When the government's national plan for the NHS was launched, stories about more doctors, nurses and beds grabbed the headlines.

The plan is a big document, however, with considerable detail. The nuts and bolts about mental health turn up in chapter 14 and there is a strong emphasis on service delivery at the primary care level. Ministers want more early intervention in mental health problems. They also believe the necessary skills can be acquired by people other than specialist community mental health nurses and psychiatrists.

The national plan states: "One thousand new graduate primary care mental health workers, trained in brief therapy techniques of proven effectiveness, will be employed to help GPs manage and treat common mental health problems in all age groups, including children."

Service users
The Department of Health says training and recruitment over the next two years will mean new workers in place for year three of the spending review (2003-04).

But where is the new breed to come from? The government's mental health "tsar", Louis Appleby, suggests psychology graduates. An expert in psychiatric nurse training, Kevin Gournay, believes that service users, those who have experienced mental illness and used mental health services, could be recruited. Meanwhile, there is wariness among more well established professionals such as community psychiatric nurses.

The new policy rests on a perception that early intervention in mental illness is crucial and currently under-resourced. A patient's condition can deteriorate rapidly if the orthodox and time-consuming route through GP, consultant psychiatrist and then treatment is followed. The new primary care mental health workers would target "common" illnesses, such as panic attacks, agoraphobia and depression, delivering so-called "brief interventions" - basic cognitive therapy rather than medication-based solutions.

A whole new type of health professional raises numerous questions about training, links with other staff and where the new recruits will come from. Appleby, appointed this year as the government's national director for mental health, says many of the details are still under discussion. He has said that psychology graduates could be an obvious source, though other social science disciplines might also be appropriate.

Logical step
Currently, psychology graduates find their way into a wide range of fields. Some, who would prefer a career in clinical psychology, are thwarted by the competitive entrance requirements and might consider training for the new posts. Others might be seeking higher pay than offered by the health service. Sally Coombes, for example, a second year student at Warwick University, said the new role was a "logical step" for someone doing psychology but it was not for her. "I'm looking at jobs in the city or banks," she says.

Gournay, the iconoclastic professor of psychiatric nursing at King's College London Institute of Psychiatry, would cast the net wider. Alongside graduates and practice nurses, he suggests that service users be brought into the frame.

He is patron of the charity No Panic, which offers telephone support to people affected by panic attacks. No Panic counsellors include those who suffer from the condition.

"We have evaluated the help given by some of the No Panic workers using brief cognitive therapies and the outcomes are really good. Evidence from the United States suggests users can be become good case managers," he says.

Enthusiastic
Gournay acknowledges that many mental health professionals have worries but he is an enthusiast for the plan. His reputation among some community psychiatric nurses as "the anti-Christ" is only half affectionate.

Brian Rogers, professional officer for the Community Psychiatric Nurses' Association, warns that the new staff "must have something specific to do". He argues: "The health service should be appointing 'local champions' who will speak for mental health, as primary care is developed over the next few years."

Rogers may have put his finger on something. Primary care is set for big shake-ups with the spread of primary care trusts, and then health and care trusts embracing social services. The new mental health workers will have to find their feet at a turbulent time. They will need all the help they can get.