Mental health services and teams in the community

This leaflet is for anyone who has been referred to a mental health service/team in the community - and for their friends and family. It describes why we have mental health services/teams in the community, how they work, who works in them and what they do. The information here is most relevant for the UK. These services exist in other countries, but may be organised in different ways. 

Most mental health problems don't need a psychiatrist. Your GP can give you support, prescribe antidepressants or refer you to a counsellor or psychotherapist. However, if your problems are more complicated, your GP may want to refer you to a mental health service or team in the community.  

Many things can cause mental health problems - physical or mental illness, past experiences, difficult relationships, drug and alcohol problems or stresses like  unemployment. Relationships can become difficult and you may find it harder to deal with the various problems of life. So -  you may need help with a number of different areas to get over a mental health problem, including:

• emotional problems
• relationship problems
• housing
• medicines
• money and benefits
• work, or something rewarding and useful to do
• getting back your self-confidence.

No one, however well trained, can do all these things well. So, mental health professionals  work in teams, usually of between 8 to 16 people. Each team has several types of workers with different knowledge and skills. They will each understand how the others work and will understand how to tackle problems together.

In many areas of the UK, you will most often see a mental health worker. They can be from a number of different professional backgrounds (see below) but will all aim to develop a trusting, respectful and helpful relationship with you.

They can help by:

• working with you to keep an eye on any changes in your behaviour, feelings and thinking
• being someone to talk to
• developing your strengths
• working to find answers to your current problems
• helping you to become more independent.

You may be seen on your own, in a group with other people or, sometimes, with your friends or family. Mental health workers share a number of important skills, but can also use their more specialist professional skills when needed. These professions include:

Psychiatrist

A psychiatrist is a medical doctor with special training in mental illnesses and emotional problems. Each team has a consultant who has completed their professional training. If you need to take medication, they will be responsible for arranging this. They may also have trained in psychotherapy. There may also be an “associate specialist” or “staff grade” doctor, who will have trained in psychiatry but who has not become a consultant. They often work with a doctor doing further training in psychiatry – a “specialty trainee” or “specialist registrar”. See our leaflet on What to expect of your psychiatrist

Community Psychiatric Nurse (CPN)

CPNs work outside hospitals and visit clients in their own homes, out-patient departments or GP surgeries. They can help you to talk through problems and give practical advice and support. They can also give medicines and keep an eye on their effects. Nurse therapists have had extra training in particular problems and treatments, such as eating disorders or behaviour therapy.

Social Worker

Like other members of the team, social workers help people to talk through their problems, give them practical advice and emotional support and provide some psychological treatments. They are able to give expert practical help with money, housing problems and other entitlements.

Occupational Therapist (OT)

Occupational therapists help people to get back to doing the practical things of everyday life. They may help you:

• to work out what you can and cannot do
• with advice on where you could or should live
• to find things to do that you want to do
• to re-build your confidence
• to become independent.

This can be through doing practical things in a relaxed environment, or talking with other people in groups.

Clinical Psychologist

Clinical psychologists have a degree in psychology. During another 3 years training in clinical psychology they work with clients and learn how to give psychological treatments. They will usually meet regularly with you for a number of sessions to talk through how you are feeling, thinking and behaving. Although cognitive behavioural therapy is a common approach, clinical psychologists may use psychodynamic and behavioural psychotherapies. They also help other members of the team to work psychologically with their clients.

Pharmacist

Pharmacists train for five years to become specialists in medicines. They can give expert advice to doctors and nurses and talk to patients and carers about medications.

Other staff

The Team Manager

The team manager will usually be a senior nurse or social worker. They often do not see clients themselves. They are responsible for:

• the practical details of running the team
• how the team works with other parts of the health service and other organisations
• helping the team to develop
• making sure that the team has high standards of practice.

Approved Mental Health Professional

The Approved Mental Health Professional will usually be a social worker, but can be any member of the team. They have had further training for assessing if someone needs to be taken to hospital using the Mental Health Act. They cannot decide to admit someone to hospital on their own, but will usually need the agreement of 2 independent doctors.

Receptionists and secretaries

In a way, every person who works in a hospital unit, day centre, or hostel is a member of the team. Receptionists and secretaries make the team run smoothly and are responsible for much of the atmosphere of the service. You may find that you get to know them quite well. However, they are not usually involved in any decisions about your care.

Other staff who work directly with clients

These can include outreach workers, mental health workers, benefits workers, support workers, recovery workers, vocational therapists, arts therapists and psychotherapists. More and more, staff without a professional qualification are also working with such teams because of their special knowledge and skills. These include people who have had mental health problems, advocates, and workers from day centres or housing organisations. Specialist old age psychiatry teams may include other professionals such as speech therapists or physiotherapists. These workers may also see people in their own homes.

Where does it work? The team may have a base, like a clinic, where they can see clients. They will also work in a whole range of other places - out-patient clinics, GP surgeries, day-centres, hostels and people's own homes.

Working with you

All the team members will understand the distress that goes with mental illness. They can all offer psychological support, encouragement and practical help.

Working together

At regular team meetings, staff discuss how best to help their clients. They try to make sure that they have a clear picture of your difficulties and strengths. They can then plan the right help with you. Staff work closely together and learn a lot from each other. You may find that nurses can deal with many social problems and that occupational therapists and social workers know something about medication. This also means that, if your key worker is away, there will usually be someone around who knows something about you.

You won't have to see the whole team, although you may see one or two different people at first. The team will then decide who should work with you. You will usually see just one person at a time.

• get to know you
• learn about your difficulties
• find out how you see your problems
• know about your strengths
• discuss any plans with you
• give counselling, information and advice
• make sure that everybody is working together properly
• make sure that you have a clear 'care plan' about how you are going to be helped.

The different parts of your help or treatment are written down in the care plan. This should include:

• the problem (or problems)
• any risks involved
• your strengths
• what needs to be done to help you recover
• who should be doing what
• your views – you should have a copy.

If you need to see the team for a while, you may be put on the Care Programme Approach (CPA). This means that there is a meeting every few months with everyone who is involved in your care plan. You should be invited to this meeting, but you don't have to come if it makes you too anxious.

If you can tell your key worker what the problem is, you may be able to sort it out together. If you can't do this, you will need to talk to the team manager. If they can't sort out the problem, you may need a different key worker.

Members of a mental health team have to keep your information confidential in the same way as other doctors and health-care staff. But

• They will share information about you with other members of the team so that they can give you the best possible care.
• They will not usually give information to people outside the team without your permission.
• They will need to be able to talk to your GP and any other doctors whom you are seeing.
• Secretaries and receptionists do not have access to most of the information that the professional staff do, but will know some details about you.

If you are worried about confidentiality, check it out with one of the team - so you can be clear about who knows what, and why they need to.

Families and carers are usually concerned and want to help. Families often need support and encouragement. Many teams provide information for families and hold regular support groups. A mental health team may want a family to be involved, but are still bound by medical confidentiality. So, they will usually ask your permission to give information about you to your family. At the same time, families have to live and cope every day with problems. A mental health team should ask you about what you are happy for your family to know, and what you do not want discussed with them.

An advocate can help you to ask questions and get your message across to professionals. He or she can go to meetings with you. They are not usually part of the mental health team, but will be employed by a voluntary organisation or another part of the health service.

This will depend both on what the team thinks would be most helpful and on what you would prefer. It isn't usually a simple choice of either pills or counselling. Most people need the chance to talk though their problems and feel understood, and most staff have counselling skills of varying degrees. Sometimes there may be a worker, often a clinical psychologist who does just counselling or psychotherapy. Many people get help from both medication and talking treatments.

Mental health teams and GPs should work closely together. After the staff have seen you, they will send your GP a letter to tell him or her about their assessment of your problems and what they suggest should be done. Your GP will often prescribe regular medications for you. Unless you are admitted to hospital, your GP remains responsible for the rest of your medical care. If you are admitted to hospital, your GP will be kept informed of your progress and the discharge plan. When you are in hospital, the psychiatrist will be responsible for your medical care.

If you cannot sort the issue out with the member of staff involved, contact the team manager. If you are not happy with what they say, you can make an official complaint to the health trust, Community Health Partnership or Health Board (depending on where you live in the UK) which is responsible for that particular team. All trusts should have a clear way of dealing with complaints.

In the UK, there is now a range of more specialist services in the community, including:

• Home treatment
• Crisis intervention
• Early onset psychosis
• First episode psychosis
• ABT (assessment and brief treatment)
• Continuing care
• Rehabilitation
• Assertive Outreach
• Forensic

They share most of the features described above, but deal with a particular set of problems.

Teams in different areas may be quite different. Some mental health teams concentrate on helping people who have severe and long-lasting mental illness. They may not be able to provide much in the way of counselling services for people with less severe depression or anxiety problems.  If you are not happy with the services available, your Independent Complaints Advocacy Service (in Wales, the  Community Health Council) may be able to take it up with the local Health Authority.

This factsheet was produced by the RCPsych's Public Education Editorial Board.

Series Editor: Dr Philip Timms.