Abstract
Recent developments in psychiatry have required increased inter-disciplinary collaboration to ensure co-ordination of specialist skills. Simultaneously, changes in management structures of participating disciplines have produced vertically organised systems of management with multiple tiers often referred to as line management. The membership of multidisciplinary teams (MDTs) now comprises individuals at varying levels in management hierarchy and with different abilities to contribute to the decision making process. Managers usually impose attitudes, expectations and obligations on staff working in MDTs which are often major obstacles to effective teamwork by causing ambivalence and opposing loyalties leaving individual workers in invidious positions (Fagin, 1985). This paper reviews current thinking on multidisciplinary teams and present day management structures among disciplines in psychiatry and discusses the practical problems and areas of conflict resulting from their interaction in settings where MDTs are expected to operate.
Highlights
MDTs have been advocated as the most appropriate method for delivery of health care in psychiatry and more in the area of community mental health (CMH) (Furnell et al, 1987; Ramon, 1989)
Many advantages are claimed for teamwork in clini cal psychiatry (0vretveit, 1986):it is assumed to pro vide a better co-ordination of different disciplines, a clearer and more equitable division of labour within the team, a holistic approach to the development of therapeutic plans for patients, a stimulating environ ment for team members where each can contribute to his/her optimal ability thereby inculcating team spirit and mutual support among team members
Many dif ferent permutations and combinations of these basic structures exist in practice depend ing on the functions of MDTs: clinical teams, planning teams, management teams, discussion forums etc
Summary
Many advantages are claimed for teamwork in clini cal psychiatry (0vretveit, 1986):it is assumed to pro vide a better co-ordination of different disciplines, a clearer and more equitable division of labour within the team, a holistic approach to the development of therapeutic plans for patients, a stimulating environ ment for team members where each can contribute to his/her optimal ability thereby inculcating team spirit and mutual support among team members. Such lofty ideals are rarely, if ever, achieved. Many model and successful pro grammes have been developed, attempts to find com monalities amongst them have not been successful and most have not been reproducible in other set tings either completely or in part
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