Frank Browne: Co-ordinator role is key in community mental health teams

National working groups have met, argued, but failed to agree on how to recruit a community mental health team co-ordinator and how to fund the position. Hence, the status quo remains with all the disciplines in these teams reporting to managers outside the team.

CHILD and adolescent community mental health teams are under the public spotlight because of the revelations of the Maskey report into the failures in South Kerry Mental Health Services.

The report highlighted the clinical practice of a non-consultant hospital doctor regarding his inappropriate prescribing of medication to children, but the greatest failure of management was the inability to appoint a fully qualified child and adolescent consultant psychiatrist for South Kerry, who could have prevented children being overmedicated in the first place.

However, the report also highlighted the failure of HSE management to appoint a team co-ordinator to every community mental health team across the country. Readers may scratch their heads in disbelief that there is no one person responsible for the day to day management of each multidisciplinary team. More shocking is the fact that this also applies to all the community adult mental health teams. Each team usually covers a catchment population of 50,000 and includes psychiatric nurses, at least two psychologists, occupational therapists, and social workers, with consultant psychiatrists and other doctors in training. The clinical leader, but not the manager, is the consultant. All the staff report to a senior manager within their own discipline but usually outside the team.

Vague management

Historically, before the national mental health policy A Vision for Change was put in place in 2006, teams were smaller and most staff were either doctors or nurses, with a senior nurse acting as the de facto team co-ordinator. However, with the increased investment and the recruitment of additional staff from all disciplines, the management of the team has become vague. 

A Vision for Change had clearly recommended appointing a team co-ordinator, a professional suitably qualified to share the day-to-day management of the team’s business, ensuring cases are allocated, work is completed, good record-keeping, and effective communication with GPs and other agencies.

One may wonder why the Irish system is unlike the NHS mental health service in Britain, where each community mental health team has a named manager who supports the consultant psychiatrist, freeing him or her up to concentrate on the clinical work of assessing and treating patients, while the manager keeps a check on all the practical aspects to managing the team. There are no separate line managers having an influence on staff from their discipline outside the team because these senior professionals are the managers of the team.

It would be unfair not to acknowledge that attempts have been made to address the situation.

Guidance document

As a member of the National Vision for Change Working Group in 2012, I chaired a team co-ordinator working group that produced a guidance document for the implementation of the role. Following many heated meetings, a guidance document was agreed to outline the key tasks of the position and the reporting relationships. We optimistically thought this would lead to the recruitment of a person who would take on the key role, akin to bygone days of the senior nurse, who would ensure the team operated as efficiently and effectively as possible. However, our hopes were to be dashed when the National Mental Health Management Team, for whatever reason, watered down the position, making the potential team-co- ordinator a time-limited position open to all staff, even those with limited experience.

Also, anyone willing to consider taking on the role would do so without any additional payment and would be required to manage at least half of their original cases. Unsurprisingly, there were few takers for the role. Even up to the end of 2020, subsequent national working groups have met, argued, but failed to agree on how to recruit a team co-ordinator and, importantly, how to fund the position.

Arguably, all the vested interest groups were unwilling to compromise on budgets, reporting relationships, and roles. Hence, the status quo remains with all the various disciplines in community mental health teams reporting to managers outside the team.

One can only conclude that without significant intervention from the Department of Health, the culture in local mental health services will always eat up any new national strategic development, no matter what its benefits might bring to those who need the service most.

Frank Browne is former chairman of the Irish Association of Social Workers