Mental Health, MDT’s and the A-Team

I’m not usually given to talking shop on a Friday night, but my ire is piqued and curiosity aroused by a spate of recent blog posts, all of which pile yet more misery on a mental health system which, if it were a human being, would have several coppers, a psychiatrist and an AMHP all trying to talk it out of throwing itself off the top of a multi-storey car park.

In a well written and understandably anonymous post, a Mental Health Social Worker (‘Being Here’) describes their redeployment from front-line mental health care within a Community Mental Health Team (CMHT) to, well, even the author doesn’t sound too sure. But it sounds a little like pushing bits of paper around a desk and pissing many years of valuable experience into the gale force winds of budget cuts and reorganisation.

Being an independent freelancer I’m lucky to be able to write stuff like this under my own name and not to have to adopt identities, but ‘Zarathustra’ works within a Child and Adolescent Mental Health Service (CAMHS) and has some further (again understandably anonymous) scorn to pour over similar losses of Social Workers from their CAMHS team. More redeployment, more cuts, and definitely less joined up working between health care and social services. With seriously distressed people already being left to fester in their own metaphorical shite by skeletal levels of mental health provision, this in itself is inexcusable. But there’s more to the story than that.

As both a Community Psychiatric Nurse and a Secure Unit Team leader I’ve been lucky enough to have spent many, many years working closely alongside Social Workers and all the other disciplines making up the typical Multi-Disciplinary Team (MDT). In the Being Here blog, the author makes a case for the inclusion of CMHT Social Workers on the basis of the oft-quoted position that the Social Work perspective adds a much needed holistic perspective to the often overly medical-model approach of the CMHT. 

Well I can see the argument there, but don’t really buy it. Not because the argument is intellectually flawed (it isnt) but because I’ve never really bought into the ‘I’m a Social Worker’, ‘I’m a Nurse’ thing. 

The most effective MDTs I’ve worked with have pretty much left the qualifications at the office door and got on with using their individual skills to simply do the stuff of helping the people we’re there to help. And the not so good teams I’ve worked with? They’re the ones with Doctors and Psychologists and Social Workers and Nurses and Occupational Therapists all sitting in their own offices with big red labels tattooed across their foreheads saying ‘DOCTOR’ ‘PSYCHOLOGIST’ ‘SOCIAL WORKER’ etc etc. You get the picture.

I’ve yet to meet a psychiatric nurse who can give a truly convincing account of the particularly special skills they bring to the MDT party, and at the risk of upsetting even more psychiatrists than I already have in these pages, there is a loudly whispered argument (even within the trade) that there isn’t much a psychiatrist does that couldn’t be done by a reasonably psych-friendly GP. 

But before making myself too troll-friendly to CMHT people currently creating voodoo dolls into which depot syringes can be sunk, let’s just say that I’ve worked with many mental health professionals who, were I given the option of hand-picking a Dirty Dozen style A-Team to staff a top quality CMHT, I would recruit in a heart-beat. Would they be Social Workers, Psychologists or Nurses? Doctors or Occupational Therapists? Would I give a toss? No. They’d be Garys and Debbies, Steves and Amandas. Just people who are really very good at doing mental health care.

Okay, I’m hearing a very loud flaw in this argument which is sounding suspiciously like the age-old ‘generic mental health worker’ mantra possibly dating from the pre-Cambrian period. Being Here refers to their skills and training as a Psychosocial Intervention specialist. I’ve worked with many individuals who have trained in this invaluable specialty. Or as Cognitive Behaviour Therapists. Or in Dialectical Behaviour Therapy. Me? I’m pretty good at depot injections, but we could train a chimp to do that. I’m also pretty good at helping people understand why they’re having a needle stuck in their bum. I’m also pretty good at crisis intervention. Can’t train a chimp to do that. 

Aha. Now we’re getting somewhere. We’re now talking specific treatment skills. So now I’m not only recruiting my A-Team based on good all round skills, ability to work as a team and a fondness for getting exceptionally silly at the CMHT Christmas Party. I’m also recruiting people who are trained in specific interventions and approaches. Skills that are not discipline-centric, but based on the ability to provide a really thorough, all round service for the pot-pourri of distressed people we’re typically going to see in the course of a working day. 

And just one more thing before I press the ‘Publish’ button and sink back into the Friday night wine bottle. Zarathustra’s well-argued and highly accurate observation is this. That health services on the one hand, and social services on the other, who are meant to be working together in a lovely, happy-clappy, seamless congruence of shared meetings, shared coffee and first-name terms, are in reality batting cases between each other like a hot potato across a very scary and rather large table-tennis table. I run lots of Dual Diagnosis courses and am more than familiar with the scenario.

So the final bit of my job description for the A-Team, once again based on experience working with the mythical ‘MDTs That Rock’, is this. 

To have the imagination, the ‘thinking-out-of-the-box-ness’ and the ability to remember just why we do this job. To consider the patient/service-user/client (you choose) as being just a little more important than the petty bureaucracy, disciplinary empire building, back-covering, petty squabbling and general anal retentiveness that seems to pervade today’s mental health care. And as a UK-wide consultant working with just about every discipline known to social care, I’d like to think I’m able to say that with some authority and a not a little sorrow.