In 2020, Health Education England (HEE), now known as NHS-E Workforce Training and Education (WTE), funded an evaluation project aimed at understanding the workforce and skills needed to deliver preventative mental health care in General Practice. The project also sought to define what such an intervention would look like.
The starting point was to complete a literature review of mental health preventative and promotional approaches and understand if such work was already been conducted in General Practice. This review was published - Mental health promotion and prevention in primary care: What should we be doing vs. what are we actually doing?
The review highlighted numerous recommendations, guidelines and policies emphasising the importance of preventative mental health care. However, these were not reliably translating into either research or clinical practice. This review informed the development of a brief psychologically-informed intervention and the service delivery model.
Four Psychology graduates were employed as Assistant Psychologists and trained in the necessary skills to offer brief interventions focused on mental health prevention and promotion. Their knowledge was continually enhanced through weekly individual and group supervision. They were deployed into two practices in Lancashire, each location had unique population needs and assets. The graduates settled quickly into their teams and were made to feel welcome. Although there was initial work to ensure appropriate referrals (people whose needs could be met within the context of a brief intervention focusing upon prevention and promotion approaches), the service quickly established itself.
The service delivered was evaluated, with statistical analyses showing statistically significant improvements across all four psychometrics measures used between the first session (1) and final session (4). The improvements were maintained at follow-up, 4 to 6 weeks later. Qualitative feedback collected via service experience questionnaires and short interviews was overwhelmingly positive.
In 2021, this approach was expanded across Lancashire and South Cumbria with the development of a new psychological practitioner role: the Associate Psychological Practitioner (APP). Over the next few years, approximately 30 of the 41 Primary Care Networks (PCNs) in Lancashire and South Cumbria had an APP as part of their team. One of their key roles was to provide a preventative mental health approach tailored to local community needs. The service provided was evaluated and summarised in the following paper- Can a new role, the (Trainee) Associate Psychological Practitioner (T/APP), add value in General Practice? Results from the pilot year evaluation.
To explore this approach in greater depth and with the necessary research rigor, the next step was to apply for NIHR RfPB funding for a feasibility Randomised Controlled Trial (RCT), which has now been completed. With encouraging findings, we are now working towards a NIHR Health Technology Assessment (HTA) application to measure clinical and cost-effectiveness.
