Name: DILO03
Job Title: Primary Mental Health Counsellor
Organisation: NHS – Mental health services
Health Board: Powys Teaching Health Board
Introduction
Primary mental health counsellors work alongside GPs to support patients who are suffering with ‘mild to moderate’ mental health conditions. DILO3 also works with patients who have experienced trauma, such as severe history of abuse. Patients are referred to a primary mental health counsellor via their GP and any patient can be referred to the service if necessary. DILO03 has daily interactions with patients with a severe history of sexual abuse, domestic abuse, suicidal tendencies and physical and mental trauma as well as those who may be on probation following a sexual assault conviction. All work is completed through the NHS. DILO03 can refer to Community Mental Health Teams for support if there are suicidal affiliations or complex trauma. DILO03 has a diverse demographic of patients, with an increase in males accepting help over the past five years.
A typical appointment with a primary mental health counsellor involves using a range of techniques and strategies to support patients presenting with mental health problems. The appointment is patient led, with some circumstances allowing another person being brought with the patient to attend the appointment for support. Each patient gets 10 sessions with an option for re-referral if further sessions are needed. Counselling appointments last 50 minutes for a typical therapy session and 90 minutes for a trauma session. Each patient referred to the service is permitted to 10 sessions with DILO03, this can be extended if DILO03 believes progress cannot be made during this time as the main aim of the service is to aid recovery.
Technology, Training and Staff Capacity
Most counselling sessions are done via telephone or through video consultation. Video consulting can now replace telephone calling which works well for staff members who do not have a work phone. Initially patients were not keen on VC, but after an adjustment period they find it easier and more convenient.
Staff in this service use EMIS (a patient record system and software) to document discussions with patients, treatment goals and progress. It is also used for referring patients to other services due to potential risks that the patient is displaying. DILO03 works within a team of 6 counsellors, but there is integration with other services such as CMHT (Community Mental Health Team), psychology services and complex trauma services to help with complex and emergency situations. DILO3 has been in the current role for 5 years, is an accredited counsellor, has a clinical masters in Psychological Trauma and has completed many training programmes including autism and trauma programmes.
Benefits of the role
DILO03 noted that the use of digital documents for patients notes and documents is beneficial to the role as it reduces the tedious and impractical tasks that are associated with paper-based documents.
Enabling patients to recover from mental illness was expressed as a benefit to the role by DILO03 as she likes to make a difference to patients, supporting them in recovery from trauma. There is additionally a supportive team in which DILO03 works within who are willing to help with difficult situations. The impact of the pathway isn’t just on an individual basis, this extends into wider society, the community, friends, family and children. There is strong evidence for recovery of patients that use the service, even the most severe cases can usually get to a more positive place.
Challenges of the role
One challenge that is faced for the role of Primary Mental Health Counsellor is the current IT systems. This includes the connectivity to VPN systems, which can prove difficult whilst accessing online documents. It can occasionally take up to 15 minutes to change the name on a document, DILO03 expressed that a lot of time is often wasted because of the poor digital infrastructure.
Working from home as a counsellor can be intense in comparison to working in person. The main issues are screen fatigue and burnout. Additionally, not having a proper at home set up can be a challenge. There is also less interaction with the wider team and DILO03 expressed they miss the colleague support that in person work can provide.
There are currently not enough resources to support the large waiting list, which results in staff completing more than their standard hours. Following the COVID19 pandemic, there was a rise in individuals who were seeking the needs of the service. There are currently not enough resources to support the demand.
What is needed to improve the service?
Improvements for a home office set up could improve working quality for staff, having a fully functioning home office which includes a suitable camera, microphone and desk would support staff who do not currently have access to this equipment.
Further recognition to the work DILO03 and their colleagues completes may improve the service by providing more insight into the tasks and challenges that are associated with role. Access to additional resources was expressed as desirable to aid the reduction of waiting times that the service is currently experiencing.
Conclusion
The role of a Primary Mental Health Counsellor (PMHC) is important in helping an individual enable their own recovery from trauma. The positive impact the role can have goes further than the individual, spanning to family members, friends, the community and society. Although there are barriers that remote working can bring for a PMHC, online counselling sessions have allowed for easier and more convenient access to support for complex issues.