Redefining the role of 'non-professionally affiliated' workers in community mental health care :a qualitative exploration of co-worker and client relationships

Abstract

Recent changes to UK health care policy have led to a dramatic increase in the non-professionally affiliated (NPA) workforce. Despite the growing presence and importance of NPA roles as part of the ‘drive for better value’, until recently they existed as healthcare’s ‘invisible workers’ (Thornley, 1997). The developing body of literature is at an early stage, with discussion usually confined to hospital wards and to consideration of the NPA-professional relationship. This study advances existing theory using an exploration of the subjective NPA experience within the novel context of community mental health services. Underpinned by an interpretivist, qualitative approach the findings are constructed using data from semi-structured interviews with workers (n=32) across a number of roles, teams and organisations, alongside interviews with team managers (n=5) and documentary analysis. Drawing on the concept of ‘community co-production’, the presented findings contrast discussion elsewhere by building a picture of working life characterised by professional distance rather than professional proximity. In light of high levels of lone working, autonomy and responsibility reported by workers it is argued that worker role may be more usefully defined in terms of the position relative to the client (supporter, facilitator or ambassador) than relative to the professional. The client interaction is introduced as an under-explored but central aspect of worker experience, shown to exert considerable influence both as a positive source of worker fulfilment and as a potential source of burden arising from risk, dependency and boundary issues. Attention is drawn to the influence of workplace, organisational and political context in shaping worker role and relationships. As NPA numbers continue to rise on a rapid, global scale in combination with an increasing move towards care in the community, the findings presented here raise a number of issues for researchers, managers and policy makers