Crew BlogEvolution not Revolution!
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 MDT are 3 letters (words) that I suspect many of us are very familiar with – Multi Disciplinary Team – but what do we mean? For me it raises more questions than answers, things like -
The aim of MDT working, is to bring together the skills & experience & expertise of all those involved & required to the table, in order to formulate (care plan) & support the person & family in their care. I would suggest that intuitively we think this should be a good idea & positive & be helpful & there is probably lots of evidence out there that it works when it works. The problem I guess is that all too often it just doesn’t!  The state invests a fair few £s in training various professionals to undertake various roles & functions & some even become experts. I will mostly put the expert conversation & the one about student tuition fees & loans to one side. When I went to Polytechnic, I was young, had hair & was slimer… it was also free & I had a full grant & I had grand notions & hopes relating to concepts & theories about social mobility & social science stuff. I was pretentious & spotty enough to read Marx & developed ideas above my station, in relation to poverty, inequality & shite housing etc. I also played rugby & drank lots of beer & missed the odd train here & there. I always preferred being part of a rugby team than any MDT. I even managed to merge the two, and did an ethnography participant observation study based on a rugby tour. Young drunk men make very unwise decisions & I am glad mobile smart phones were not a thing. The MDT is also about assessing & seeking to manage & mitigate risk & sometimes about public protection. Over the years as a social worker, ASW, AMHP & BIA, I have worked in a number of services/teams: AOT, Rehab & Recovery, Forensic Services, Homeless CMHT, CMHT & dedicated AMHP Team. When I look back over that, I think it is clear, that the MDT sort of works for us as professionals. I also think it’s clear that the good Dr (Consultant Psychiatrist), is very often the captain of the team. The Team Manger tends to be the coach. The other professionals had demarcated roles & didn’t always agree with the captain or manager or indeed with each other. Depending on the set up, you might have a couple of junior doctors, a sprinkling of CPNs, an OT, a social worker, perhaps a Psychologist & trainee - if you were really lucky. The good Dr would tend to have a medical secretary, the MDT would have had admin support & there might be a number of associate support staff e.g., a nursing or social work or even OT assistant – to do the practical doing tasks.
I think MDTs work best, when they can tolerate robust & frank exchanges of views & when the culture & relationships & professionals involved can tolerate dissent & dissonance. Ward rounds are an interesting variation on the MDT theme & I suspect that the person in question or their family when invited to attend, don’t very often feel a part of the team. In terms of AMHP practice, I often find myself wondering what the MDT looks like. When I see a referral for a Mental Health Act Assessment (MHAA) from a CMHT Responsible Clinician (RC), I often find myself wondering what went on before & what role they intend to play in the MHAA?
The AMHP might sometimes need an officer of the law or 3 to join the team, & that is easier said than done. The girls & boys in blue are very busy fighting crime & this is about health. Yup that is very true officer, but I don’t actually work for health & the power & authority in the warrant is actually that of a constable & not mine - I am only an AMHP.
I am not convinced that the ambo crew feel like that are part of the team & sometimes it feels like the Bed Manager is playing for the opposition team. I sometimes find myself wondering who is actually obstructing the AMHP (S.129)? Then there is the mythical S.140 & the CCG to be thinking about. They appear to be on the subs bench, but are not overly keen on getting on to the pitch. #AMHPs are not in #Team999- AMHPs don’t get cars with go faster stripes or flashing blue lights. No one ever thinks where the AMHP might park or about the AMHP on the bus. The AMHP gets a Jones & a mobile phone & is left to crack on & moan. The #AMHPwinge is a thing… So, the AMHP gets a Dr or two & maybe if they a are lucky, a Crisis Resolution Home Treatment nurse, but with no bed available the AMHP is left to mind the gap. The team is then very often me & thee & the family. The people, kids & families on the receiving end of what AMHPs do, very often form part of the team. The vast majority of people actually cooperate & acquiesce with the AMHP & the process. But I suspect that it doesn’t feel like team work or dream work. It is all too often an improvised solution to system dysfunction. Anyway less of my #AMHPwaffle & here is what some others thought.
So, a little bit of an #AMHPrant & some thoughts on the MDT & what it might mean to me & thee. Tony Deane (@asifAMHP) Principal Social Worker & #NotsogrumpyAMHP 29th November 2021 I was summonsed (invited) to Brighton by @SteveyBMH aka the now retired National Mental Health Co-ordinator @CollegeofPolice Steve is a tip top fella & this was his gig & final hurrah. Steve is/was very clear, that the girls & boys in blue, should not be the first line of response to people experiencing mental health crisis. However the reality is, that far too often, the girls & boys in blue #Team999 & the almost ubiquitous S.136, are the only response on offer.  I have been to a couple of these conferences now & to be fair, the girls & boys in blue really do appear to get it. They now know what an #AMHP is & does. They mostly know that the “P” stands for “Professional”. They know that the #AMHP has to find a S.12 Dr or 2 & that the #AMHP doesn’t do beds. They know all about S.140 & that NHS compliance with this particular section of the MHA, is part of the solution. Most of them now know, that S.136 is actually an arrest (preserved power of & not for an offence). They know that coordinating a Mental Health Act Assessment in custody, too often represents a huge challenge for #AMHPs & they also know that we #AMHPs probably need somewhere to park. They, like you & @seandilleyNEWS, also know (see article here), that the mental health system is dysfunctional & struggles to meet the demands placed on it. They acknowledge that they are sometimes placed between a rock & a hard place & they know who is actually placing them in that position. The big cheese @DCCRachelBacon certainly appears to understand her brief & she is being ably supported by @BenjaminRoweso1 & Tony Jarred (needs to join @Twitter soon) @metpoliceuk. It isn’t very often, that a wee boy from Derry, gets to sit next to a Deputy Chief Constable. It struck me as I listened & wandered about the very posh Grand Hotel, just how much these girls & boys in blue cared about this stuff. Police Forces from up & down the country, from over Hadrian’s Wall, from the Valleys & the PNSI were represented & they are all trying to do this stuff better. They are all trying to make multi agency partnership working, actually work. So I stood up & did the A to Z of #AMHPing. I banged on about the need for better legal literacy & suggested that people actually need to read the MHA & the MHA Code of Practice & probably the MCA.
I might have suggested that the girls & boys in blue need more training in mental health. (but to be fair, the boss pays me to say that 😉)
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