Multidisciplinary team functioning and decision making within forensic mental health

Alina Haines,Elizabeth A Evans,Elizabeth Perkins,Rhiannah Mccabe

doi:10.1108/mhrj-01-2018-0001

Abstract

PurposeThe purpose of this paper is to investigate the operation of multidisciplinary team (MDT) meetings within a forensic hospital in England, UK.Design/methodology/approachMixed methods, including qualitative face to face interviews with professionals and service users, video observations of MDT meetings and documentary analysis. Data were collected from 142 staff and 30 service users who consented to take part in the research and analysed using the constant comparison technique of grounded theory and ethnography.FindingsDecisions taken within MDT meetings are unequally shaped by the professional and personal values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and responsibility of each member of the team. Service users’ involvement is marginalised. This is linked to a longstanding tradition of psychiatric paternalism in mental health care.Research limitations/implicationsFuture research should explore the nuances of interactions between MDT professionals and service users during the meetings, the language used and the approach taken by professionals to enable/empower service user to be actively involved.Practical implicationsClear aims, responsibilities and implementation actions are a pre-requisite to effective MDT working. There is a need to give service users greater responsibility and power regarding their care.Originality/valueWhile direct (video) observations were very difficult to achieve in secure settings, they enabled unmediated access to how people conducted themselves rather than having to rely only on their subjective accounts (from the interviews).

Highlights

The concept of multidisciplinary working in the UK is not new and in mental health care has been written about since the 1970s
A body of research evidence has been established to identify some of the benefits of multidisciplinary psychiatric teams (MDT) working within mental health services, such as reduced bed use (Marks et al, 1994), improved service contact after discharge from hospital (Ford, 1995), preferred by service users and (The authors affiliations can be found at the end of this article.)
This paper aims to address this gap by exploring team functioning and MDT decision making within forensic settings; while acknowledging that the way in which MDTs operate within forensic mental health is different from community or other acute settings

Summary

Introduction

The concept of multidisciplinary working in the UK is not new and in mental health care has been written about since the 1970s. In 1984 the Department of Health’s “Planning for the Future” strategy recommended the establishment of multidisciplinary psychiatric teams (MDT) comprising psychiatrists, psychiatric nurses, psychologists, social workers and occupational therapists to provide comprehensive treatment and care for people with mental health problems (Study Group on the Development of the Psychiatric Services, 1984). A body of research evidence has been established to identify some of the benefits of MDT working within mental health services, such as reduced bed use (Marks et al, 1994), improved service contact after discharge from hospital (Ford, 1995), preferred by service users and (The authors affiliations can be found at the end of this article.). The authors thank all those service users and staff who took part in the interviews and the observations

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