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Promoting Excellence In Psychological Health & Wellbeing

Guest Blog: Transition from community PWP to senior PWP within The Mental Health Treatment Requirement (MHTR) Service, by Emily Thompson

23 Aug 23

For qualified PWP’s interested in a change in role and an opportunity to develop your skills as a practitioner you may be interested to find out more about opportunities within Mental Health Treatment Requirement (MHTR) teams.

If you do not work within the unique and relatively small world of forensic mental health, it would surprising if you have heard of Mental Health Treatment Requirements (MHTR)’s. I had not heard of them before making my application to the post, and I have subsequently had to explain the role to most people I have come across; the majority of whom are probation officers or mental health practitioners themselves, which demonstrates how infrequently they have been utilised in the past.

More information can be found here, but in summary they are an out of court sentencing option for individuals whose mental health difficulties have impacted on their offending behaviours. When I saw the post of ‘Primary Care MHTR Mental Health Practitioner’ I was initially, very intrigued, and then shocked when it stated that this was a pilot programme. To me it made sense that offending must so frequently be a sign of mental distress being externalised, and I couldn’t believe that the role had not been in place for several years. I began working for the pilot project in Bolton, Greater Manchester in September 2021, and the last 2 years have demonstrated how clearly my initial hunch was correct.

The post was advertised as Band 6 for PWP’s, Nurses, Social Workers, or Occupational Therapists, with experience of formulation and treatment of psychological interventions. As a current PWP with previous experience working as a police officer – the role seemed like a perfect match for my skills and interests, and I was privileged to be the first individual in post.

What followed was very different to the world of being a PWP in a traditional team. When I was informed my caseload would be 20 rather than 35, I was delighted and I thought I was in for a walk in the park. When I also heard that prison PWP’s have the same reduced caseloads compared to community staff, I was almost outraged and wondered why I hadn’t started working for forensic services sooner.  

When I began my assessments and clinical work, I realised why this was the case. The world of primary care is designed for the masses and not the marginalised. My previous role was protected in the sense that if someone failed to attend for their assessments or appointments then I could discharge them without thought. What I realised working within the MHTR service was that I was providing a service to individuals who had previously slipped through the net. Clients who had missed previous assessment opportunities because of a transient lifestyle, those refused because of substance use and individuals deemed ‘too risky’ for a primary care service owing to their offending behaviours.

Alongside those who presented with significant trauma, I was also witness to increased neurodiverse presentations, physical health injuries and co-morbid substance use. The majority of clients on my caseload are either homeless or on the brink of homelessness and they have limited routine, structure and positive personal support. Many clients required support to put a calendar reminder on their mobile phones. It made me realise that the world of mental health is designed for individuals with calendars and routines: individuals who lack these skills may automatically be discharged when in fact they require the most support.

The work is the most simultaneously interesting, challenging but rewarding I have done. I work with people longer than normally prescribed for a PWP, but being supervised by a psychologist and the role flexibility has allowed me to expand on my CBT knowledge and the privilege of additional training in alternative techniques to meet the needs of the harder to reach clients. If you like a challenge, then I would keep an eye out for roles such as mine in the future. Currently primary care MHTR’s have a 60% UK coverage, but this expected to be 100% by 2024. Make sure you set an alert on your jobs for ‘Mental Health Treatment Requirement (MHTR)’. Currently these posts are advertised as either a band 5 Assistant Psychologist, or alternatively advertised specifically for PWP’s.