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About this book

Presenting a model for interdisciplinary working, this book offers an overview of practice and policy across a range of mental health settings. It explores how to combine skills, theories and expertise from a range of disciplines in response to the diverse needs of service users, from children to older people, and those with complex needs.

Table of Contents

The Contexts of Interdisciplinary Working

Frontmatter

1. The Evolution of Interdisciplinary Working: Definitions and Policy Context

Abstract
Key Issues:
  • A definition of interdisciplinary working needs to reflect contributions from professionals, service users, carers and the increasing number of non-professionally affiliated staff in the mental health workforce.
  • Over the past century, interdisciplinary working has evolved — beginning with uniprofessional working synonymous with the asylum era of care and the dominance of the disease model for understanding mental ill health.
  • The 1983 Mental Health Act marked a significant legislative milestone in promoting multidisciplinary practice.
  • Many services are now at different stages of developing interdisciplinary ways of working depending upon the extent to which they include professionals and service users interacting in order to work collaboratively.
Di Bailey

2. Models and Values for Interdisciplinary Working in Mental Health

Abstract
Key Issues:
  • Interdisciplinary working in mental health requires teams and services to establish a shared value base for collaborative care delivery.
  • Power dynamics and professionalism need to be explored in relation to an increasingly diverse workforce.
  • The ‘recovery model’ combines team members’ perspectives, skills and expertise and supports interdisciplinary working.
  • Dimensions of interdisciplinary working span the organizational/strategic, team and individual practice levels. Change must be supported at all levels for interdisciplinary practice to be effective.
Di Bailey

3. Interdisciplinary Working and the Mental Health Legislation

Abstract
Key Issues:
  • The Mental Health Act (MHA) (1983) is revised as a result of the MHA 2007 which came into being on 1st October 2008.
  • The 2007 MHA has implications for interdisciplinary working because of the way it redefines mental disorder and widens the definition of treatment.
  • Professional roles are subject to change as a result of the new legislation that fits with the overall New Ways of Working initiative, having the biggest impact on Consultant Psychiatrists and Approved Social Workers (ASWs).
  • The new role of the Independent Mental Health Advocate (IMHA) is introduced which has the potential to increase service users’ contributions to interdisciplinary decision making about their care and treatment.
Di Bailey

4. Interdisciplinary Care Planning in Mental Health

Abstract
Key Issues:
  • The Care Programme Approach (CPA) provides the administrative framework for delivering effective interdisciplinary mental health care and consists of assessment, care plan design and delivery and monitoring/ review.
  • Since 2008, the government has refocused the CPA on people who have complex mental health needs and are likely to require an interdisciplinary response from a range of workers and agencies.
  • The CPA may be strengthened by the implementation of integrated care pathways that seek to improve either elements of the care delivery process or specific intervention strategies for a specified mental health problem.
  • The Care Coordinator should be a professional member of the relevant mental health team who has the skills, knowledge and influence to facilitate effective interdisciplinary working.
  • Interdisciplinary care planning will need to transcend the boundaries of Community Mental Health Teams and the hospital-community interface to provide continuous care for individuals.
Di Bailey

5. Interdisciplinary Risk Assessment, Planning and Management

Abstract
Key Issues:
  • Risk assessment is a misleading term. It masks a process that involves the collection of information, judgements about whether risks are likely or not to occur and the severity of the consequences if they do.
  • Whilst practitioners may be able to do little to reduce the elements of risk presented by a service user, they have greater control over how to monitor and influence the outcomes of these through risk management.
  • Risk assessment and management should be a collaborative endeavour including working in partnership with service users and their families.
  • Practitioners should be aware of biased thinking in making judgements about risk and effective interdisciplinary working is one way to challenge these biases.
  • Interdisciplinary working that locates the accountability and responsibility for risk taking within interdisciplinary teams, supported by their organization, should lead to more robust strategies for risk assessment, planning and management.
Di Bailey

Interdisciplinary Working in Practice

Frontmatter

6. Involving People Who Use Services in Interdisciplinary Working in Mental Health

Abstract
Key Issues:
  • Service user involvement in mental health is embedded in societal changes, influenced by top down government policies and bottom up lobbying from service user groups and the survivor movement in psychiatry.
  • Service user involvement can be understood on a continuum from the giving of information and explanation to service user control. The latter accords with a democratic model of service user involvement and lends itself to interdisciplinary working.
  • Choices regarding the level and type of involvement are fundamental to an interdisciplinary approach and service users should be in a position to influence this individually or collectively.
  • Partnership working with service users is integral to interdisciplinary mental health care and occurs where leadership is co-created to develop a shared vision of service provision and care delivery.
Di Bailey

7. Interdisciplinary Working with People with Mental Health Problems in Primary Care

Abstract
Since April 2004 all primary care services in England have been provided by Primary Care Trusts (PCTs). Serving an average population of 100,000 PCTs constitute the basic organizational units of the NHS in England. Their function is to manage, commission, and, in some areas, provide primary care services that were typically offered by GP fund holding practices. In 2002 the Department of Health gave PCTs the additional remit of commissioning all mental health services resulting in some organizations amalgamating community and mental health trusts, serving populations in excess of 350,000. Some of these organizations are now in the throes of converting to Foundation Trust Status, a requirement for all NHS Trusts by 2013 (DH, 2010).
Di Bailey

8. InterdisciplinaryWorking with Children and Young People with Mental Health Problems

Abstract
Key Issues:
  • Children and adolescents may experience mental health issues directly with some mental health problems showing an increased prevalence in a younger age group.
  • Indirectly parental mental health problems may affect young people’s experience through child-rearing and attachment and/or as young carers looking after a parent with mental health needs.
  • Young people need services that are integrated and responsive spanning needs which can be addressed by mental health promotion through to specialist child and adolescent mental health services.
  • Statutory child care policies need to dovetail with the CPA for adults to underpin interprofessional working.
  • A biopsychosocial model that addresses the needs of children and their parents in accordance with this framework can provide a useful starting point for an integrated assessment that takes into account the needs of children and their caregivers in a holistic way.
Di Bailey

9. Interdisciplinary Working with Older Adults with Mental Health Needs

Abstract
Integrated working in respect of older adults with mental health problems spans several domains of practice:
  • Older adults with cognitive impairments, most commonly, dementias;
  • Older adults who experience emotional distress and or mental illness as secondary to physical health issues;
  • Diagnosed mental health problems that may have begun earlier in a person’s life and are present in late adulthood, the most common of these being depression.
Di Bailey

10. Interdisciplinary Working with Individuals with Complex Care Needs

Abstract
Key Issues:
  • People with complex needs include people with mental health and substance misuse issues and offenders with mental health problems in the criminal justice system.
  • Interdisciplinary working with these service user groups is supported but also undermined by government policy and legislation.
  • Initiatives to coordinate improved interdisciplinary and inter-agency working include ‘mainstreaming’ and the ‘equivalence principle’.
  • The Care Programme Approach and the Offender Mental Health Care Pathway provide mechanisms for delivering more holistic, interdisciplinary care that addresses the interrelatedness of service users’ difficulties.
Di Bailey

11. Interdisciplinary Education and Training

Abstract
Key Issues:
  • Interdisciplinary learning and education is about the interactiveness of the learning encounter between professionals and non-professionally affiliated staff, service users and carers. It involves learning with, from and about each other with the explicit aim to improve collaboration and the quality of care.
  • The need for interprofessional education has been supported by a raft of policy developments since the mid 1990s.
  • Interprofessional education becomes interdisciplinary when service users, carers and non-professionally affiliated groups in the workforce interact with professionals to learn with, from and about each other to improve collaboration and the quality of care delivered.
  • Interdisciplinary learning needs to be planned, designed and delivered with the explicit aim of enhancing collaborative practice.
Di Bailey

12. Managing Interdisciplinary Working and Practice in Mental Health

Abstract
In order to manage interdisciplinary working and practice, managers of mental health services need to be able to:
  • Manage themselves, manage and lead others and the service.
  • Achieve a balance between leading and developing people and ensuring that the tasks of the team are completed.
  • Interface effectively between their team, the organization to which they belong and other teams/networks that interlink to provide a service including collaboration with service users.
  • Ensuring processes are in place for professional development and supervision that takes account of individual disciplinary contributions and collective roles and responsibilities.
Di Bailey

Concluding Comments

13. Concluding Comments

Abstract
This book has attempted to explore the evolution of interdisciplinary working in mental health and has defined this as an extension of multiprofessional working; to include meaningful interactions between disciplines including service users and carers to achieve enhanced care delivery.
Di Bailey
Additional information