Running an effective community mental health team

Abstract

Community psychiatric teams are an integral part of modern mental health services. The development of such teams has allowed the care of patients to be transferred from institutions to the community. A Cochrane review of community-based programmes showed that community team-based psychiatric services led to a reduction in suicide rates, improved patient engagement and were more acceptable to patients (Tyrer et al, 1999). Community care also reduces the number of days patients stay in hospital, but not the number of admissions (Marshall et al, 1995). However, community mental health teams (CMHTs) have been criticised for their ambiguous and overambitious aims, and their tendency to neglect people with the most challenging health- and social-care needs (Patmore & Weaver, 1991; Sayce et al, 1991). All mental health workers are not necessarily eager, or skilled, to work effectively in teams. Building and maintaining an effective team requires commitment, clarity of purpose, a shared vision and frequent review of team operations. In a previous issue of APT, Burns & Guest (1999) described the adaptation and running of an assertive community treatment team in an inner-city area. Here I examine the attributes of effective CMHTs (Box 1), enumerate barriers and challenges to team-working (Box 2) and suggest strategies for improving team effectiveness (Box 3).

A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality

“…A key issue for CMHTs, therefore, is how they gate-keep access to their service [12]. Previous studies have suggested that gate-keeping decisions have been largely determined by individual clinicians and teams, rather than through formal strategic control [13].…”

Teamwork Within Mental Health Services in Ireland: Resource Paper

“…69 Lack of throughput can result from members' retaining, and failing to discharge, their fixed case-loads of chronic, stable and familiar cases, and their reluctance to take on potentially complex cases. 32 This again underlines the need for teams to stay outward looking, continually fostering links with other more socially inclusive forms of support. Excessive workloads can also predispose to generic monitoring and support, thus rendering team members' specialist skill-sets redundant.…”

“…32 While diversity within teams is to be prized, such conflicts are probably self-indulgent. Service user need requires models that encompass a wide variety of approaches and that, most importantly, have explanatory (rather than merely descriptive) power for users and their supports.…”

“…However, with the support of the clinical leader, the team co-ordinator is likely to have a significant (although nondeterminant) input into how these decisions are made. S/he also monitors members' workloads to both inform equitable work burden distribution 32 and to protect team capacity for new referrals (see Section 5.3).…”

Steps towards effective teamworking in Community Mental Health Teams

“…The choice of care model is often hotly contested among team members from differing disciplines who may compete to assert the primacy of their preferred model and the superiority of their associated interventions (Singh 2000). However, this competition and subsequent choosing of a particular 'professional' model (e.g., the biopsychosocial model) (Clare 1976) is time poorly spent, as it does not satisfy the diverse needs of service users (Byrne & Onyett 2010).…”