Multidisciplinary team functioning and decision making within forensic mental health
| Pages | 185-196 |
| DOI | https://doi.org/10.1108/MHRJ-01-2018-0001 |
| Date | 10 September 2018 |
| Published date | 10 September 2018 |
| Author | Alina Haines,Elizabeth Perkins,Elizabeth A. Evans,Rhiannah McCabe |
| Subject Matter | Health & social care,Mental health |
Multidisciplinary team functioning
and decision making within forensic
mental health
Alina Haines, Elizabeth Perkins, Elizabeth A. Evans and Rhiannah McCabe
Abstract
Purpose –The purpose of this paper is to investigate the operation of multidisciplinaryteam ( MDT) meetings
within a forensic hospital in England, UK.
Design/methodology/approach –Mixed methods, including qualitative face to face interviews with
professionals and service users, video observations of MDT meetings and documentary analysis. Datawere
collected from 142 staff and 30 service users who consented to take part in the research and analysed using
the constant comparison technique of grounded theory and ethnography.
Findings –Decisions taken within MDT meetings are unequally shaped by the professional and personal
values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and
responsibility of each member of the team. Service users’involvement is marginalised. This is linked to a
longstanding tradition of psychiatric paternalism in mental health care.
Research limitations/implications –Future research should explore the nuances of interactions between
MDT professionals and service users during the meetings, the language used and the approach taken by
professionals to enable/empower service user to be actively involved.
Practical implications –Clearaims, responsibilities and implementationactions are a pre-requisite toeffective
MDT working. Thereis a need to give service users greaterresponsibility and powerregarding their care.
Originality/value –While direct (video) observations were very difficult to achieve in secure settings, they
enabled unmediated access to how people conducted themselves rather than having to rely only on their
subjective accounts (from the interviews).
Keywords Decision making, Forensic mental health, Service user involvement,
Multidisciplinary team (MDT) meetings, Team functioning, Video observations
Paper type Research paper
Background
The concept of multidisciplinary working in the UK is not new and in mental health care has been
written about since the 1970s. In 1984 the Department of Health’s“Planning for the Future”
strategy recommended the establishment of multidis ciplinary psychiatric tea ms (MDT)
comprising psychiatrists, psychiatric nurses, psychologists, social workers and occupational
therapists to provide comprehensive treatment and care for people with mental health problems
(Study Group on the Development of the Psychiatric Services, 1984). Based on the assumption
that MDTs can improve the quality of care by including the perspectives of these professionals
into the service users’planning of care (Department of Health, 2007; Wagner, 2004),
multidisciplinary working is now standard practice across all mental health services in the UK.
“Effective and efficient multidisciplinary team working”is now the agreed approach for mental
health services to address complex needs in severe mental illness (RCP, 2009).
A body of research evidence has been established to identify some of the benefits of MDT
working within mental health services, such as reduced bed use (Marks et al., 1994), improved
service contact after discharge from hospital (Ford, 1995), preferred by service users and
Received 29 January 2018
Revised 21 June 2018
Accepted 29 June 2018
© Alina Haines, Elizabeth Perkins,
Elizabeth A. Evans and
Rhiannah McCabe. Published by
Emerald Publishing Limited.
This article is published under the
Creative Commons Attribution
(CC BY 4.0) licence. Anyone may
reproduce, distribute, translate and
create derivative works of this
article ( for both commercial & non-
commercial purposes), subject to
full attribution to the original
publication and authors. The full
terms of this licence may be seen
at http://creativecommons.org/
licences/by/4.0/legalcode
Declaration of interest: the authors
report no conflicts of interest. The
authors alone are responsible for
the content and writing of this
article. The authors thank the
hospital staff for their support with
the research and facilitating the
data collection in such a difficult
environment, especially the video
observations. The authors also
thank all those service users and
staff who took part in the
interviews and the observations.
(The authors affiliations can be
found at the end of this article.)
DOI 10.1108/MHRJ-01-2018-0001 VOL. 23 NO. 3 2018, pp. 185-196, Emerald Publishing Limited,ISSN 1361-9322
j
MENTALHEALTH REVIEW JOURNAL
j
PAG E 18 5
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