Multidisciplinary team meetings in community mental health: a systematic review of their functions

Pages119-140
DOIhttps://doi.org/10.1108/MHRJ-03-2015-0010
Publication Date13 Jun 2016
AuthorCaoimhe Nic a Bháird,Penny Xanthopoulou,Georgia Black,Susan Michie,Nora Pashayan,Rosalind Raine
SubjectHealth & social care,Mental health
Multidisciplinary team meetings in
community mental health: a systematic
review of their functions
Caoimhe Nic a Bháird, Penny Xanthopoulou, Georgia Black, Susan Michie, Nora Pashayan
and Rosalind Raine
The authors affiliations can be
found at the end of this article.
Abstract
Purpose Previousresearch has identifieda need for greater clarityregarding the functionsof multidisciplinary
team (MDT) meetings in UK community mental health services. The purpose of this paper is to identify the
functionsof these meetingsby systematicallyreviewingboth primary researchand academicdiscussion papers.
Design/methodology/approach Papers relatingto adult community mental health teams(CMHTs) in the
UK and published between September 1999 and February 2014 were reviewed and appraised using NICE
quality checklists. The search was broad in scopeto include both general CMHTs and specialistCMHTs such
as early intervention psychosisservices and forensic mental healthteams. A thematic synthesisof the findings
was performed to develop an overarching thematic framework of thereported functions of MDT meetings.
Findings None of the 4,046 studies identified directly investigated the functions of MDT meetings.
However, 49 mentioned functions in passing. These functions were categorised into four thematic domains:
discussing the care of individual patients, teamwork, team management and learning and development.
Several papers reported a lack of clarity about the purpose of MDT meetings and the roles of different team
members which hindered effective collaboration.
Practical implications Without clearly agreed objectives for MDT meetings, monitoring their effectiveness
is problematic. Unwarranted variation in their functioning may undermine the quality of care.
Originality/value This is the first systematic review to investigate the functions of CMHT MDT meetings in
the UK. The findings highlight a need for empirical research to establish how MDT meetings are being used
so that their effectiveness can be understood, monitored and evaluated.
Keywords Teamwork, UK, Multidisciplinary teams, MDT, Community mental health
Paper type Literature review
Background
Multidisciplin ary teams (MDTs) ar e assumed to improv e the quality of care b y incorporating a
range of professional perspectives into care planning (Department of Health, 1999, 2007a;
Wagner, 2004). MDTs are widespread throughout the UK National Health Service (NHS) and
have a long history in c ommunity mental h ealthcare in the for m of community ment al health
teams (CMHTs). Despite a sustained emphasis on multidisciplinary care in UK mental
health policy (Department of Health, 1995, 1998, 2001a, 2007b, 2009a), there has been little
empirical investigation of MDT meetings, the formal mechanism for achieving this
multidisciplin ary collaboratio n.
There is limited national guidance on the objectives, organisational structure and processes of
mental health MDT meetings, and policy has been inconsistent regarding what should be
Received 4 March 2015
Revised 7 September 2015
Accepted 29 September 2015
This research was supported by
NIHR Research Capability Funding
allocated through University
College London Hospitals NHS
Foundation Trust and the UCL
Graduate School through the Yale-
UCL Collaborative Exchange
Programme. The funders had no
role in study design, data
collection, data analysis, data
interpretation or reporting
of the study.
Author contributions: Caoimhe Nic
a Bháird designed the study,
undertook the systematic search
and thematic synthesis and wrote
the first draft of the paper. Penny
Xanthopoulou independently
screened and quality assessed a
proportion of the reviewed papers,
and contributed to writing and
critically revising successive drafts
of the paper. Georgia Black
contributed to writing and critically
revising successive drafts of the
paper. Rosalind Raine, Susan
Michie and Nora Pashayan
contributed to the interpretation of
results and critically revised
successive drafts of the paper.
All the authors approved the
final draft.
DOI 10.1108/MHRJ-03-2015-0010 VOL. 21 NO. 2 2016, pp. 119-140, © Emerald Group Publishing Limited, ISSN 1361-9322
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MENTALHEALTH REVIEW JOURNAL
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PAG E 119
discussed. For example, conflicting policies state either that all cases should be discussed
(Department of Health, 2002, 2010), that only complex cases should be discussed (National
Health Service Executive, 1999; Department of Health, 1995), or that only significantor
importantdecisions should be discussed (Department of Health, 2010). Consequently, the
content, format and organisation of MDT meetings is largely locally determined (West et al., 2012;
Department of Health, 1995), leading to wide variations (West et al., 2012).
The need for improved consistency of care in UK mental health services has been recognised
by policy makers. The Care Quality Commission has committed to developing definitions of
what good looks likein mental healthcare and is establishing an assessment framework
of indicators to facilitate quality inspections (Care Quality Commission, 2013). The government
has also recently announced plans for an information revolution around mental health and
wellbeing(Department of Health, 2014b, p. 11) to better monitor variation in provision. A strong
evidence base documenting current practices and challenges is necessary to support such
quality improvement initiatives. This paper reports on a systematic review of the academic
literature, which was conducted to provide an overview of the functions of community mental
health MDT meetings.
Method
The study was conducted in accordance with ENTREQ (ENhancing Transparency in Reporting
the synthesis of Qualitative research) guidance (Tong et al., 2012) and PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidance where applicable (Moher
et al., 2009).
Eligibility criteria
The term community mental health teamwas defined broadly, to include specialist teams
catering to older adults, assertive outreach teams (AOTs), early intervention services (EIS), home
treatment teams, crisis resolution teams (CRTs) and memory clinics, as well as general CMHTs.
A number of inclusion and exclusion criteria were defined in order to determine the relevance of
the papers to the review question (Table I).
As the review aimed to collate the range of views regarding the purpose of MDT meetings, a
diverse range of publication types was included. This included both primary sources which
reported original research and secondary sources such as editorials and books. Secondary
Table I Inclusion and exclusion criteria for screening articles in the systematic review
Parameter Inclusion criteria Exclusion criteria
Location UK Outside of UK
Language English Not English
Time frame 1999-2014 Studies published prior to 1999
Population Studies of mental health teams caring for adults in the community Studies of inpatient care
Studies of childrens services
Studies of illness populations other than mental health
Content Mentions one or more functions of MDT meetings
Study design Qualitative and quantitative studies investigating MDT meetings Drug trials
Disease prevalence studies
Publication type Primary sources
Peer-reviewed journal articles
Published comprehensive research reports (e.g. Sainsbury Centre
for Mental Health)
Secondary sources:
Editorials
Books
Conference abstracts
Letters to the editor
Policy documents
Book reviews
Newsletters
Magazines
Study protocols
Obituaries
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