Working together in adult community mental health services: An inter-professional dialogue

Abstract

This paper draws upon an initiative by the Centre for Mental Health Services Development to establish a multi-professional dialogue between senior mental health care professionals in order to explore key problems of inter-professional working in adult community mental health services and to formulate a realistic agenda for addressing them. These aims were pursued through a programme of facilitated discussion and work groups focusing on the community mental health team (CMHT), which is identified in the literature as an arena for inter-professional conflict and frequently characterised by over-ambitious and unfocused aims and confusion about accountability and responsibility of staff. Problems of inter-professional working in health and social care are well known, but within CMHTs these appear to take a particular character. Discussions revealed and explored four key reasons why mental health professionals working within teams are reluctant to comply with operational directives. These are: loss of faith by mental health care professionals in the system within which they work; their strong adherence to uni-professional cultures; absence of a strong and shared philosophy of community mental health services; and a mistrust of managerial solutions to the problems of inter-professional working. The provisional agenda developed by the multi-professional group had four main elements: drawing upon users' aspirations as an explicit philosophy for guiding the development of CMHTs; clarifying accountability and responsibility of CMHT staff; clarifying roles of CMHT staff; developing a framework to explore the relationships between multi-disciplinary groups; and drawing upon theoretical sources for understanding team effectiveness. The first four elements need, the paper suggests, action mainly at the level of national professional organisations, whereas the final element requires action mainly at the level of local mental health services.