Effective Partnerships In Multidisciplinary Mental Health Care: A Reflective Essay.

Critically evaluate the theoretical underpinnings of partnership working in health and social care.

Contextualise current policy drivers in relation to working in partnership in health and social care.

Critically explore the perspectives of different professions, and users and carers of services, in relation to partnership working.

Articulate the distinctive features of different models of partnership working and evaluate their application in health and social caresettings.

Identify and critically evaluate interpersonal skills that are essential for effective partnership working.  

Benefits of Effective Partnerships in Mental Health Care

Mental health nursing is considered to be a very demanding as well as the rewarding profession where mentally ill patients are provided care for regaining back their mental stability and to provide them a quality life. After the institutionalization of mental health was brought to a halt due to serious criticism, researchers have tried their best to provide outpatient care delivery systems by deinstitutionalization with specific evidence based practice. As a result of this, the number of patient readmissions witnessed a drastic reduction, as they showed a marked development in regaining stability of their lives (Kutash et al., 2014). The key responsibility of the healthcare professional is to provide suitable care to the patient on the basis of all the needs the patient have.  Research indicates that if healthcare providers work in collaboration with each other, it is easier for them to achieve full recovery of mentally ill patients in a shorter span of time. Work efficiency increases as a result of collaboration and best results are achieved in all possible service areas (Reeves et al. 2013). A patient can be provided with optimal care services due to this positive change and utilization of primary nursing care models is best witnessed. Collaborations and successful partnerships not only ensure a comprehensive approach for patient treatment but also help professionals develop their skills in the respective field of practice (Constand et al. 2014).

The essay will mainly be a reflective one which will provide various scenarios of effective partnerships between different members of a multidisciplinary team of mental health care, important partnership models that exist, different barriers that may arise and recommendations for effective partnership presentation in such teams. We will follow the Gibbs’s cycle (Howatson-Jones 2016) to effectively structure the essay that will reflect my experiences.

Case scenario:

In the acute care setting of the healthcare organization, a patient named Mr. Samuel Brown was admitted in a very serious condition by his son. He had been suffering from depression after the sudden death of his wife in a car accident. A critical analysis of his conditions and also after thorough investigation from the family members, it was known that he is also suffering from bipolar disorders where he had tried to harm himself trying to take his own life as he believes that he has no aim to stay in the world. He had also taken up the habit of drinking excessive alcohol which also made it a case of substance abuse. He had experienced falls a number of times and had marks of bruises. I had been entrusted with the responsibility of acting as a governing nurse of the admitted patient and developed the aim of for providing optimal care through my practice.

Reflective Scenario: Providing Optimal Care for a Patient with Multiple Mental Health Conditions

The healthcare organization I am associated with is a well-reputed and established organization, providing efficient services at the mental health care department. The department is well-known for having a number of successful cases of mental health recovery of patients in the country in the past. I work here as a nursing mentor in the role of a senior nurse. One of the main reasons that can be noted for its achieving success is the choosing of proper partnership strategy (Zwarenstein, Goldman and Reeves 2009). I have seen that partnerships are mainly done with an aim to improve the abilities of different healthcare staffs so that they can provide a highly coordinated health as well as social care services (Gilmer et al. 2014). Moreover, researchers also suggest that individuals working in a collaborative manner are been able to effectively handle complex situations which becomes too difficult for a particular staff to accomplish it. I have seen that it is not only results in correct division of a laborious work of care among different members of the partnership but also ensure that each of the experts provide the best skill to provide excellent care in their domain. When all the individuals work in a collaborative manner, each displaying their maximum level of skills, the patient can expect a better quality life thereby regaining the stability of life (Kohrt et al. 2016). Moreover, I have also understood that working in partnerships is also helpful in reducing the gaps in provision and delivery of health and social care services. This is mainly achieved by our organization by pooling together of different resources such as medical equipments, pharmaceuticals and also different personnel, such as counselors and cognitive therapists, who proves to be extremely important for efficient provision of mental health care and also of social care services (Morrison-Valfre 2016).

Besides, the above mentioned important reasons, other reasons noticed by the researchers. This include provision of wider ranges of services to the mental health patients effectively which had resulted in increased satisfaction of patients and family members. Moreover I have also seen that when partnerships take place between two appropriate parties, it is ensure that the health care service delivered meets the statutory requirements imposed on by different regulatory authorities at the national level (Shaw 2015).

Benefits:

While handling the above mentioned case, a successful partnership was established between the important stakeholders who had taken the responsibility of treating Mr. Brown’s case. He was diagnosed with a number of mental health conditions and therefore a planned intervention was very important for addressing all the concerns the patient had. For the entire treatment plan, I called in for a meeting with the important healthcare staffs to discuss the roles that are needed to be played by each of the professionals and thereby plan an entire care intervention strategy for meeting the requirements of the patient. A patient centered care was decided to be followed as researchers believe that such care is meaningful and also valuable for individual patient and includes listening to the patient calmly along with informing and including that patient every time in his care ensuring that his preferences, needs and values are properly paid attention to (Nic et al. 2016). Our department usually provides much importance to patient centered approach as this type of treatment has been found to provide the best results to the patient. Efficient healthcare staffs need to maintain eight of its important aspects to provide full proof person centered approach. This includes respect for patients’ preferences along with proper coordination and integration of care by the healthcare staff (Padula et al. 2017). Other aspects that should be ensured in patient centered care are proper information and correct education to do so, with the provision for right physical comfort and also emotional support. Other aspects of person centered care that our multidisciplinary team also believes in are the involvement of family and friends in the treatment along with continuity and transitions and access to care (Lund, Tomlinson and Patel, 2016).

Multidisciplinary Team and the Keyworker Model

The team comprising of different experts for handling the case of Mr. Brown was designated as the multidisciplinary team. I advised the team to follow the models of correct service delivery which said that staff member’s main role would be to work with responsibility within that team that will result in adequate skill mix within the team to provide a huge set of different stages of interventions (mhcirl.ie 2017). The model of service delivery also states that there should be strong link between different mental health services and good general knowledge about the different local resources (Batalden et al. 2015).

With these mentioned principles of the model of service delivery for multidisciplinary teamwork, one can denote two important models that can be used here to explain the different collaborative partnerships which if achieved successfully will result in best results for patient treatment. A model called the Keyworker model that is extensively used in United Kingdom can be described in this context (Renehan, Goeman and Koch 2017). This model suggests that keyworkers are mainly the prime therapists for the patients and these key workers can come from any professional disciplines. They have the right to cooperate, coordinate and in this way lead the intervention plan that had been decided. Therefore, they serve as the patient as well as the caregiver’s main access point to the team. Any services who adopt this model, any professional in the mental health care team can be considered as the keyworkers with the primary role being delivering and managing the care provided to the patients. This model mainly involves three important stakeholders. They are the clinical leader of the team who performs a number of functions like ensuring probity of team functioning, gaining team cohesion at the same time of the provision of vision and direction of service development. A close working relationship with a collaborative and partnership outlook is maintained along with the set up of genuine respect for different professionals including shared decision-making (LaMontagne et al. 2014). Another important stakeholder here is the team coordinator who usually is responsible with the maintenance of the teams’ clinical business. He mainly helps in establishing the close relationships with not only general practitioners but also with the different referring agencies as well. He monitors the workload of all the team members at the same time of leading the role in auditing team activity. They also perform the important function of liasing with different mental healthcare professionals, with clinical team leader and with other groups and agencies in the social circle. There is another important task holder called the business manager who mainly performs the administrative tasks of the mental health care team with duties of maintain the budget, enabling audit, reviews and monitoring functions (Caplan 2013).

Conclusion

This model usually works with the team coordinator performing the first step. He triages the referral to the most appropriate staff that can assess the case before presenting the referral to the full team. I carried out a comprehensive patient assessment covering the bio/psycho/social/cultural/environmental elements specific to the patient (Gillard and Holley, 2014). The second step is presented to the full team based on the needs identified. Here, a keyworker is allocated who have the important skill to fulfill the different needs to investigate the requirements in more depths. The third step mainly consists of the completion of proper assessments of each symptom of the patients. A care plan would be proposed would be followed in future. All the disciplines along with that of the patient will have a set of notes, which help all the team members to access different important details without raising any issue in confusion.

Many other models that can be also be used in this context is the intensive case management (ICM) (Dieterich et al. 2017), the ‘strengths’ model (Tsoi et al. 2015); the ‘rehabilitation’ model (Moe and Brataas 2016), brokerage (Dennis et al. 2015) and many others. However, all of them have some form of disadvantages, such as limited scope for professional autonomy and less patient engagement, for which they are not entirely accepted as proper partnership or collaborative models in health care.

I have seen the utilisation of the Keyworker model, which helped in the establishment of proper partnerships and collaborative activities in order to bring out the best service that would help the patient in fast recovery. Here I was the nursing mentor and I and the doctor both played the role of clinical leaders who mainly paid importance to the team functioning and provided vision and mission to the entire team, which consisted of the nurses, psychiatrists, physiotherapist, occupational therapist, consultants and the others. Doctor analysed Mr. Brown’s condition and discussed the various symptoms and the interventions required for the patients. The doctor also instructed me about the experts whom she needs to incorporate in her team whose partnerships will bring the best effect. Here I also acted as the team coordinator who plays the important work for marinating relationships among the different mentioned healthcare staffs so that each of them remains aware of the other’s expertise. I performed a comprehensive assessment of the diseases and came to an opinion that his depression as well as his bipolar disorder is interconnected which had compelled him to take up alcohol as a resort to forget the personal pain he is going through. After having different sorts of assessment and thereby critically analysing the bio/physical/social/cultural/and environmental elements, I was able to identify the key needs of the patient.

I then allocated a keyworker, which was mainly the senior nurse and then presented the entire case to the different important healthcare professionals. The senior nurse mainly worked with the different experts with necessary skills so that further requirements if any can be assessed. The senior nurse then explained the case to the experts in the next team meeting in order to ensure that a perfect partnership is established between everyone so that everyone remains clear about the work that they have to conduct and their time schedules of attending the patients for carrying out their part of the planned intervention (Moorhead et al. 2014). The care plan was developed in every one’s presence by properly discussing the needs of the patients. The nurses were mainly provided with the duty of carrying out primary care for the patients involving the daily activities like bathing, feeding, dressing, wound dressing, medication administration and others. As the patient had several bruises on his body, therefore the nurse was responsible for proper dressing of his wounds and taking care that his self-harming activities would be controlled (Dougherty and Lister 2015). The role of the psychiatrist was to counsel the patient with an aim to make him look for the positive sides of lives by regaining back his emotional stability (Stuart 2014). 

Application of proper counseling techniques would ensure him to get over the depressions and bipolar disorders that he is facing due to death of his wife. Occupational therapists were mainly performing the role of providing the patients with every suggestion that will help him regain back his skills that are needed by him to live a quality life to the fullest. He mainly plays an important role in providing interventions, which helped to achieve functional outcomes promoting his mental health and prevent his injuring himself (Keltner 2013). As he had experienced many falls, summoning a physiotherapist had also become very important for handling the case of the patients. The pharmacists was also considered to be involved in this partnership was mainly due to performing the reviews of the list of medications that is being provided to the Mr. Brown. He would helps in playing a key role in letting the team know that the multiple medications administered to Mr. Brown would result in any sort of drug interactions and poor adherence (King et al. 2015). Therefore, it can be easily understand that each healthcare professional must involve with each other in proper partnership so that they can provide the best quality treatment for Mr. Brown which can never be achieved without this successful partnership (Stuart 2014).

Challenges faced:

However, there may arise many challenges, which may lead to disruption in effective partnership among the healthcare professionals. The first one being the lack of understanding between the professionals that leads to the misconceptions and bias among the stakeholders (Kassianos et al. 2015). This often affects the patient’s health. Secondly, there may also arose conflicts due to lack of proper communication between the stakeholders, which may be due to complexes or ego clashes amongst themselves. It was also seen that in case of Mr.  Brown, there arose a conflict regarding the scheduling of appointments where the nurse did not properly communicate between the physiotherapist and the psychiatrists. This made them being present at the same time claiming to attend the patients. Ego clashes prevented them to critically analyzing the stressful situation of the patient thereby affecting service delivery (Dadich and Olson 2017). Thirdly, often-reduced commitment from the other partner often created issues where the later partner also becomes reluctant ultimately harming the patient’s health (Dowdy et al. 2015). This led to poor performance of both the partners. In the case of the Mr. Brown, occupational therapist was assigned the task of applying cognitive behavioral therapy for his substance misuse. However, he forgot to do that and due to this, the medication was bound to be changed, as the intervention plan was not followed. The nurse became reluctant that harmed the patients’ health. Moreover, another barrier was improper sharing of information among the different professionals regarding the patients’ health, which often lead to confusions, repeated interventions, and many others, which harmed patient (Mey et al. 2015).

Therefore as I have clearly understood how the keyworker model works and the benefits and challenges of different partnership, therefore it would help me to develop a proper action plan along with my coworkers which will provide the best results.

Conclusion:

Thereby from the entire discussion, one can easily understand the importance of partnerships among the mental health professionals in order to handle a serious case of mental disorder. Therefore, it often becomes important for the professionals to properly develop communication skills among their team members and pay more importance to the patient health rather than giving way to different types of complexes. Moreover, they should also develop the habit of properly sharing information at the right time in order to avoid any sort of breaches in quality service delivery. They should develop their understanding of maintaining partnerships among each other from effective partnership model so that they can provide a planned care to the patient that helps him to get back in his regular normal life.

References:

Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L. and Hartung, H., 2015. Coproduction of healthcare service. BMJ Qual Saf, pp.bmjqs-2015.

Cameron, A., Lart, R., Bostock, L. and Coomber, C., (2014). Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health & social care in the community, 22(3), pp.225-233.

Caplan, G., 2013. An approach to community mental health (Vol. 3). Routledge.

Constand, M.K., MacDermid, J.C., Dal Bello-Haas, V. and Law, M., 2014. Scoping review of patient-centered care approaches in healthcare. BMC health services research, 14(1), p.271.

Dadich, A. and Olson, R.E., 2017. How and why emotions matter in interprofessional healthcare. International Journal of Work Organisation and Emotion, 8(1), pp.59-79.

Dennis, S., Hasan, I., Pulver, L.J., Wilson, I. and Zwar, N., 2015. Experiences and views of a brokerage model for primary care for Aboriginal people. Australian Health Review, 39(1), pp.26-32.

Dieterich, M., Irving, C.B., Bergman, H., Khokhar, M.A., Park, B. and Marshall, M., 2017. Intensive case management for severe mental illness. The Cochrane Library.

Dougherty, L. and Lister, S. eds., 2015. The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.

Dowdy, E., Furlong, M., Raines, T.C., Bovery, B., Kauffman, B., Kamphaus, R.W., Dever, B.V., Price, M. and Murdock, J., (2015). Enhancing school-based mental health services with a preventive and promotive approach to universal screening for complete mental health. Journal of Educational and Psychological Consultation, 25(2-3), pp.178-197.

Gillard, S. and Holley, J., (2014). Peer workers in mental health services: literature overview. Advances in psychiatric treatment, 20(4), pp.286-292.

Gilmer, T.P., Stefancic, A., Tsemberis, S. and Ettner, S.L., (2014). Full-service partnerships among adults with serious mental illness in California: impact on utilization and costs. Psychiatric Services, 65(9), pp.1120-1125.

Howatson-Jones, L., 2016. Reflective practice in nursing. Learning Matters.

https://www.mhcirl.ie/. (2017). Multidisciplinary Team Working: From Theory to Practice. [online] Available at: https://www.mhcirl.ie/File/discusspapmultiteam.pdf [Accessed 23 Mar. 2017].

Kassianos, A., Ignatowicz, A., Greenfield, G., Majeed, A., Car, J. and Pappas, Y., 2015. “Partners rather than just providers…”: A qualitative study on health care professionals’ views on implementation of multidisciplinary group meetings in the North West London Integrated Care Pilot. International journal of integrated care, 15(3).

Keltner, N.L., 2013. Psychiatric nursing. Elsevier Health Sciences.

King, O., Nancarrow, S.A., Borthwick, A.M. and Grace, S., 2015. Contested professional role boundaries in health care: a systematic review of the literature. Journal of foot and ankle research, 8(1), p.2.

Kohrt, B.A., Marienfeld, C.B., Panter-Brick, C., Tsai, A.C. and Wainberg, M.L., 2016. Global mental health: five areas for value-driven training innovation. Academic Psychiatry, 40(4), pp.650-658.

Kutash, K., Acri, M., Pollock, M., Armusewicz, K., Olin, S.C.S. and Hoagwood, K.E., 2014. Quality indicators for multidisciplinary team functioning in community-based children’s mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 41(1), pp.55-68.

LaMontagne, A.D., Martin, A., Page, K.M., Reavley, N.J., Noblet, A.J., Milner, A.J., Keegel, T. and Smith, P.M., 2014. Workplace mental health: developing an integrated intervention approach. BMC psychiatry, 14(1), p.131.

Lund, C., Tomlinson, M. and Patel, V., 2016. Integration of mental health into primary care in low-and middle-income countries: the PRIME mental healthcare plans.

Mey, A., Hattingh, L., Davey, A.K., Knox, K., Fejzic, J. and Wheeler, A.J., 2015. Preparing community pharmacists for a role in mental health: An evaluation of accredited Australian pharmacy programs. Currents in Pharmacy Teaching and Learning, 7(3), pp.371-377.

Moe, A. and Brataas, H.V., 2016. Interdisciplinary collaboration experiences in creating an everyday rehabilitation model: a pilot study. Journal of multidisciplinary healthcare, 9, p.173.

Moorhead, S., Johnson, M., Maas, M.L. and Swanson, E., 2014. Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health Outcomes. Elsevier Health Sciences.

Morrison-Valfre, M., 2016. Foundations of Mental Health Care-E-Book. Elsevier Health Sciences.

Nic a Bháird, C., Xanthopoulou, P., Black, G., Michie, S., Pashayan, N. and Raine, R., 2016. Multidisciplinary team meetings in community mental health: a systematic review of their functions. Mental Health Review Journal, 21(2), pp.119-140.

Padula, W.V., Millis, M.A., Worku, A.D., Pronovost, P.J., Bridges, J.F. and Meltzer, D.O., 2017. Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines. Journal of medical economics, 20(3), pp.288-296.

Reeves, S., Perrier, L., Goldman, J., Freeth, D. and Zwarenstein, M., 2013. Interprofessional education: effects on professional practice and healthcare outcomes (update). The Cochrane Library.

Renehan, E., Goeman, D. and Koch, S., 2017. Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community. BMC Health Services Research, 17(1), p.501.

Shaw, C.D., 2015. How can healthcare standards be standardised?. BMJ Qual Saf, 24(10), pp.615-619.

Stuart, G.W., 2014. Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences.

Tsoi, W.S.E., Tse, S., Fukui, S. and Jones, S., 2015. Study protocol for a controlled trial of Strengths Model Case Management in mental health services in Hong Kong. BMJ open, 5(10), p.e008303.

Zwarenstein, M., Goldman, J. and Reeves, S., 2009. Interprofessional collaboration: effects of practice?based interventions on professional practice and healthcare outcomes. The Cochrane Library.