The PHASE research programme is an NHS-Executive funded, randomized controlled trial of assisted self-help for common mental disorders, delivered by practice nurses in primary care. The self-help guide – Managing anxiety and depression: a self-help guide published by the Mental Health Foundation – is conceptualized as a ‘health technology’ where the nurse's role is to educate patients how to get the best out of the technology, supervise its safe delivery and monitor its continued use by patients so that they can use it independently with little reliance on nurses or other health professionals. Twenty-three nurses were trained on one of five, 3-day courses to deliver PHASE. As the final task during the training course, nurses were asked to describe what they would say to a patient when delivering PHASE. From these data a qualitative thematic content analysis was used to develop a coding framework which showed that nurses were able to articulate a sophisticated health technology rationale, including relevant psychological models and the principle of an evidence base. This study demonstrates that it is possible to equip primary care nurses with both a highly developed understanding and the knowledge to deliver self-help mental health care. Training nurses using this model moves us away from traditional mental health training courses that have attempted to produce ‘watered down’ versions of specialist practitioners to a more appropriate skills and cultural ‘health technology’ fit for delivering primary mental health care.

Common mental health problems are highly prevalent in primary care, the UK National Service Framework for mental health demanding that effective and accessible services be made available. Although built upon a strong evidence base, traditional psychological therapies are often limited in terms of their applicability and availability. As a consequence innovative self-help programmes are increasingly being advocated as an alternative means of managing mental health illness within primary care. This study reports the results of a three month evaluation of a self-help service provided by a busy UK urban Primary Care Trust. Levels of utilization, effectiveness and stakeholder acceptability were examined through a combination of quantitative and qualitative data. A total of 662 patients were referred to the self-help clinics over a three month period, 67% of whom attended their first appointment. The mean number of sessions per patient was 2.8 (SD = 2.4), with an average total time of 69.6 min (SD = 48.2). Mean Clinical Outcomes in Routine Evaluation (CORE-OM) scores improved significantly between baseline and three month follow-up (P < 0.001), 39% of patients demonstrating a clinically significant improvement. Both selfhelp therapists and referring general practitioners reported moderate to high satisfaction with the self-help treatment model, with the majority of patients perceiving the intervention to be appropriate to their needs. Data demonstrated that, whilst there was a clear need for a simple self-help service to be based in primary care, the ultimate success of this provision necessitates a well developed infrastructure capable of providing sufficient support and information to ensure that it is flexible and responsive to individual needs.

Employment initiatives for people who have experienced mental health problems offer development strategies that could be seen to match the philosophy and circumstances of mental health services in developing countries. Simple strategies to develop employment initiatives with a strong emphasis on self-reliance would appear to fit with current thinking on the promotion of mental health in developing countries (Üstün and Jenkins, 1998). The need for effective models to act as exemplars for programme development has been noted (Üstün and Jenkins, 1998). There are numerous models of employment rehabilitation detailed in the literature that might offer ideas for direction and development, but much of the research has been focused on Western European and North American models. Little attention has been paid to such schemes in developing countries, and therefore what is required is a project to identify emerging and innovative models of employment rehabilitation at a global level. The insights gained would assist in the development of guidelines for working with existing organizations in supporting and promoting good practice in developing countries. Development projects do not take place within a sociocultural vacuum, and indeed their success or failure is inextricably linked to social structures and social interaction. This paper sets out a research agenda for understanding and evaluating employment projects using the concept of ‘social capital’ as a framework.