Relational security, which involves the therapeutic relationship between staff and patients and the mix up of staff, is a key concept within forensic services ( Davies, 2004, p. To maintain safety, inpatients in secure care, whether high, medium or low secure services, are subject to a combination of physical, relational and procedural security. Thus there is a strong emphasis on risk and security. The treatment within these services aims to manage the mental disorder at the same time as reducing the risk to others and offending behaviour, with the ultimate goal of a safe return into the community. However, as with the functioning of all teams, the operational reality of the MDT may be somewhat different, influenced by specific characteristics that make up a team (micro level), a ward/unit/type of security within a service (meso level), a mental health trust, with its policies and philosophy (macro level).įorensic mental health services are concerned with the treatment and rehabilitation of service users who suffer from mental disorders and who pose, or who have posed, risks to others. Underpinning the perceived strength of MDT working is the creation of a clinical environment that enables different professions to use their skills, knowledge, attitudes, values and abilities within their scope of practice ( Orovwuje, 2008). “Effective and efficient multidisciplinary team working” is now the agreed approach for mental health services to address complex needs in severe mental illness ( RCP, 2009).Ī body of research evidence has been established to identify some of the benefits of MDT working within mental health services, such as reduced bed use ( Marks et al., 1994), improved service contact after discharge from hospital ( Ford, 1995), preferred by service users and carers ( Simmonds et al., 2001), and improved job satisfaction amongst team members ( Onyett and Ford, 1996). Based on the assumption that MDTs can improve the quality of care by including the perspectives of these professionals into the service users’ planning of care ( Department of Health, 2007 Wagner, 2004), multidisciplinary working is now standard practice across all mental health services in the UK. In 1984 the Department of Health’s “Planning for the Future” strategy recommended the establishment of multidisciplinary psychiatric teams (MDT) comprising psychiatrists, psychiatric nurses, psychologists, social workers and occupational therapists to provide comprehensive treatment and care for people with mental health problems ( Study Group on the Development of the Psychiatric Services, 1984). The concept of multidisciplinary working in the UK is not new and in mental health care has been written about since the 1970s.
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