What happens in a Community Mental Health Team?

What is a Community Mental Health Team (CMHT)?

Community Mental Health Teams are multi-disciplinary
Community Mental Health Teams are made up of multi-disciplinary professionals

Have you ever wondered what happens in a Community Mental Health Team (CMHT)? Let’s take a look.

They were developed in the UK to deliver Care in the Community in the late 1980s. This was a British policy of deinstitutionalisation; treating and caring for physically and mentally disabled people in their homes rather than in institutions. 

A GP might refer an out-patient, but in-patients are generally allocated to a CMHT prior to hospital discharge. These CMHTs are made up of various multi-disciplinary professionals such as:

  • Community Psychiatric Nurses (CPNs) and unqualified support staff
  • Social workers and Approved Social Workers (ASW’s); social workers who’ve undergone specific training in mental health law; the Mental Health Act 1983. This then enables them to carry out Mental Health Act assessments with other professionals.
  • Consultant Psychiatrist, Senior Registrar and/or Senior House Officers (SHOs) who are Doctors undergoing their six months training in a particular area of medicine. In this case, Psychiatry.

Once referred to the CMHT, an assessment would be completed to build up an accurate picture of a person’s needs. The patient might get help from either one or two of the above professionals, depending on their needs.

My first placement at a Community Mental Health Team

How a basement CMHT might look
How a basement CMHT might look — Image by Washingtonpost.com

As a Mental Health Nurse student, I was allocated to Alan, a CPN who would be my supervisor during this placement. I arrived early so I had a coffee and introduced myself to a few of the team while waiting for Alan.

It was eight fifty-five and the team’s overall mood matched the weather that stormy Monday morning. Had they not been sitting at desks, behind the flexy-plastic window, I might have thought they were patients with depression — just staring blankly into oblivion.

I smiled as the front door opened and an older gentleman walked in. He was wearing a tatty tweed jacket, a moth-eaten jumper and a shirt so old, the collar was frayed. His creased trousers looked as though they’d had an argument with his ankles and his black plastic slip-on shoes squeaked as he walked.

Still, his gappy-toothed smile was welcoming. He stuck out his hand, pushed open the inner door with his backside and introduced himself as Javid, a Social Worker.

I explained who I was and he took me down to what looked like a fusty old storeroom. He pointed out his desk, Alan’s desk and the one opposite that I could use, and off he went.

Student nurse Practice Based Assessments

I went through my Practice Based Assessment (PBAs) to see which ones I might be able to meet — sooner rather than later. Students have a list of evidence-based tasks, to be carried during placements, which are assessed for competency by their supervisor. This was a lengthy process so I always liked to get a head start and not leave the PBA’s right ’til the end of placements.

While idly thumbing through a patient file, I happened to look up and saw a rickety old bike being chained to the railings outside. I watched from the basement window as a pair of green wellies marched up to the front door. The wellies stomped about a bit before thundering down towards the basement.

The office door crashed open and there stood Alan! He pulled himself up to his full six-foot-plus, puffed out his chest and glared at me. “What on earth do you think you’re doing?” a broad Glaswegian accent rasped. Think Billy Connolly!

“Javid said I could look through……..”

“Is Javid your supervisor? No, he’s not. I am. Javid is an ASW and you. are. a. mental. health. student. Are you not?” He turned on his heels saying “I’ll get a coffee and see you when I come back!”

And this was how Alan continued over the next few weeks; barking orders at me and ignoring any questions, or feeding me wee snippets about his patients.

Depot injections by Community Mental Health Team

Intramuscular depot injection administered by Community Mental Health Team
Intramuscular depot injection administered by Community Mental Health Team

I was surprised one morning when Alan told me I was to run the weekly Depot Clinic under his supervision. This is where patients come every 1-4 weeks to have antipsychotic medication via intramuscular injection.

Some patients prefer this as they tend to forget or refuse to take their daily tablets. Other patients must have medication by injection under a Section of the Mental Health Act 1983. If a patient is known to be non-compliant with medication, Depot injections are often recommended during Multi-disciplinary team (MDT) meetings.

“You know how to administer injections, I presume?” snapped Alan. And without waiting for an answer, “don’t forget to check which side they had their last injection. I’ll countersign the medication charts when you’ve done.” I’d observed several injections during my in-patient placement but I’d never actually administered one. I told Alan and all he did was nod; indicating me to just get on with it.

My first patient was due in soon so I checked her medication chart and spotted the small letter ‘L’ underneath the signature box. I gathered this meant that their last injection was on the left buttock so this time it would be on the right. Injections sites were alternated to stop the buildup of scar tissue on one side.

Administering my first depot injection

Preparing depot injection
Preparing depot injection — image by Pixabay

Sally, a 36-year-old female, appeared sullen and I wasn’t sure I’d be able to engage her in idle chit chat before stabbing her with the needle.

However, she chatted amiably about me being a new student and asked whether I liked football. The needle was out — and I told her I was an Arsenal fan. “Blinding. Me too. But I ain’t never been to a game.”

I did take her along to a match some years later, but that’s another tale. Anyway, there I was, scribbling my signature on her medication chart when she turned her head to me and chirped “Come on, ‘urry up mate!”

“All done Sally.” Ha! I’d given my first real injection and she didn’t even notice. Her eyebrows shot up then I got a wink and a smile of approval as she buckled up her jeans.

“You’re alright you are. She can come ‘ere again Alan.” She gave me a knowing look and glared at him as she left the clinic. Not a word from him, just another of his withering looks as I passed him the chart to countersign.

My first Community Mental Health home visit

Community Mental Health Teams work with patients in their own homes
Community Mental Health Teams work with patients in their own homes — Image by Pexels

A month passed and Alan continued to arrive late every day. One morning, Javid asked if I’d like to go out and visit some of his patients with him, and I jumped at the chance.

We arrived at Anne’s house to see her in the front garden barefoot and wearing a flimsy but colourful kaftan. She twirled around on the grass, head back and arms outstretched as she sang. Julie Andrews popped into my head and I fondly remember Anne whenever I hear “The sound of music”.

Anne grinned when she saw Javid and waved him in with a dramatic curtsey, then called the children in for lunch. Four skinny under-twelves trooped into the living room and hungrily snatched up huge doorstep sandwiches.

The kids danced, skipped and jumped all over the two mismatched sofas as they munched. They sang silly songs and clapped loudly, dropping crumbs everywhere. Their likeness to the much loved Von Trapp family didn’t go unnoticed.

They were clean, wearing all manner of clothing; some too big and some too small, all barefoot, but they looked happy and were both well-spoken and well mannered.

Bipolar disorder

Bipolar disorder and mood swings
Bipolar disorder and mood swings — Image by Crazyhead comics

Anne had a diagnosis of Bipolar disorder which used to be known as manic-depression. Someone with Bipolar has episodes of mania (feeling very high and overactive) and periods of depression (feeling very low and lethargic).

Unlike simple mood swings, each extreme episode (high or low) of bipolar disorder can last for several weeks, or even longer. Bipolar disorder is treated with mood stabilisers such as Lithium or Valproate, which were all originally made for treating epilepsy.

Community Mental Health Assessment

Javid asked Anne if it was okay for me to complete a mental health assessment, done by observation and direct questioning, assessing things like:

  • mood, behaviour and appearance
  • thought form for speed and coherence
  • thought content for delusions, suicide, homicidal or violent thoughts, obsessions and perception
  • cognition for orientation to time, place and person, attention and concentration

Finally, I assessed her insight to gauge whether Anne knew her incessant chatter, thought disorder and her behaviour wasn’t normal, given the weather and both her and the children’s appearance. However, she didn’t believe she was currently unwell “This is nothing.” she chirped. “You’ve seen me worse Javid.”

Javid smiled, then we stood to bid our goodbyes, and I couldn’t help but giggle when Anne and the children burst into song “So long, farewell, Auf Wiedersehen, adieu. Adieu, adieu. To you and you and you.”

Sitting in his car, Javid talked me through the visit and agreed that yes, he had seen Anne worse? “Really?” I asked. He nodded and chortled. However, he said he’d check to see if there was a bed so that he could plan a voluntary hospital admission over the next few days.

Javid said that Anne would use all kinds of delaying tactics but would eventually agree to voluntary admission. “She knows she has a chronic (long-term) diagnosis and she’s well known to services. She’s aware that if she doesn’t go voluntarily, she’d be admitted under Section 3 of the MHA 1983”. This means patients can undergo coercive interventions, such as enforced medication, seclusion and restraint.

Mental Health documentation to be completed

CPNs have to complete lots of documentation
CPNs have to complete lots of documentation — image from Pexels

After a few more less-exciting home visits Javid and I returned to the CMHT around four-fifteen, just in time to complete our documentation.

Alan threw me a look of utter disdain as he snapped his briefcase shut and headed for the door. Thank God for the weekend!

Alan’s lateness carried on, his behaviour remained erratic and his lack of interest or guidance was getting me down. There were days I was in tears, despite the admin girls telling me to ignore him, and making me laugh.

Every day Alan was late I went out on visits with Javid or other staff who’d asked if I’d like to accompany them. I was gaining so much experience as some staff were supportive and fed back to me my strengths and small areas that I could build on.

My Practice Based Assessment

Most of my PBA’s had been completed I and was pleased with the evidence I’d attached. I’d made sure there were no names or numbers that could identify individual patients.

The staff I’d worked with wrote on my PBA’s that I was really intuitive and empathic, that I had excellent communication skills, and had been proactive in achieving the high standards I’d set myself. Overall they said they were impressed. All I needed now was for Alan to sign them off as having been completed.

The arrogant shit refused! He hadn’t seen me complete any of the tasks listed on my PBA’s so he would not sign them! He couldn’t possibly! Aaarrgghh!

Over to you

But it got worse……….. I’ll do a short follow-up. But in the meantime, I’m happy to answer any questions and look forward to hearing what you think about care in the community. Does it work? Or even, just say “Hi.”

Author: mentalhealth360.uk

Mum to two amazing sons. Following recovery from a lengthy psychotic episode, depression, anxiety and anorexia, I decided to train as a Mental Health Nurse and worked successfully in various settings before becoming a Ward Manager. I am a Mental Health First Aid Instructor and a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor. Just started my mental health from the other side blog.

23 thoughts on “What happens in a Community Mental Health Team?”

  1. That’s unfortunate that you were stuck with such a jerk!

    My favourite job was working at a community mental health team. We had loads of people on depots. We had a problem for a while with Risperdal Consta. The needle that was included with the kit was actually a needle luer-locked onto another piece, and then that whole bit you would luer lock onto the syringe. Problem was, the pre-assembled needle plus other bit wasn’t tightened securely in the factory, so sometimes we would pull out the syringe and the needle would be left in the patient, because the factory-assembled bit came apart. That was bizarre.

  2. Hey,Caz.
    I am glad the U.S does not commit people based on disheveled appearance and wacky behavior. My personality would be on trial more than my mood swings😉

    1. Lol — obviously it was a lot more than appearance etc. But I hear ya! And I’m with you. I got as tidied up as I could on my last visit to mental health emergency department 🙂

  3. That’s a great graph of what Bipolar can look like! Mine looked like for years before we got thing totally, or total as you ever get under control. Now after all these years I fall to the depressive side and stay there. No good hypo days! Boy where they nice but as they say something alwasy has to come back down.

    1. Yep! Patients can relate to that graph and I’m glad you got your sorted out. Research says that as you get older, the mania reduces and the depression stays 🙁

      I agree too. Watching a patient (including my brother) go down after a high is really sad!

  4. Ah, so now I know why the nurse folks rotate where in my butt they give me my IM shot. Dang, you’re good with injections. I always feel pain, tense up, and then feel everything.

    1. It’s a silly little thing but I think patients ought to be told this is why they change sides with the IM jabs lol.

      I always found that engaging the patient in idle chit chat used to distract them while I inserted the needle. They never knew I’d done the injection until I told them 😉

      1. Not silly to me haha. I feel more at ease when my providers explain things.

        Unfortunately for the nurses who give me my jab, my Mandarin isn’t good enough, and their English isn’t good enough! 😆 So we mix both enough to get the injection done but definitely not good enough for chit chat beyond “busy day?” “Oh yes”.

  5. Care in the community is very much the model in place where I am, Caz. In many places there is no other option. As for its effectiveness, well it always comes down to the quality of the nurse, helper and the like.

  6. Yep, you’re right about effectiveness. Unfortunately in London we have some poor quality lazy nurses in the Community. They’re the ones who can’t or don’t want to cope with patients on busy wards, and they think Community nursing is a doddle!!

  7. Reading this makes me wonder if there’s anything similar in the U.S. Not Alan, of course, but the care at home. 😅 I know there are people who rely on caregivers due to disabilities, but I should really learn more about what qualifications are required and who is eligible for that care.

    1. Mmmmm, I wonder if they have these in the US too? Be interested if anyone else knows how they work out there?
      They opened the CMHT’s when the shut down the large Asylums, to care for people in their own “homes”. Yes, it stopped the institutionalisation and cut costs, but at what cost to the patients. I suppose, like everything else, CMHT’s have their pros and cons.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.