# MHApps Take Control – Multidisciplinary Team – Treatment And Recovery Partners – Describing the Modern Health Recovery Team

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- A Multidisciplinary Team Multidisciplinary team-working is central to a modern mental health service. This means that a number of professionals with different expertise work together to support a person through times of ill health and into recovery. The make up of teams can vary from place to place but they generally include a consultant psychiatrist, social worker, community mental health nurse, psychologist and occupational therapist.

- There is a real sense of fulfilment when ‘team work’ works!

- Most parts of the country now have full teams working with people. MDTs are used in hospitals, in day services and in the community.
  We asked a few mental health professionals who work as part of a team to describe, in their own words, what they do and how they support people experiencing mental ill health.
  Rehabilitation and Recovery Multidisciplinary Team:
- A consultant psychiatrist’s view What is my job? As consultant psychiatrist, I am the leader of the team and responsible for the treatment and standard of care for each service user. I oversee the junior doctors and direct how other members of the team carry out their work.

- In the past the consultant was seen as the person who had the final say in all decisions, but in the modern mental health service the consultant works together with other professionals (nurses, occupational therapists, social workers, psychologists, art therapists, care assistants, etc) in a more democratic way to make sure that the person’s needs are met to the best of everyone’s abilities.

- This is how a ‘multidisciplinary team’ works. This means that I accept that I may not always have the right knowledge or skills to ensure recovery in all service users. For example, a nurse or psychologist with the necessary training in talking therapies may have a better plan, or the occupational therapist or social worker may be the most suitable professional to work with the service user on their recovery journey. Usually, the best solutions come from service users themselves and sometimes from others who are not mental health professionals at all. Part of my job, like the work of the team, is to find the means to make these solutions work.
- How do I work with people? It is absolutely necessary to listen to what the service user wants if I am to treat their psychiatric, psychological and social problems.

- Along with all the other professionals on the team and other significant people (such as family members, advocates), I need to ensure that everyone is working together with the service user (and not working ‘on’ the service user) to achieve what recovery means for that person.

- This way of working is effective for most mental health problems; it is particularly important for those with severe and enduring disability. In my experience it is also the most rewarding way of working. The rewards come from seeing real changes in peoples’ lives, often despite their mental health problems, like finding a place in society, having control over how or where to live, having a relationship or a job. There is a real sense of fulfilment when ‘team work’ works!
  On the other hand it is frustrating when the team doesn’t work so well or as quickly as I would like: then there is a need to be flexible, to find out where the problem lies, to listen more and to remind myself and others what the purpose of our service is and who I am employed to serve”.

- Community mental health nurse “The CMHN is part of a multidisciplinary team, which includes medical and nursing personnel, an occupational therapist, psychologist, consultant psychiatrist and social worker.

- The community mental health nurse usually has the role of key–worker to service users.

- I engage with the service user and, with their consent, their immediate family. It is a partnership approach, which aims to improve the person’s immediate wellness and enhance their future quality of life. The partnership is collaborative in nature, with the expertise of both the nurse and the service user’s self-experience influencing the plan of care.
  The relationship is based on trust borne of a deep respect of the right of choice and self-determination of the individual, along with an appreciation of the person’s uniqueness, individuality, personal experience together with their dreams and hopes. These are the underlying guiding influences in creating a therapeutic relationship, which will promote recovery. The CMHN will focus on your strengths and advocates with you for your needs, to ensure you get a good team recovery package of care.

- Probably the most important fact is that we will believe in you and share your dreams and hopes. We will be honest with you, working to establish realistic goals.

- I see the role as partly that of coach or mentor, empowering the service user to enable them to make informed, positive choices that will underpin and sustain their longterm wellness. I provide information and education to the service user and their families in respect of the illness and the various treatment options. Highlighting the link between stress and illness can help to normalise the experience, reduce stigma and increase the likelihood of the service user taking more control of their own situation, ensuring greater personal responsibility.
  The CMHN will focus on an individual’s strengths and seek to avoid labels. An important function of the role is the identification of the needs of the service user that can be fulfilled by the assistance of various members of the multidisciplinary team. It is the role of the CMHN to engage the relevant disciplines to meet these needs, and liaise regularly to ensure success. The CMHN communicates regularly with the GP and other primary care clinicians regarding the service user’s progress or physical needs, ensuring a holistic package of care.
  Service users are encouraged by me to take a proactive role to support fellow users by sharing their experience and getting involved in further therapeutic education and support groups. All service users are encouraged and facilitated to develop their own Wellness Recovery Action Plans (WRAP) and a copy of the crisis plan is placed in their medical file and adhered to as far as possible should a relapse occur.
  Service users are encouraged to involve their family. Education and support is offered as acknowledgment of the caring role well performed. Family members are encouraged to join the local relatives’ support group, which is facilitated by the CMHN and to participate with the service user in a representative role involving service planning.
  The role while very challenging is also very rewarding in so far as one can witness the great beneficial transformation that it can bring to a person’s wellbeing and quality of life.

- The role privileges the nurse to travel and witness recovery on a daily basis”.

- Occupational therapist The Occupational Therapist works in collaboration with the Community Mental Health Team to contribute towards a holistic approach. Following a referral from any member of the team, the O.T. will arrange to meet the individual in hospital, home or Community Mental Health Centre. An assessment is completed which will help identify their needs. Using this and by listening to the individual, goals of treatment are identified. These may focus on work, domestic activities, leisure or self-care, to promote optimum function and a balanced routine. The treatment programme aims to provide support, practice and education to develop self awareness, responsibility, motivation, interest, confidence and endurance.
  The O.T. can also help people to develop skills to cope with anxiety, low self esteem and to address time management issues. Together the O.T. works with the individual at their pace, to enable them to resume fulfilled roles and healthy habits. On some occasions when the individual is ready, they may be asked to join a group of people with similar needs. If appropriate, treatment may also involve community related activities.
  Should you feel that you would benefit from the input of an O.T, inform your doctor or another member of the Community Mental Health Team
- Social worker “I love my job as a mental health social worker, I get to meet lots of interesting people and no two days are ever the same! I work with individuals, couples, families and groups. My role is to provide counselling and support to service users and family members, in addressing problems and making changes in different aspects of their lives.
  Referrals can come from Primary Care, other members of the multidisciplinary team, and self-referrals from service users or family members. I am based in a community mental health centre, and I also meet people in their homes, the hospital or other places in the community.
  Social workers take a holistic view when someone is experiencing mental health difficulties.

- Often the problem is located in the person’s environment and the intervention that is needed is to change the system (for example when people are being discriminated against or being treated unfairly because of stigma, or when there are problems in the family).

- Other times, people may be in distress because of relationship difficulties, financial concerns, legal issues, housing conditions or worries about children. Some people want to explore employment, education or training options. It is important to assist people in identifying their passions and strengths, and to talk about what has helped in the past. Having a solutions focused approach gives a positive focus to the work.
  An important part of the social work role is to provide relevant information and education to people and to link service users and family members with services in the community. Good social supports are a key part of recovery. There is no substitute for being able to connect with other people who have had similar experiences and who can provide hope of a positive future.
  We are lucky to have a vibrant peer support centre in our area that is run by service users and is home to many different types of support groups and activities, such as the Phrenz group. I facilitate the SHINE Family Support Group that meets monthly at the centre.
  Another part of my job is to support the development of new services that are needed in the local community. I am involved in interagency initiatives to address domestic violence, suicide in young people, and homelessness. I am also working in partnership with service users to develop self-advocacy initiatives, mindfulness groups, and WRAP (Wellness Recovery Action Planning).
  The best part of my job is having the opportunity to accompany a person part of the way on their recovery journey. It is fantastic to see people making positive changes in their lives, especially when they are able to give themselves the credit for making those changes!”
- Clinical psychologist “Clinical psychologists are trained to recognise a breadth of influences that lead to mental health difficulties.

- There are as many pathways to the diagnosis of schizophrenia as there are individuals with this diagnosis.

- For those people who experience significant mental ill health, extreme distress or disturbance in their normal life, a difficult and challenging process of recovery may lie ahead. This path is often unclear and what helps someone travel along this path can vary dramatically from one person to the next.
  The clinical psychologist is one of several mental health professionals who help to try and understand the best help that each individual may require along their road to recovery. Clinical psychologists work within a multi-modal framework, drawing on a wide-ranging array of theoretical models. They tend to rely on the ‘stress vulnerability’ and ‘bio-psychosocial’ models of mental health.

- Put simply, clinical psychologists recognise the fact that each individual is unique and that several factors may be involved in leading a person both into and out of mental ill health.

- More specifically the clinical psychologist helps to develop an understanding of each individual’s psychological needs and the nature of the difficulties they are experiencing. This may involve a focus on current symptomatic difficulties, long standing personal issues, early traumatic experiences, difficulties with thinking, memory or attention, emotional or familial difficulties. An assessment of these needs may then lead on to a psychological therapy.
  Psychological therapy can take on a variety of forms, ranging from brief problem or symptom focused interventions, to longer-term in-depth therapeutic interventions. For many individuals, coming to some understanding of what is happening inside them is absolutely essential in learning to cope with the extreme experiences being endured. Aiding someone to make sense of hallucinatory experiences, extremes in mood states or deeply held fears of threat is often the goal of a psychological therapy.

- In many ways the psychologist lends the person their thinking, when thinking becomes muddled or difficult.

- When emotions become intense or confusing, when experiences seem bizarre or unusual, when the world does not seem to share your view of what is happening to you, it is vital that you have someone to talk to about these experiences.
  The sense of being overwhelmed and alienated, that is so common amongst people who experience serious mental health problems is something best shared. It is a psychologist’s job to help people in these ways to understand and cope with their experiences, sometimes in great depth, in lending their thoughts and supporting each person’s efforts to come to terms with their experiences”.

- Surprisingly a lot of relatives find themselves in the same cycle of fear and confusion, not knowing what is real, what is right or who to turn to.

- The advertised route to accessing the mental health services is:
  · You have a problem
  · You attend your GP
  · The GP listens carefully
  · He or she suggests you attend a specialist and writes you a letter of referral
  · You attend the specialist. He/she listens carefully
  · He or she suggests you go for counselling, take medication, or that admission to a department of psychiatry is necessary, where you will receive all of the above
  · After a number of weeks you leave hospital with a multi disciplinary team supporting you in your community
  · You recover and live a full and happy life
  The above scenario is what many people experience.

- “Who do you turn to when it happens to you? We knew since John was about 6 that he had amazing energy; he would be climbing the walls. He was disruptive in school; he had been expelled from 2 schools. We brought him everywhere, looking for a solution to his behaviour. Attention Deficit Disorder appeared hopeful for a time, you might think it is funny to want your child to have something like that, but we were at our wits end, and were seeking any straw to grasp. We felt that if we had a diagnosis we could cure him or something. As he got older he gravitated towards a group of young people who drank a lot. He embraced this scene with a passion, so much that we had to bring him to an alcohol addiction centre by the time he was 17. It was only then it came to light that he may be experiencing a mental illness.”

- “People would be saying, “your brother is mad, he is great crack”, yeah, right to you maybe. For me I was incredibly embarrassed about him. I was ashamed and sometimes would not acknowledge him as being by brother. All I wanted was a normal older brother who would play with me and stick up for me.
  My reality was a home, which was disrupted and angry all the time. My parents spent so much time looking out for John that we may as well have been invisible; I hated him. Looking back on it now, I feel sometimes guilty knowing what he had to go through. But hey, I was a kid and I thought like a kid, all I could see was the stress and strain my parents were under because of him. Wishing for the umpteenth time, when he ran away that he wouldn’t come back and we could be a normal family.
  If there is one thing I have learned as a result of my brother’s mental health difficulty, it is that he is my brother and as the song goes “he aint heavy, he’s my brother” and I love him very much. Even if I am still a tiny little bit resentful of the time and attention my brother got, and I still can’t listen to that phrase, “he needs us more.”

Team
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