Psychiatric rehabilitation is by nature multidisciplinary, with many skills and perspectives needed to successfully help patients—yet only limited research on multidisciplinary teams in psychiatry exists.

While this topic warrants further examination, available research indicates that psychiatrists are well-positioned to lead multidisciplinary teams treating mental illness.

 

Psychiatrists as team leaders

In the leadership role, a psychiatrist can individualize and prioritize a long list of evidence-based services with continuity, competency, consistency, coordination, fidelity, and collaboration in mind, according to an article published in Psychiatric Services.

Liberman RP, Hilty DM, Drake RE, et al. Requirements for multidisciplinary teamwork in psychiatric rehabilitation. Psychiatr Serv. 2001;52(10):1331–1342.

 

The authors cited several attributes essential to the psychiatrist who assumes leadership, including persistence and realistic optimism—that is, appreciation for the patient’s prospects for improvement, along with respect for the patient’s strengths, attributes, and goals.

Good leaders for a multidisciplinary team also have a collaborative mindset, well-developed skills at networking and coordinating the use of resources within the system, and teaching ability. As role models, they demonstrate that the boundaries between “medical” and “psychosocial” domains are illusory, and work toward integrating each of these areas in the rehabilitation effort.

Especially when dealing with patients with severe illness, psychiatrist-leaders must expand beyond drug prescribing alone and accrue knowledge, attitudes, and skills that jibe with contemporary practices. They must inspire mutual respect between themselves and other team members. Finally, as the Psychiatric Services authors noted, the ability to manage large caseloads and coordinate care with other agencies is required.

 

Room for improvement?

The Psychiatric Services authors wrote that training, mentoring, and clinical experiences can help establish a psychiatrist’s skills as a team leader. Psychiatrists can also seek formal training on leading a multidisciplinary team, as well as on strategies to foster collaborative therapeutic interactions with patients and their families.

Psychiatrists who wish to make substantive contributions to a rehabilitation team should have a working knowledge of the changing scene of evidence-based interventions.

“Even if psychiatrists who wish to lead a team do not regularly conduct skills training or family psychoeducation or provide supported employment services, they should have knowledge and competence in these areas,” the authors advised.

“More important, because leadership involves role modeling, the psychiatrist-leader should be able to demonstrate (and supervise) certain psychosocial interventions capably and confidently to clients, families, and colleagues,” they added. “Although the psychiatrist’s profile of competencies may concentrate on the ‘bio’ component of biobehavioral assessment and treatment, indifference to other modalities of rehabilitation will be the death knell for psychiatric leadership of a team.”

In a review published in Australasian Psychiatry, researchers determined that routine monitoring and evaluation, strong communication, equality among team members, and clear documentation were characteristics of good multidisciplinary teams in psychiatry.

Woody CA, Baxter AJ, Harris MG, et al. Identifying characteristics and practices of multidisciplinary team reviews for patients with severe mental illness: A systematic review. Australas Psychiatry. 2018;26(3):267–275.

 

Success factors included defined leadership and clear team goals.

“Four sources described considerations for patients with complex clinical needs, including allocating sufficient time for discussion, maintaining connections with community providers, and ensuring culturally sensitive practices,” the authors added.

 

Power plays and team dynamics

UK researchers writing in Mental Health Review Journal found that multidisciplinary teams are shaped by the professional and personal values and assumptions of team members—which sometimes conflict.

Haines A, Perkins E, Evans EA, et al. Multidisciplinary team functioning and decision making within forensic mental health. Ment Health Rev (Brighton). 2018;23(3):185–196.

There is a tendency for decisions made by the team to be influenced by power dynamics linked to the knowledge and responsibility represented by each team member.

 

Although service users (patients) are considered part of the team, their involvement is often nominal. Risk management considerations can limit patients’ opportunity for self-determination, and respect for the patient’s point of view may be lacking.

Service users’ involvement is marginalized. This is linked to a longstanding tradition of psychiatric paternalism in mental health care.

 

Benefits of team leadership

Studies have shown that individuals with increased levels of responsibility and more competencies are most satisfied with their jobs. For psychiatrists, this could mean clinical, supervisory, consultative, educational, and administrative roles.

Teaching, supervising, and consulting with family, colleagues, and agencies are ranked top among these roles, according to the Psychiatric Services article.