Multi-disciplinary working.. or not.


I read in on the Times website that a letter has been written to the British Journal of Psychiatry,  in which 36 signatories complain that

‘patients with serious problems are often referred to psychologists and social workers rather than clinicians and do not receive the medical therapies they need.’

Now, I don’t have access to the British Journal of Psychiatry so have to rely on the Times reporting.

Apparently, this is a great disservice to the patients who are in need of medical treatment (a position that I can understand as far as it is the case) I’m a little baffled though, as all the referrals we take into our service are referrals to our team which includes a consultant psychiatrist, a  Specialist Registrar (I know, they’ve changed the names – but I can’t remember what grade they equate to now!), a clinical psychologist, some CPNs, Social Workers and an Occupational Therapist. None of us accept direct referrals to individual professionals without the team being involved first.

– and, according to the Times article

The changes came about under a scheme, New Ways of Working, established in 2005. GPs now refer patients with symptoms of mental illness to a team of up to eight people, which will include psychologists, nurses, social workers and a psychiatrist

Now, I reserve the write to be completely wrong here – it wouldn’t be an unusual position for me to take, but my understanding of New Ways of Working initiative is that although a report was published back in 2005, it is still in the consultative phase and was being discussed in 2005 then rather than being ‘established’. Some tentative steps might be being taken in that direction in some trusts but it by no means ‘up and running’

Multi-disciplinary Teams – these ‘teams of up to eight people which  include psychologists, nurses, social workers and a psychiatrist’ have been in play for many years – certainly prior to 2005.

So I’m a little confused by the issues and the facts – although not being able to read the original letter of course, means that I’m relying on the second-hand reporting of the Times.

It seems that the main area of concern is that people with severe and enduring mental illnesses will see one of the team that provides ‘psycho-social’ support rather than ‘medical’ support.

So

‘“If a GP suspected a patient had cancer, he wouldn’t dream of referring him to anybody other than a cancer specialist. A cancer patient might need jollying along, but what he really needs is the correct diagnosis and treatment. That’s what he gets from a specialist. But patients with mental illness are not automatically referred to psychiatrists. If they only see a social worker, there’s every chance that mental illness, or underlying physical illness, will be missed. Patients are getting a bum deal.”

winnie the pooh mbbp winnie the pooh mbbp at flickr

Of course, I am not a doctor and nor do I want to take the role of a doctor. I don’t want to diagnose or prescribe – but I’d also take issue that people that I work with ‘get a bum deal’ when I am involved in their care – not least because there is not a single person that I see that I don’t discuss in a team setting with our consultant psychiatrist on a regular basis. As I said earlier, all allocations come through a team discussion which includes the presence of doctors initially.

And as I work with someone, when there is any change or concern, he is the first person I would contact to discuss these concerns with.

I can’t say I speak for all multi-disciplinary teams in the country but although I’m not a medic or medically trained, I’d like to think I can recognise areas of concern and bring a psychiatrist in very quickly when required (and sometimes when not required – I tend to play safe) . I don’t need to diagnose in order to recognise.

A part of the multi-disciplinary team structure is to work towards strengths. I would also hope that I provide a little more input than ‘jollying along’ but sometimes you just take what you can get and what you can work with.

The New Ways of Working, is, as far as I understand it, is a way of delivering a wider range of services by a broad group of professionals – but not about training others to do the job of doctors or about deskilling specialists. It is, as far as I could understand, about providing a higher skilled professional with more training , into the picture.

Noone wants to see a poor service being delivered or any kind of practice that would detract from medical treatment being provided when necessary. I would never consider myself a replacement for a medical professional but as a different branch of the same tree – because that’s where my expertise lies. I don’t want to be a ‘poor man’s doctor’. I want to be a social worker and not a doctor and to do the job that I am trained and expected to do and I want to do it well.

If that includes ‘jollying along’ so be it but not at the expense of clinical need. Social circumstances and considerations do have a very important role to play within Mental Health services though and to ignore those needs too can be an issue for concern for the patient.

10 thoughts on “Multi-disciplinary working.. or not.

  1. Shame we can’t see this letter yet. Keep an eye on: the correspondence page: http://bjp.rcpsych.org/current.shtml#CORRESPONDENCE

    Having read the article it too makes me angry. What gets me is that we (Im an OT) work with the medics involved. They should know we aren’t all complete numpties. Yes, a few cases do slip through the net – yet they do with even the specialists, and yes, not all social workers or AHP’s are good at spotting mental health illness’, but to say that people are getting ‘a bum deal’ I think is a bit harsh. This really rubs me up the wrong way and further puts evidence to my own subjective thoughts that a lot of medics are so arrogant and stuck in the dark ages regarding modern models of health & social care. Complain that social workers and AHP’s aren’t having the right training, complain that they are not ALL good – don’t just say ‘we need trained doctors [psychiatrists] to do this or nothing at all’. Get off your high horses & change with the times.

    Saying this there is a gem of realism in there that I like.
    “Patients are now known as “service users” rather than patients — even though, when asked, 67 per cent preferred the word patient and only 9 per cent service user”
    Kind of a messed up statistic that. We don’t have any details on this data – who was asked exactly? What stage of care were they at? etc.. But I have often thought that in our attempt to handle mental illness with the care and consideration it deserves it is at the detriment to make mental illness a bigger issue for the general community at large. .. Anyway a far different argument in my mind. The letter certainly appears like a rant if this is included in it rather than a focused complaint at the new ways of working policy.

  2. Thanks Will – it’s a funny one, isn’t it? I couldn’t find the original letter but I’ll keep my eye out with that link.. or try and locate a copy at work. It just surprised me to be honest. I don’t think it reflects the opinion of psychiatrists I’ve worked alongside (although perhaps I’m deluding myself)..

  3. actually there’s beena bit of a debate about the whole service user / pateient issue thing in the blogosphere, heres a link to what the shrink found.
    http://lakecocytus.blogspot.com/2008/04/whats-in-name.html

    Personally i am a patient and resent being called a service user.
    When being assessed for my illness i want to be seen by a medically qualified practitioner. Being assessed in a multidisciplinary team by someone who is not medically qualified is unacceptable to me.

  4. I know we work in different areas of service, but the feeling is the same. I don’t think there is anything that makes me angry faster than being accused of not doing my job. I think in this field we pour our souls into our work much the same way an artist puts theirs into their art. I would also venture a guess related to the last comment- that no SW would want any person who needed medical attention to receive it from anyone but a qualified medical professional, but couldn’t we agree that a team approach would always be better for the patient than one person’s/doctor’s opinion? Just a thought!

  5. Yeah, I don’t want to be a doctor or diagnose or pretend to be a doctor. I don’t want people who need medical treatment not to get it on account of seeing me but I don’t think that people I do see get a ‘bum deal’. And I think that the ‘jollying along’ comment is quite insulting.

  6. You should be able to read the full article here:
    http://f1.grp.yahoofs.com/v1/0FRlSH-gM3nmKDfdSETIbO63l7RMFbDkApHgFGgKNx7KVbMgX4Fy7IcL3Xu_f7t8_BpJkwQpavOrSYX5zjYxLJaHCS7TmhguD_xHBB–PWE/Revised%20Proofs%20of%20wake%20up%20call%20article%20BJP-2008-053561.pdf

    If you have trouble opening it contact me and I will forward it. It is an article not a letter.

    Today I had an email from a professional – not from my area – describing in a crisis the psychiatrist doing the “jollying along” as he hadn’t the skills to help – where what was neded was skilled psychological support.

    I kow good psychiatrists and good psychologists. The service works as its best when all professionals – nurses, OTs, psychologists, psychiatrists – and the cleaners, office staff, cooks, all assistants, students, all those I have forgotten – and dare we even add family members (?) – work gether as a team in the most effective way possible. That is at the heart of New Ways of Working. It should empower everybody.

    We can all be afraid of change – but I believe this change is well intentioned and for the best. Conservative elements from any side fighting it may be understandable – but I believe is misguided.

    M

  7. I have tried posting a lnk to the original article here several times – they must have a jinx on allowing their article to be read. Why should that be. If they want people to know their views why hide it. However I have a copy so if you would like to read it please contact me and I will forward it. It is an article – not a letter as described in the Times.

    (Edit – deleted duplicate text! CB)

  8. *sighs* Why is communication so difficult on this medium! LOL If you want the original article from the British Journal of Psychiatry then email me at mindriddles@yahoo.co.uk

    If they are publicising it in the Times then why do they want to keep it secret?

    M

  9. Thanks for that, Mike – for some reason some of your comments were sent to the spam filter but I’m sorting it out (I think it might have been due to the link.. !).

    And I have to say, again, the actual article in the Times just baffled me more than anything because it just doesn’t represent my working experience (thankfully) where I’ve been in teams that have very much used the strengths and skills of those involved, as you say, in ‘the most effective way possible’ – I would venture a guess that those involved in signing the letter are perhaps not the same psychiatrists that actually work in these multi-disciplinary teams themselves – but that is just conjecture..
    And of course family members are a vital part of the team (!) and actually, as I’m sure you know better than I, the New Ways of Working is supposed to be able to a shift to user and carer knowledge being a key part of the ‘team’.

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