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Membership and management: structures of inter-professional working in community mental health teams for older people in England

  • Mark Wilberforce (a1), Sue Tucker (a1), Michele Abendstern (a1), Christian Brand (a1), Clarissa Marie Giebel (a1) and David Challis (a1)...



Community mental health services are regarded as the preferred first tier of specialist psychogeriatric support, with integrated multidisciplinary teams believed to offer improved decision-making and greater continuity of care than separate single-profession services. In England over 400 community mental health teams (CMHTs) form the cornerstone of such support, yet research has neither assessed progress toward integrating key professional disciplines nor the nature of their membership and management arrangements.


A self-administered questionnaire was sent to all CMHTs for older people in England, seeking a combination of objective and subjective information on team structure and management.


Responses from 376 (88%) teams highlighted broader multidisciplinary membership than found in a 2004 survey, with particular growth in the number of support workers and other unqualified practitioners. Only modest progress was found in the integration of psychologists and social workers within CMHTs. The data also revealed a trend toward “core” team membership, and away from “sessional” membership in which staff may have divided loyalties between services. Multidisciplinary working was reported as beneficial by many respondents, but examples of “silo working” were also found, which may have hampered service delivery in a minority of teams.


The reported growth in the number of practitioners without professional registration raises issues about the appropriate skill mix and substitution within CMHTs, while local agencies should review barriers to the integration of psychologists and social workers. Further research is required to explore the quality of multidisciplinary team working.


Corresponding author

Correspondence should be addressed to: Mark Wilberforce, Personal Social Services Research Unit (PSSRU), University of Manchester, Dover Street Building, Oxford Road, Manchester M13 9PL, UK. Phone: +44-0161-275-5391; Fax: +44-0161-275-5790. Email:


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Audit Commission. (2000). Forget Me Not: Mental Health Services for Older People. London: Audit Commission.
Brown, B., Crawford, P. and 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, 425435.
Carpenter, J., Schneider, J., Brandon, T. and Wooff, D. (2003). Working in multidisciplinary community mental health teams: the impact on social workers and health professionals of integrated mental health care. British Journal of Social Work, 33, 10811103.
Challis, D., Hughes, J. and Sutcliffe, C. (2010). Social Work and care/case management, In Ames, D., Burns, A. and O’Brien, J. (eds.) Dementia (pp. 180185). London: Hodder Arnold.
Department of Health. (2001). National Service Framework for Older People. London: Department of Health.
Department of Health and Care Services Improvement Partnership. (2005). Everybody's Business: Integrated Mental Health Services for Older Adults: A Service Development Guide. London: Department of Health.
Draper, B. (2000). The effectiveness of old age psychiatry services. International Journal of Geriatric Psychiatry, 15, 687703.
Draper, B. and Anderson, D. (2010). The baby boomers are nearly here – but do we have sufficient workforce in old age psychiatry? International Psychogeriatrics, 22, 947949.
Evans, S. (2004). A survey of the provision of psychological treatments to older adults in the NHS. The Psychiatrist, 28, 411414.
Evans, al. (2012). The social care component of multidisciplinary mental health teams: a review and national survey. Journal of Health Services Research and Policy, 17, 2329.
Fay, D., Borrill, C., Amir, Z., Haward, R. and West, M. (2006). Getting the most out of multidisciplinary teams: a multi-sample study of team innovation in health care. Journal of Occupational and Organizational Psychology, 79, 553567.
House of Commons. (2008). Improving Services and Support for People with Dementia: Sixth Report of the Committee of Public Accounts, Session 2007–08. London: TSO (The Stationery Office).
Huxley, P., King, S., Evans, S., Davidson, B. and Beresford, P. (2003). ‘No Recovery Without Time and Support’ (or ‘More than Bowling Together’): Evaluation of the Introduction of Support, Time and Recovery Workers in Three Pilot Sites. London: NHS, Social Care Workforce Research Unit, King's College London.
Huxley, P., Evans, S., Beresford, P., Davidson, B. and King, S. (2009). The principles and provisions of relationships: findings from an evaluation of Support, Time and Recovery workers in mental health services in England. Journal of Social Work, 9, 99117.
McKenna, H. F., Kenney, S. and Hasson, F. (2005). Health care assistants: the views and perceptions of course co-ordinators in the Republic of Ireland. Journal of Nursing Management, 13, 165172.
McRae, N., Banerjee, S., Murray, J., Prior, S. and Silverman, A. M. (2008). An extra pair of hands? A case study of the introduction of support workers in community mental health teams for older adults. Journal of Nursing Management, 16, 734743.
Miller, C., Freeman, M. and Ross, N. (2001). Interprofessional Practice in Health and Social Care: Challenging the Shared Learning Agenda. London: Hodder Arnold.
Mistral, W. and Velleman, R. (1997). CMHTs: the professionals’ choice? Journal of Mental Health, 6, 125140.
National Audit Office. (2007). Improving Services and Support for People With Dementia. London: NAO.
Ng, C., Herrman, H. and Chiu, E. (2009). Community mental health care in the Asia-Pacific region: using current best-practice models to inform future policy. World Psychiatry, 8, 4955.
Norman, I. and Peck, E. (1999). Working together in adult community mental health services: an inter-professional dialogue. Journal of Mental Health, 8, 217230.
Onyett, S. (2011). Revisiting job satisfaction and burnout in community mental health teams. Journal of Mental Health, 20, 198209.
Onyett, S. and Ford, R. (1996). Multidisciplinary community teams: where is the wreckage? Journal of Mental Health, 5, 4755.
Ovretveit, J. (1993). Coordinating Community Care: Multidisciplinary Teams and Care Management. Buckingham, UK: Open University Press.
Priest, P., Dunn, C., Hackett, J. and Wills, K. (2011). How can mental health professionals best be supported in working with people who experience significant distress? Journal of Mental Health, 20, 543554.
Rosen, A. and Callaly, T. (2005). International teamwork and leadership: issues for psychiatrists. Australasian Psychiatry, 13, 234240.
Royal College of Psychiatrists. (2006). Raising the Standard: Specialist Services for Older People with Mental Illness. Report of the Faculty of Old Age Psychiatry. London: Royal College of Psychiatrists.
Simpson, A. (2006). Shared care and inter-professional practice. In Rassool, G. (ed.), Dual Diagnosis Nursing (pp. 130139). Oxford, UK: Blackwell.
Tucker, al. (2007). Old age mental health services in England: implementing the National Service Framework for Older People. International Journal of Geriatric Psychiatry, 22, 211217.
Wilberforce, M., Harrington, V., Brand, C., Tucker, S., Abendstern, M. and Challis, D. (2011). Towards integrated community mental health teams for older people in England: progress and new insights. International Journal of Geriatric Psychiatry, 26, 221228.
World Health Organization and Alzheimer's Disease International. (2012). Dementia: A Public Health Priority. Geneva, Switzerland: WHO.
World Health Organization and World Psychiatric Association. (1997). Organisation of Care in Psychiatry of the Elderly. Geneva, Switzerland: WHO.



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