Crisis resolution and community mental health: An Ethnography of two teams.

Abstract

"Crisis Resolution" teams are a growing element of community mental health services in the England. The Department of Health intended to have 335 services established by the end of 2004 and had in fact achieved a total of 343 by mid 2005. This study focuses on two such crisis teams operating in the north east of England and aims to describe important features of their routine work. Using a fusion of observation and discourse analysis (the latter based on audio recordings made during team meetings and interviews with team members), areas such as multidisciplinary team working, expertise, user involvement and the understanding of mental health crisis itself are subjected to scrutiny, discussion and analysis. The study was funded as an ESRC CASE studentship. A variety of professional expertise comes into play in the formation of any multidisciplinary community mental health team. How these disciplines interact when delivering crisis resolution is a key focus of the study in hand. Both teams are made up of the same professional disciplines; medicine, nursing, and social work. In addition, support workers are present in both teams. This research examines the interaction of these disciplines and roles, the possibility and actuality of conflict between them and the various ways in which individuals work together to create a team. While Department of Health guidelines deliver a referral criteria with a definition of the constituents of a mental health crisis, this definition is general and cannot describe the numerous interpersonal processes involved in accepting a referral. Hence, the nature of mental health crisis itself is debatable. The study examines a variety of ways in which "crisis" is constructed and understood. Also, the practice of crisis resolution does not simply involve the work of mental health professionals; it also involves the input of the mental health service users themselves. "User involvement" is a phrase that commonly appears in contemporary Health Service literature. This study seeks to describe what this phrase actually means in the day to day delivery of the service.