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A multi-disciplinary team
Target
CRT staffing includes dedicated time from at least 8 of the following groups:
i) nurses; ii) occupational therapists; iii) clinical or counselling psychologists; iv) social workers; v) psychiatrists; vi) service user-employees; vii) other support staff without professional mental health qualifications; viii) pharmacists ix) Approved Mental Health Professionals or equivalent; x) non-medical prescribers; xi) family therapist; xii) accredited cognitive behavioural therapist.
Why this is important
The Department of Health's Mental Health Policy Implementation guide outlines the need for an appropriate mixture of staff to ensure that a full range of interventions can be provided within the team. The National Survey showed that CRT staff members greatly valued being part of a multi-disciplinary team. It was felt having multiple perspectives allowed a more flexible and responsive attitude towards service users' needs, and for more appropriate care to be provided.
Ways of doing this well
Sessional staff
If it is not possible to employ staff such as psychologists or pharmacists on the team directly, bringing in such staff from other teams on a sessional basis can help to expand the expertise available.
Advertising for staff
West Kent CRHT Case Study
West Kent CRHT is a full multidisciplinary staff team.
Within West Kent CRHT we have the benefit of having staff from numerous backgrounds, along with our Support Time and Recovery workers who bring with them a wealth of life and practical experiences, we also have registered mental health nurses, occupational therapists, psychologists, social workers (with approved mental health act practitioner status) and speciality doctors attached to the team.
This means that we are able to offer access to a wealth of opinions and assessments that will very accurately inform a person's signposting for future care, and ensuring that they are suitably cared for in the community.
We have achieved this by opening our vacancies as "community mental health workers", rather that just nurses or social workers for example, meaning that we can recruit from the wider professional pool, obviously in terms of our psychologist and medical staff these are specific roles, designed to perform specific functions of assessment and diagnosis within the team, which add to the compliment of diverse skills we can offer anyone accessing our team.
As a team this diverse skill base is extremely important in the service we offer and the thoroughness that we apply to our assessments, we are able to look at needs and risks from a number of differing points of view, which enables better care planning and hence more positive outcomes.
Examples of good practice
In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:
- Bristol Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
- Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
- Maidstone CRT, Kent and Medway NHS and Social Care Partnership Trust
- Newham Psychiatric Acute Community Team, East London NHS Foundation Trust
- Redbridge HTT, North East London NHS Foundation Trust
- Great Yarmouth CMHT, Norfolk & Suffolk NHS Foundation Trust
- Norwich HTT, Norfolk & Suffolk NHS Foundation Trust
Relevant reading
McGlynn (2006) CRHT: A Practical Guide
Multidisciplinary working
Professional differences may occur in any team and this is not necessarily a bad thing. The real danger is if this is allowed to impinge on the package of care delivered to an individual and, worse still, if it compromises risk management. There is value in diversity and teams consisting of many disciplines can have diversity in abundance. While a team can bring together a wealth of experience, both from training and from life experiences, it can also create some differences in methodologies and approaches.
Effective leadership and a commitment to a shared philosophy usually assist in the cohesion of teams. If this is in place then they can reduce the risks significantly. Members of the CRHT team need to be able to trust each other and respect their opinions and experiences in order to enable positive risk management. The role of the team manager/leader is paramount in securing and fostering a culture where staff can practise in a manner that does not inhibit therapeutic, creative and innovative approaches. (p.36)
Sainsbury Centre for Mental Health (2001) Crisis Resolution
Skills mix
A good skills mix should be sought when recruiting the staff. The team should be multidisciplinary and include nurses, social workers, support workers, occupational therapists, psychologists and medics whose skills will help serve the local population best. For example, staff may be recruited based on specific skills around dual diagnosis. The team should reflect the local population in terms of race representation, major local languages and ethnicity. (p.14)
Department of Health (2001) Mental Health Policy Implementation Guide
The table below gives details of suggested staffing levels and skill mix for a team with a caseload of 20 to 30 service users at any one time.
Designated named workers: Key skills: • High energy level • Team player • Ability creatively to engage service users • Understanding of needs of service users, including specific needs related to cultural background/age/gender etc • Able to co-ordinate care and provide broad range of interventions | Total 14 per team Team leader plus up to 13 others Designated named workers include: CPNs ASW OT Psychologists Support workers including service users Appropriate mix of staff is needed to ensure that all the interventions listed can be provided within the team |
Medical staff • Active members of the team • 24 hour access to senior psychiatrists able to do home visits is vital | • Involvement from both consultant and middle grade psychiatrists • Level of psychiatric input to be determined by local need and service configuration |
Specialist skills • These skills should be available within the team either by employing a fully qualified practitioner or by training other team members • External supervision, support and training needed for 'non specialists' providing these interventions | • OT/OT skills • Psychologist/psychology skills • ASW/strong links to social services and ability to undertake thorough assessment and activate services as needed |
Support workers • People with health, social care or appropriate life experience or personal experience of mental health problems/treatment | • Number of support workers to be determined by the team • Support workers to reflect the demography of the local population |
| Programme support | • 1 wte administrative assistant • IT, audit and evaluation support may also be needed |
(p.20-21)