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Evolution not Revolution!
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MDT, and what it might mean to me, and thee...

29/11/2021

 
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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 -
  • What does it look like?
  • What does it feel like?
  • What does it do?
  • How does it work & for who?
  • Who selects the team?
  • Who manages the team?
  • Who is the captain of the team?
  • Are all the players in the team equal?
 
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!

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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.

Everyone always assumed that the social worker did benefits & housing, & to be fair we mostly did, even though I & others would point out often, that we don’t actually work for the DWP or Housing Department.

​MDT meetings were the forum where things were discussed & cases presented & allocated & tasks delegated & decisions made & where the odd Drug Rep would turn up with a free lunch and to top up the office pen and post-it supplies
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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?
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​​Too often the expectation appears to be, that the AMHP & others, will simply crack on with the “dirty work” & the RC will not be part of the MHAA MDT. Too often neither will there be a bed should it be required & the ambo will be delayed…

​When coordinating a MHAA or sorting a S.135 warrant or responding to a S.136. The AMHP has to find and coordinate a team response. The AMHP will need to find at least one & sometime two S.12 Drs. To be fair, we can usually find these. They are well remunerated volunteers & there is of course now an App don’t you know.
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.​
  • A certain smurf thought that the captain needed to walk the plank & that MDT meetings were “another hurdle to jump over”.
  • Another AMHP described silo working & thinking dressed up as MDTs not actually working.
  • A mother & her #LDdude, described having not a Scobby-Doo about who or what the MDT was or did or indeed who was in charge of the team.
  • A big NHS cheese on the receiving end thought it worked best when the person and family were actively in the meetings as importantly as any professionals. To be fair that particular cheese, he also suggested “giving social workers more of a say than NHS docs…”

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

Brighton #AMHPTrip #MHP21

8/10/2021

 
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.
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​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.
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I may have mentioned S.140 & pointed out that the NHS (Dr & Bed Manager) is responsible for finding the bed. That a Mental Health Act Assessment is a thing of chaos, but that it is also a legal process.  

​That an #AMHP makes an application to detain a person/child to a hospital & not to a bed. We are all obsessed with the  “bed”.​​
​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 😉) ​
I may have sneaked in a picture or two of the #AMHPhound (oh look, there she is) & I did touch upon Street Triage & Serenity Integrated Mentoring #StopSim.

​​
I may have said that @MentalHealthCop never ever said “No warrant, no police”.
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​That absolute star of the show was Milo @OscarKiloNine 
​
Your man Arden @Thalamos was very impressive & remember I am almost like a proper Luddite. Arden was also very helpful & supported me to not miss the train 😉 I have a terrible habit of missing the odd train here & there #AMHPskills
​
So it was fun & informative & an opportunity to share & learn. The lesser spotted #GrumpyAMHP is available for future events - weddings, funerals & bar mitzvahs. Just ask the boss lady @DCC-i

Signing off for the weekend

@AsifAMHP
​8th October 2021

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