Community mental health teams

Community mental health teams (CMHTs) have evolved alongside the downsizing of mental hospitals. They originated in mental health services in the UK and France in the 1950s and 60s. Generic CMHTs provide assessment and treatment for the population of a defined sector (usually stratified by age: child, adult and old age), who are referred by GPs or other health professionals. Despite considerable variation there are regular features of such teams - in particular their approach to multidisciplinary working management and caseloads - which are broadly similar and are outlined here. Common issues of CMHTs addressed in this contribution include leadership, size, the mix of disciplines and the management of multiple lines of authority. As secondary care teams, CMHTs generally need to be particularly clear about liaison and relationships with their referring GPs and arrangements around shared responsibilities with social services. Despite attempts by governments it is neither possible nor sensible to impose a rigid model of working across all circumstances. It is the need for clarity around these principles of liaison and shared working responsibilities that is essential and fixed. CMHTs have increasingly adopted standardized approaches to patient management such as the Care Programme Approach (CPA), fixed caseloads and the development of referral and discharge protocols. They remain responsive and complex organizations that have endured despite several attempts to supplant them and despite the challenges and frustrations that they can present to those who work in them. © 2004 Elsevier Ltd. All rights reserved