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.


‘“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.