The impact of team processes on psychiatric case management.
AIM
This paper is a report of a study to identify the structures and interactions within community mental health teams that facilitate or impede effective teamwork and psychiatric case management.


BACKGROUND
Effective case management requires close collaboration between case managers or care co-ordinators and other members of the multidisciplinary mental health team, yet there has been little research into this relationship.


METHOD
A multiple case study of seven United Kingdom community mental health teams was conducted between 1999 and 2001, using qualitative methods of participant observation, semi-structured interviews and document review.


FINDINGS
Factors were identified that impacted on the ability of care co-ordinators to act effectively: 'structure and procedures'; 'disrespect and withdrawal'; 'humour and undermining'; 'safety and disclosure'. Care co-ordination was enhanced when team structures and policies were in place and where team interactions were respectful. Where members felt disrespected or undermined, communication, information sharing and collaboration were impaired, with a negative impact on the care provided to service users.


CONCLUSIONS
Teams require clear operating procedures alongside interprofessional trust and respect to ensure that there is open, safe and reflective participation. Further research is required to identify how best to bring about collaborative, effective teamwork in mental healthcare.