Social Theory & Health

, Volume 5, Issue 4, pp 356–377

Multidisciplinary Teamwork in a UK Regional Secure Mental Health Unit a Matter for Negotiation?

  • Monica Shaw
  • Bob Heyman
  • Lisa Reynolds
  • Jacqueline Davies
  • Paul Godin
Article

Abstract

Multidisciplinary teamwork in healthcare is strongly advocated in policy documents and the professional literature, but evidence about its value is sparse. This paper argues that multidisciplinary rhetoric disguises the complexity of the relational processes involved. These processes are explored with reference to a qualitative study, conducted during 2002–2004, of a UK medium secure forensic mental healthcare unit. Although some instructive examples of selective collaboration emerged from the present study, in general, non-medical professionals felt that their capacity to negotiate new ways of working was thwarted by medical dominance. Patients, the recipients of interventions from a range of professions, mostly bracketed them together as an all-powerful ‘they’. Multidisciplinary working promoted only limited partnership in this organizational setting, and became primarily a process through which structural differences were reproduced. The paper draws on insights derived from symbolic interactionist theory to explore the achievement of, and failure to achieve, collaboration across professional boundaries. It will be argued, firstly, that organizational constraints on multidisciplinary collaboration together with actors’ attempts to overcome them can be usefully analysed in terms of a dialectic between role-taking and role-making; and, secondly, that the impact of professional power differences can be understood through analysis of organizations as autopoietic systems.

Keywords

forensic mental health multidisciplinary relationships symbolic interactionism professional boundaries medical dominance blame culture 

References

  1. Abbott A (1988). The System of Professions: An Essay on the Division of Expert Labor. University of Chicago Press: Chicago.Google Scholar
  2. Allsop J (2002). Regulation and the medical profession. In: Allsop J and Saks M (eds). Regulating the Professions. Sage: London. pp 79–93.CrossRefGoogle Scholar
  3. Barker PJ, Walker L (2000). Nurse's perceptions of multidisciplinary teamwork in acute psychiatric settings. Journal of Psychiatric and Mental Health Nursing 7: 539–546.CrossRefGoogle Scholar
  4. Barr H (2000). New NHS, new collaboration, new agenda for education. Journal of Interprofessional Care 24: 81–86.CrossRefGoogle Scholar
  5. Blumer H. (1962). Society as symbolic interaction. In: Rose A (ed). Human Behavior and Social Processes. Houghton Miflin: Boston.Google Scholar
  6. Blumer H. (1969). Symbolic Interactionism. Prentice-Hall: Englewood Cliffs.Google Scholar
  7. Bradshaw PL, Bradshaw B (2004). Health Policy for Health Care Professionals. Sage: London.Google Scholar
  8. Brown B, Crawford P, Darongkamas J (2000). Blurred roles and permeable boundaries: the experience of multidisciplinary working in community mental health. Health and Social Care in the Community 8: 425–435.CrossRefGoogle Scholar
  9. Cicourel AV (1973). Cognitive Sociology. Penguin: Harmondsworth.Google Scholar
  10. Coffey M, Jenkins E (2002). Power and control: forensic community mental health nurses’ perceptions of team-working, legal sanction and compliance. Journal of Psychiatric Mental Health Nursing 9: 521–529.CrossRefGoogle Scholar
  11. Cott C (1997). We decide, you carry it out: a social network analysis of multidisciplinary long-term care teams. Social Science and Medicine 45: 1411–1421.CrossRefGoogle Scholar
  12. Cott C (1998). Structure and meaning in multidisciplinary teamwork. Sociology of Health and Illness 20: 848–873.CrossRefGoogle Scholar
  13. Davies J, Heyman B, Godin P, Shaw M, Reynolds L (2006). The problems of offenders with mental disorders: a plurality of perspectives within a single mental health care organisation. Social Science and Medicine 63: 1097–1108.CrossRefGoogle Scholar
  14. Denzin N (2001). Interpretive Interactionism. Applied Social Research Methods Series, Volume 16. Sage Publications: Thousand Oaks.CrossRefGoogle Scholar
  15. Dingwall R (1980). Problems of teamwork in primary care. In: Lonsdale S, Webb A and Briggs T (eds). Teamwork in the Personal Social Services and Health Care. Croom Helm: London. pp 111–137.Google Scholar
  16. Douglas M (1990). Risk as a forensic resource. Daedalus 119: 1–16.Google Scholar
  17. Glasby J, Lester H (2004). Cases for change in mental health: partnership working in mental health services. Journal of Interprofessional Care 18: 7–16.CrossRefGoogle Scholar
  18. Goffman E (1968). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Harmondsworth: Pelican.Google Scholar
  19. Happell B, Manias E, Roper C (2004). Wanting to be heard: mental health consumers’ experiences of information about medication. International Journal of Mental Health Nursing 13: 242–248.CrossRefGoogle Scholar
  20. Heyman B, Shaw M, Davies J, Godin P, Reynolds L (2004). Forensic mental health services as a risk escalator: a case study of ideals and practice. Health, Risk and Society 6: 307–325.CrossRefGoogle Scholar
  21. Hugman R (2003). Going round in circles? Identifying interpersonal dynamics in Australian health and social welfare. In: Leathard A (ed). Interprofessional Collaboration: From Policy to Practice in Health and Social Care. Brunner-Routledge: Hove, East Sussex. pp 56–68.CrossRefGoogle Scholar
  22. Jones J, Plowman C (2005). Risk assessment: a multidisciplinary approach to estimating harmful behaviour in mentally disordered offenders. In: Wix S, Humphries M (eds). Multidisciplinary Working in Forensic Mental Health Care. Elsevier Churchill Livingstone: London. pp 133–150.Google Scholar
  23. Kings Fund London Commission (1997). Transforming Health in London. Kings Fund: London.Google Scholar
  24. Leathard A (2003). Policy overview. In: Leathard A (ed). Interprofessional Collaboration: From Policy to Practice in Health and Social Care. Brunner-Routledge: Hove, East Sussex. pp 12–43.CrossRefGoogle Scholar
  25. Luhmann (1993/2002). Risk: A Sociological Theory. Aldine Transaction: New Brunswick.Google Scholar
  26. Mason T, Carton G (2002). Towards a ‘forensic lens’ model of multidisciplinary training. Journal of Psychiatric Mental Health Nursing 9: 541–551.CrossRefGoogle Scholar
  27. Mason T, Williams R, Vivian-Byrne S (2002). Multi-disciplinary working in a forensic mental health setting: ethical codes of reference. Journal of Psychiatric Mental Health Nursing 9: 563–572.CrossRefGoogle Scholar
  28. McCallin A (2001). Interdisciplinary practice – a matter of teamwork: an integrated literature review. Journal of Clinical Nursing 10: 419–428.CrossRefGoogle Scholar
  29. McGuire J (2002). Multiple agencies with diverse goals. In: Buchanan A (ed). Care of the Mentally Disordered Offender in the Community. Oxford University Press: Oxford. pp 264–287.Google Scholar
  30. Meltzer B, Petras J, Reynolds L (1975). Symbolic Interactionism: Genesis, Varieties and Criticism. Routledge & Kegan Paul: London. p. 2.Google Scholar
  31. Morgan M, Calnan M, Manning N (1985). Sociological Approaches to Health and Medicine. Croom Helm: London.Google Scholar
  32. Nolan P (2005). The historical context. In: Wix S, Humphries M (eds). Multidisciplinary Working in Forensic Mental Health Care. Elsevier Churchill Livingstone: London. pp 1–18.Google Scholar
  33. O’Neil O (2004). Accountability, trust and informed consent in medical practice and research. Clinical Medicine 4: 269–276.CrossRefGoogle Scholar
  34. Onyett S (1997). Collaboration and the community mental health team. Journal of Interprofessional Care 11: 257–267.CrossRefGoogle Scholar
  35. Perinbanayagam R (1991). Discursive Acts. Walter de Gruyter: New York.Google Scholar
  36. Robinson D, Kettles A (1998). The emerging profession of forensic nursing: myth or reality?. Psychiatric Care 5: 214–218.Google Scholar
  37. Shaskolsky L (1970). The development of sociological theory in America – a sociology of knowledge interpretation. In: Reynolds I & J (eds) The Sociology of Sociology. McKay: New York.Google Scholar
  38. Strauss A, Corbin J (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage: London.Google Scholar
  39. Strauss A, Schatzman L, Bucher R, Ehrlich D, Sabshin M (1964). Psychiatric Ideologies and Institutions. Collier Macmillan: London.Google Scholar
  40. Turner R. (1962). Role-taking: process versus conformity. In: Rose A (ed) Human Behavior and Social Processes. Houghton-Mifflin: Boston.Google Scholar
  41. Warne T, Stark S (2004). Patients, metaphors and teamworking in mental health. Journal of Psychiatric and Mental Health Nursing 11: 654–661.CrossRefGoogle Scholar
  42. Warner J, Gabe J (2004). Risk and liminality in mental health social work. Health Risk and Society 6: 387–399.CrossRefGoogle Scholar
  43. Whyte L (1997). Forensic nursing: a review of concepts and definitions. Nursing Standard 11: 46–47.CrossRefGoogle Scholar
  44. Whyte L, Brooker C (2001). Working with a multidisciplinary team in secure psychiatric environments. Journal of Psychosocial Nursing and Mental health Services 39: 26–34.Google Scholar
  45. Wix S, Humphries M (eds) (2005). Multidisciplinary Working in Forensic Mental Health Care. Elsevier: London.Google Scholar
  46. Zarenstein M, Reeves S (2000). What's so great about collaboration?: We need more evidence and less rhetoric. British Medical Journal 320: 1022–1023.CrossRefGoogle Scholar

Copyright information

© Palgrave Macmillan Ltd 2007

Authors and Affiliations

  • Monica Shaw
    • 1
  • Bob Heyman
    • 1
  • Lisa Reynolds
    • 1
  • Jacqueline Davies
    • 1
  • Paul Godin
    • 1
  1. 1.The Health Care Research Unit, St Bartholomew School of Nursing and Midwifery, City UniversityLondon

Personalised recommendations