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Multidisciplinary working is work undertaken jointly by workers and professionals from different disciplines or occupations Pearson Thomas 2010:342 and it has evolved at varying speeds over the past 30 years or so in response to imperatives of central government. Mental health was among the first professions to adopt teams of workers from different professions. The community mental health team is widely regarded as the model for multi-disciplinary working. (Community Care, 2010). Relating this to social work the distinctive quality is demonstrating a holistic approach, by working with a range of situations, people and having an attribute for developing multi-disciplinary and partnerships,(Higham,2006:) c
The crisis centre is run by a Local Council and NHS Trust based in a local community. Which corresponds with the 1975 White paper Better Services for Mentally Ill, professions working together to provide a community based service. (Scie, 2010) The crisis centre provides beds for four adults suffering a mental health, social crisis, who have been referred to them by the Crisis Resolution Home Treatment Team, the service users for instance can be referred from in their home or accident and emergency. Next they complete an assessment inline with local authority guidelines and procedures, then produce a care plan and risk assessment. If they decide the service user is in crisis and can't return home, then they contact the crisis centre for a place with the goal of leaving the centre after the crisis, normally within two weeks. Once the service user is placed, there are numerous methods of contacts from the Crisis Resolution Home Treatment Team and social workers through emails, phone calls and visits.
During this observation multidisciplinary working was witnessed between the crisis centre staff and the Crisis Resolution Home Treatment Team about a service user already in the centre through a phone call. The crisis resolution home treatment team seemed to be following the National Occupational Standards key roles section three, by supporting the individual, representing their needs, views and circumstances by acting as an advocate (Higham 2006: 98) as they were informing the crisis centre of what was happening. The crisis centre staff were asking questions in a way that was treating the service user as an individual by listening to their individual case, respecting and maintaining dignity by only asking questions relevant to the crisis centres needs and criteria. They also spoke clearly and discussed the dynamics of other service users (respecting confidentiality) already in the centre declaring any conflict or positive interactions that had arisen since their last visit (GSCC,2010).These skills are fundamental to social work practice as they are valuing the individual and having a holistic approach.
Furthermore, in the 1990's new labour recognised that problems cannot be addresses by people and organisations working in isolation. So the Department of Health 1998 introduced the white paper Modernising Social Services, which had multi-disciplinary working as a key objective. (Wilson, et, al, 2008:388). In 2000 No secrets actively promoted that multidisciplinary teams, empower and promote well-being of vulnerable adults, through the services they provide and the need to act in a way, which supports the rights of the individual to lead to independence. (Department of Health 2000)
This was observed, by the service user, crisis centre and Crisis Resolution Home Treatment Team via staff communicating frequently throughout the day and providing an environment where service users can come and go freely, yet still have support, during their crisis, they were also encouraged to cook and clean for themselves .This was seen during the observation also in Tony Ryan's (2010) evaluation of crisis centre and Crisis Resolution Home Treatment Team, asked service users what they valued best about their stay, their responses "I was on the lowest rung of the ladder in terms of depression and self esteem. Now I can cook and iron. It has restored my 'get up and go'." and "It is given me a sense of life back and helped me to find myself. I couldn't have gone on any longer. Staff have taught me to cope better and manage my panic attacks." This demonstrates partnership working with the service user and multidisciplinary working. The White Paper Our health, our care, our say also emphasises the importance of people having more control over their lives and access to responsive, preventative services by working together in multidisciplinary teams. (Department of Health 2006). The crisis centre fulfils this.
Throughout the day through discussions and observation it appeared that the crisis centre staff and Crisis Resolution Home Treatment Team encouraged emancipatory practice by involving the service user in their support which shows good practice also staff were not routinized as each day was different, they discussed how each individual was unique with a unique situation. If social workers become oppressed by working in routines this does not always benefit the service user, it is not good practice and is not fundamental to social work values. An example of this was observed when a member of the Crisis Resolution Home Treatment Team came to the crisis centre and completed a visit with a service user. During her visit to the crisis centre she was constantly contacted from her office through phone calls, one of which was a new service user needing to be assessed urgently, she had already one visit booked in after the crisis centre, but had to re -evaluate her cases as the new referral was seen to be more of a priority. She did this by speaking to her manager on the phone and re -arranging for another colleague to see her service user and then asked the office to let the service user know about this change.
The above paragraph demonstrates multidisciplinary working and partnership working with the service users are fundamental and collaboration is needed for social work and the interpretation from the staff involved demonstrates good practice. To show the importance of partnership working with service users in the crisis centre Tony Ryan (2010) completed a service evaluation of the crisis centre and Crisis Resolution Home Treatment Team, they asked service users how they felt about staff. Service user's responses "Any questions or anything you are upset over, you can go and ask the staff" and "Staff are very supportive and help sort problems out." As social work is about working with people to help them to sort their problems out. Also each individual brings unique skills and experience into the working professional relationship. (Thompson. N. Thompson, S. 2008:24)
So far this essay has demonstrated positive multidisciplinary working through observation at the crisis centre. However, in reality multidisciplinary working can be negative and can be totally dysfunctional. As when a group of diverse people with varied skills come together into a team, things don't always go smoothly. (Community Care, 2010) Cree, 2003:163 believes that multidisciplinary working can be positive but also frustrating, isolating and difficult. (Dalrymple Burke 2006:139) Wilson et al (2008) also agrees multi disciplinary working does not always work effectively and such failures have been documented in such finding of Victoria Climbie enquiry and baby Peter, lastly Thompson (2005) believes that multidisciplinary can do more harm than good and can make situations worse.
During the course of the day it was bought to attention through a staff handover that one of the service users in the crisis centre had at first experienced a positive interaction of multidisciplinary practice, but sadly it turned into a negative experience. Conquesenlty, this seemed due to the breakdown of communication between multidisciplinary teams such as his social worker, Crisis Resolution Home Treatment Team, crisis centre staff and medical staff. According to Thompson (2009) without effective communication the notion of multidisciplinary becomes unobtainable. Staff at the crisis centre believed it was due to lack of budgets and lack of communication. During this handover reflective practice was witnessed, as, as a team they spoke about what, why and how things had gone wrong for the service user and how they could approach the situation to get the best outcome for the service user.
The staff at the crisis centre spoke about how they valued supervision meetings as it gave them the chance to voice any concerns they had and also gave the manger chance to deal with any systematic practice that was leading the staff to become unfocused. (Thompson. N. Thompson, S. 2008). As supervision meetings demonstrate good practice and in social work codes of practice, developing ones self through development opportunities to strengthen skills and knowledge.
This essay has demonstrated through observation that it is important to work with other professionals as one person cannot solve another person's problems and dilemmas alone (Thompson. N. Thompson, S. 2008:19) and that multidisciplinary working is a fact of live for social workers and many other professionals also, this essay showed a balance outlook on multidisciplinary working as it has positive and negative points.