme, spare capacity on MHWP training courses was offered to NHS drug and alcohol services for the second cohort in 2023.
Course fees and 12-month training salary were met by NHS England as part of the training offer, conditional on the post being maintained post-qualification. Further pilots have since commenced in the West Midlands gambling harms service and in some prisons.
Great fit
Dr Luke Mitcheson, consultant clinical psychologist for Lambeth Drug and Alcohol Service (working for South London and Maudsley NHS Foundation Trust – SlaM) first heard about the roles through training places being offered across secondary care mental health provision within his trust.
‘The interventions delivered seemed a great fit for drug and alcohol services,’ he says. ‘There’s undoubtedly a real need to meet the psychological needs of our clients – roughly 60-70 per cent have underlying mental health problems, largely depression, anxiety or mood disorders. Our client group often do not meet entry criteria for NHS talking therapies for anxiety and depression, or for secondary care mental health services.’
SLaM recruited one trainee MHWP into their Lambeth service, a post secured by Vincent Heavey, who was among the first MHWPs to complete training. Coming from a lived experience background, after entering recovery Vincent progressed from volunteering to working as a recovery worker. ‘I did a master’s in addiction psychology and counselling while still working as a recovery worker,’ he says. ‘Then this opportunity attracted me, because it was pulling me into psychology but still within a substance misuse context. From recovery worker to a mental health worker, there were a lot of changes.’
‘Vincent carries a caseload, but each client also has a keyworker,’ explains Luke. ‘He has a specialism – it’s an adjunct to keyworking. The keyworker might lean back a little while Vincent leans in. Vincent has been a catalyst for us slightly flexing our model by delivering psychological wellbeing workshops that are skills-based, dealing with low mood, emotional regulation, and loss. Clients trust us.
‘Getting mental health support while they’re here is very helpful to their recovery,’ he continues. ‘It might be sufficient for their needs, or it might get them to a point of stability where they are then able to access mental health services. Even with Vincent, we’re a small psychology resource, but addictions services have to do some mental health work. Sending everyone to mental health services is unrealistic and service users won’t go. Mental health services should be equally pragmatic.’
Inclusion
‘Inclusion’, part of Midlands Partnership University NHS Foundation Trust, deliver services across the UK and took on a number of MHWP trainees as part of the drug and alcohol pilot.
Kieran Doherty, head of quality and governance, states ‘I very much see the value of talking therapies within drug and alcohol services. There have been challenges accessing talking therapies for people who use our services who may need clear, structured interventions to help with their mental health needs. We were taking a financial risk with this project as there were start-up costs, supervisory costs and the need to make workforce changes, but it had strong support from Inclusion’s leadership team. We recognised that we need to build people with these skills into our workforce. Developing supervisory networks was possible internally because we already deliver talking therapy services. It’s our aim that MHWPs become part of the mixed treatment economy within our services.’
While there’s still work to do to improve links between mental health and drug and alcohol services it can be life-changing, says Kieran. ‘People who wouldn’t have received a talking therapies intervention are now getting one. It’s having a profound impact on people who use our services.’
Debbie Hart and Karina Cichocka both qualified in the first trial cohort at different Inclusion drug and alcohol services. ‘The focus of our sessions is mental health,’ says Karina. ‘Recovery workers also work within a CBT model, but the tools that we use are very different, and the goals that we work on are very different. We work in parallel for joint outcomes for the client, focusing on different areas that the client is struggling with. My line manager has been very specific about protecting my job role and not getting it confused with the recovery worker’s role.’
‘At the start it was a struggle for everybody to understand where we fit within the service, as the role was so new,’ adds Debbie. ‘Now I feel like we’re embedded. We’re getting more referrals from recovery workers who understand more about what our role is.’
Gambling harms
The West Midlands Gambling Harms clinic, also delivered by Inclusion, offers self-referral with rapid access to a formulation-based assessment process. Clients are allocated to one of three pathways: ten-week group, one to one, or an online/blended support programme. Elective psychological therapies are offered in parallel based on need, and this is where trainee MHWP Ela Osei Williams comes in.
‘I assess purely mental health and wellbeing,’ says Ela. My role is fluid; I might come in at the beginning of someone’s treatment journey, or midway, when low mood, depression or anxiety are an issue, to do some structured work. There’s a benefit in having an MHWP who solely focuses on mental health support. The rest of the team can focus on the gambling treatment.’
Learning curve
Operations manager Andy Ryan states ‘We rely on the insight of therapists working on the gambling side to bring Ela in when mental health issues arise. Ela’s interventions are invaluable in supporting people and keeping them engaged. We can build a scaffold around the person, drawing on the multi-disciplinary team. We’re one of 15 gambling clinics, and we are all experimenting with different methods and care pathways. We’re on such a learning curve.’
Dr Sarah Stacey, consultant clinical psychologist and professional lead for psychology at Inclusion, has been leading the pilot cohort of MHWPs in prisons, which commenced in April 2024.
‘We started having conversations about the feasibility of this in autumn 2022,’ she says. ‘Our leadership team already had experience from the drug and alcohol pilot, and insights that practitioners like Karina and Debbie helped us think about how this might work in prisons. Inclusion run psychosocial substance use services in over 20 prisons.
‘We decided to pilot the roles in prisons where we’ve got integrated mental health and substance use teams, so that the practitioners could have the experience of working with substance use, but could also be part of an established mental health team where they’d have support from senior practitioners. We chose sites with practitioner psychologists in post too – it’s a really nice fit.’
In the trainee’s sites, there’s an integrated primary and secondary care mental health service while for the secondary care population, there’s been a treatment gap with psychological interventions, and the MHWPs ‘slot in really nicely’, she says. ‘The interventions they’re being trained to provide will definitely meet a need. It’s early days, but our hope is that we can provide interventions that support people to manage distress and difficulty in prison. They can get on with doing other things in prison that will give them a better chance of the life that they want on release.’
Making a difference
Across these three settings, MHWPs are clearly making a difference and improving mental wellbeing. Inclusion and SLaM both deliver mental health services, bringing existing governance infrastructure for supervision and appropriate clinical escalation which have been vital to these new roles.
So what can we take away from the mental health and wellbeing practitioner pilots so far? NHS England’s Workforce, Training and Education Directorate are currently finalising their evaluation, but early indications seem positive. A challenge will be to navigate the frequent tendering and remodelling of services through commissioning cycles, often moving from NHS to third sector provision, and vice versa. NHS innovation within the psychological professions workforce must be recognised and understood by commissioners, with the value of MHWP and similar roles built into service specifications. Psychological interventions work, as demonstrated by a body of evidence.
MHWPs – and potentially other new roles emerging within the psychological professions’ taxonomy – represent a move towards designated psychological practice capacity for mental health and wellbeing within drug and alcohol services, as well as gambling, prison healthcare, and other specialist settings.
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James Varty is programme manager, Psychological Professions Network (Midlands)