The psychiatric multidisciplinary team

The multidisciplinary team consists of one or more members of each professional group involved in psychiatric patient care: doctors, nurses, clinical psychologists, social workers, and occupational therapists. Much good work is also done by less qualified support workers, who are cheaper to employ and who therefore have more time than other specialists to forge enduring relationships with individual patients.

Teams for general adult psychiatry are usually responsible for a given sector, defined geographically (for example, by postcode) or by GP. Other teams, often covering a wider area, deal with specialties such as old-age psychiatry, child psychiatry, learning disability, substance misuse, forensic psychiatry, psychotherapy, and rehabilitation.

A community mental health team may be based in a hospital, a health centre, a converted house, or a purpose-built unit within the community served. Each team member is involved in assessment and management of referred patients, contributing both from their professional viewpoint and from their personal knowledge of the patient. It is usual to have a weekly team meeting, at which new referrals are discussed and progress or problems with existing patients are shared and reviewed.

Social workers in the teams used to be employed and managed by local authority departments of social services, leading to potential problems, as most of the rest of the team were employed by health services. Recently, there have been moves to bring all staff under the same management.

Each team may have up to 500 patients on the books at any one time; day-today clinical management of most of them is carried out by non-medical team members. Ultimate responsibility for patient care remains with the consultant, if the patient is seeing a psychiatrist. If the patient is seeing only a member of the team, and is not seeing a psychiatrist, responsibility lies with the team manager and/or the referring GP.

The role of the psychiatrist in the team is not only to have a caseload, but also to be a resource for the rest of the team: he must be approachable and available for advice and discussion, and able to work flexibly. Fitting in patients for consultation as soon as problems start to develop is particularly appreciated, and probably reduces everyone's workload in the long run.

In some areas, community mental 'resource centres' have been set up by social service departments with input from the voluntary sector, especially mental health charities.

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