This leaflet is for
anyone who wants to know about mental health teams. This could
include anyone who has been referred to a mental health team, or
anyone who has a friend or relative who is being seen by a mental
health team. The leaflet describes why we have mental health teams,
how they work, who works in them and what they can do for you.
Introduction
Many people with mental health problems never see a
psychiatrist. Their GP may prescribe anti-depressants or refer them
to a counsellor. However, you may have problems that are more
serious, or too complicated to be helped in this way. Your GP may
then refer you to a mental health team. If you are over the age of
60, you may be seen by a team which specialises in the mental
health problems of later life.
Why do we have mental health teams?
Mental health problems can be caused by physical, mental or social
conditions - or any combination of these. Many different parts of
your life may need to be understood to make sure that you get the
right help for a mental health problem. A physical or mental
illness, past experiences, difficult relationships and stresses
such as unemployment and drug or alcohol problems can all play a
part.
Getting over a mental health problem can also mean that you
may need help with different parts of your life - help with
medicines, help with relationship problems, help with housing or
with sorting out benefits. You may need to find something rewarding
and useful to do during the day, or some special help to get back
your self-confidence.
So, a lot of different skills can be needed to help someone
with a mental health problem. No single professional, however well
trained, can possibly be expert in all these skills. This is why
different mental health professionals work in teams, usually of
about eight to sixteen people.
The team should have workers from different professions, who
understand each other's different skills and ways of approaching
problems. Most people recover from their mental health problems
without coming into hospital, and so the team is usually called a
community mental health team (CMHT).
Who might you meet in a community mental health
team?
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 and is often involved in
the first assessment of someone's problems. If you need to take
medication, they will be responsible for arranging this. They may
also have training in psychotherapy. They usually work with a
trainee, or junior psychiatrist called an SHO (senior house
officer) or specialist registrar. These trainees have been
fully-trained as doctors and have worked in general medicine, but
are receiving further training in psychiatry.
Nurses in CMHTs work outside hospitals, usually visiting
patients in their own homes, out-patients departments or family
doctors' surgeries. They are called community psychiatric nurses
(CPNs). CPNs can help people to talk through their problems and
give them practical advice and support. They can also give
medicines and keep an eye on their effects. Some nurses have
received extra training in particlar problems and treatments, such
as eating disorders or behaviour therapy. They are called nurse
therapists.
Clinical psychologists are trained in psychological
treatments. They will usually meet regularly with you for a number
of sessions to talk through problems and find ways of solving them.
Occupational therapists help people to get back to doing things,
and help them to regain their self-confidence. This can be through
doing practical things in a relaxed environment, or talking with
other people in groups. Social workers are an essential part of the
CMHT, although they may be employed by the local authority rather
than the hospital. They are able to help with money and housing
problems and play an important part in helping with child-care
issues.
Pharmacists train for five years to become specialists in
medicines: as part of a mental health team they offer expert advice
to doctors and nurses about the benefits and side-effects of
different medications. They are also available to talk to patients
and their carers about their medication and answer any questions
they may have.
Besides these main professions, CMHTs may include other sorts
of worker. These include outreach workers, mental health workers,
support workers, vocational therapists, art therapists and
psychotherapists.
More and more, staff without a professional qualification may
work with the team because of their special experience. These
include other people who have experienced 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. Such workers may
also see people in their own homes.
Where does the team work?
The team may have a base, like a clinic, where they can see
clients. They will also work in a whole range of places -
out-patient clinics, GP surgeries, day-centres, hostels and
people's own homes.
Team working
As well as their professional skills, the team members will have
experience in understanding the distress that goes with mental
illness. They can all offer support and encouragement. By working
together, they try to make sure that the team has a clear picture
of your difficulties and strengths. Then, they can plan the right
help for you. Staff work closely together and so they often learn a
lot from each other. You may find that nurses can deal with many
social and work-related problems and that Occupational Therapists
and social workers know something about medication.
Usually, you won't have to see the whole team. After you have
been seen once or twice, the team will meet to decide who will work
with you.
The key worker
Usually, one of the team members would become your key worker. Any
member of the team can be a key worker, although it is usually a
social worker or nurse. The keyworker's job is to get to know you
well and to make sure that you are getting the help you need.
This should be a helpful and supportive partnership. Your key
worker should learn about your difficulties and about how you see
your problems. He or she should discuss any plans for treatment
with you. They may give counselling, information and advice.
As well as their own special skills, the key worker is
responsible for keeping in touch with other workers who may be
seeing you. This is to make sure that everybody is working together
properly. They also need to make sure that you have a clear plan
about how you are going to be helped - a care plan.
The different parts of your help or treatment are written down
in the care plan. This should list the problem, what needs to be
done, and who should be doing what. You should be involved in
putting together your care-plan and will usually be offered a copy
(as will your GP). If you are going to need to see the team for a
while, you may be put on the Care Programme Approach (CPA). This
means that you take part in a meeting every few months, to look at
your care plan and change it when necessary.
What if I don't get on with my key
worker?
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 about it to someone else in the team. If the problem can't
be sorted out, the team may need to arrange a different key worker
for you.
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.
Will every patient meet the whole team?
The thought of meeting a room full of strangers is a bit daunting
for most of us. You only need to meet the members of the team who
are involved in your care. For most people, this will be only one
member of staff at any one time, but they will have the back-up of
the team. Every so often there will probably be a meeting for
everyone who is looking after you. You should be invited to this,
but you don't have to if it makes you too anxious.
What about confidentiality?
Members of a CMHT are expected to respect your confidentiality in
the same way as other doctors and health-care staff. They will
share information about you within the team so that they can plan
your care effectively. They will not usually share information
about you to outsiders without your express permission. They will
need, however, 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 clients. If you are worried about confidentiality, do
check it out with one of the team so that you can be quite clear
about who knows what, and why they need to.
Can relatives and friends become
involved?
Families and carers should be important to mental health teams.
Relatives and friends will usually already be concerned and
involved. Families often need support and encouragement, but also
information to help them better understand the problems involved.
Many teams provide education about the mental ill-health for
families, hold regular support groups and encourage families to be
involved in planning and reviewing treatment.
However, CMHTs are still bound by medical confidentiality and
so can not usually do this without the patient's clear permission.
CMHTs recognise the patients' need for privacy and their wish,
sometimes, to sort things out before discussing them with family
members. At the same time, families have to live and cope every day
with problems. If there are difficulties, a CMHT should make strong
efforts to persuade a client to allow their family to be
involved.
What about advocates?
An advocate is someone who can help you to make sure that your
voice is heard by professionals. He or she can accompany you to
meetings with professionals. They can help you ask the questions
you need to, and make sure that you get your message across. They
would not usually be part of the mental health team, but might be
employed by a voluntary organisation or another part of the health
service.
Will I be offered the choice of pills or
counselling?
The treatment you will be offered will depend on your needs and
should be discussed with you. It's very rarely a case of either
pills or counselling. Most patients need some counselling (a chance
to talk though their problems and feel understood) and most CMHT
staff have counselling skills of varying degrees. Sometimes there
may be a worker who does just counselling or psychotherapy. Many
people will benefit from both medication and talking
treatments.
How does my family doctor fit in?
Usually it will be your GP who has asked for you to see the team.
Community mental health teams and GPs work closely together. After
CMHT 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 plays an important part in the treatment plan, and
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 told, will be
kept informed of your progress and will be told when you are
discharged. When someone is in hospital, the psychiatrist usually
assumes full medical responsibility. Often team members work
closely with GPs, and you may be able to see your social worker,
CPN or psychiatrist in the GP surgery.
What can I expect in my area?
Teams in different areas may be quite different. Some CMHTs
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.
What any CMHT provides is decided between your local Health
Authority, who have the money, and your local Mental Health Trust,
who run the CMHT. If you are not happy with the services available,
your Independent Complaints Advocacy Service (in Wales Community
Health Council) may be able to take it up with the Health
Authority.
This factsheet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
Series Editor: Dr Philip Timms.
© 2006 Royal College of Psychiatrists. This factsheet may be
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