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MULTI DISCIPLINARY MENTAL HEALTH TEAM

Team work is significant in any setting more so in a mental health setting. The milieu needed to care for patient depends up on the qualification,experience,skillful handling of the situation by all members of the team with similar approach. For promotion of a therapeutic environment members of the various discipline coordinate their activity. The multidisciplinary mental health team is no longer viewed as solely limited to professionals. A grooving conviction exist that if treatment is to be effective , the team must include the client and the family as integral members. This position reflect the fact that effective treatment of a person with mental illness , especially one who has serious , persistent illness must include the insight and experiences of those who know him or her best the client and those who have known him or her over a period of time and who help the clients care on a daily basis , most often the family. Four health care professionals constitute the core mental health disciplines : psychiatric nursing, psychiatry, clinical psychology, and psychiatric social work. They all emerged as specialties with in their respective professions during the last half of the nineteenth century at the time when the behaviorally disturbed persons are viewed as being ill rather than as being posses by demons or morally corrupt. PSYCHIATRIC NURSING The first school of nursing in a psychiatric setting was established at Mc Lean hospital in 1882. This schools purpose was to improve the care of the psychiatric patients by upgrading the skills of attendants. Nurses are professionals whose initial educational preparations is through an associated degree, baccalaureate degree or diploma programme. An increasing number of nurses with baccalaureate degree have continued their education to attain masters degree in a particular clinical specialty. The nurses prepared as clinical specialists in clinical psychiatry or mental health nursing at have advanced preparation in promoting the mental health of the individuals , groups , families and communities as well as in assisting those persons in increasing the effectiveness of their adaptation. She provides individual , group and family therapy in a hospital and community setting. Participates actively in primary, secondary
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and tertiary prevention of mental disorders. Takes up responsibility for teaching, administration and research besides publishing work in a mental health setting. Works as a leader and can practice independently. Psychiatric nurse clinical specialist-should have a masters degree in nursing, preferably with post graduate research work. Registered nurse in psychiatric unit or hospitals-registered nurse goes through a general nursing and midwifery programme or BSc nursing or post basic BSc nursing programme or diploma in nursing education and administration. PSYCHIATRY Psychiatrists are the physicians who had several years of supervised residency training in the medical specialty of psychiatry. They should have post graduation in Psychiatry and two to three years of residence training. The psychiatrists unique function is prescribing medications and administering other somatic treatments such as electroconvulsive therapy. In addition he is the only person equipped to make a medical diagnosis and is particularly skilled in identifying and treating persons whose problems have highly inter related emotional and psychological components. He serves as the leader of the mental health team. CLINICAL PSYCHOLOGY Clinical psychology began with the university as an academic research oriented discipline devoted to the scholarly study of human behavior. Psychologists are the professionals who have advanced education in the study of mental process and the treatment of mental disorders. As in the field of nursing and medicine , psychology has become such a broad discipline that most psychologist specialize . Those who are most directly involved in the treatment of those with mental disorders are called as clinical psychologists. These clinical psychologist concerned with the diagnosis of mental illness have developed expertise in the use of inferential tools designed to assist in the diagnostic process and assessment of treatment process. Such tools are projective techniques, personality inventories etc. only clinical psychologist are trained in the interpretation of these highly complex instruments. PSYCHIATRIC SOCIAL WORK Social work began as an organized profession in1880s , but the specialty of psychiatric social work began in the 1900s. Mary C Jarrett believed to be the first psychiatric social worker . he or she is a graduate in social work and a post graduate in psychiatric social work.
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Social workers are health professionals and are prepared to work with individuals and families who have wide variety of physical, emotional and social problems. Psychiatric social workers are particularly skilled in assessing familial ,environmental and social factors that contribute to the dysfunctional behaviors of the individual and family. They are also contributors to the planning and implementation of follow up care. They are aware about the state laws and legal rights of patients and protect these rights. They are skillful in interview techniques and group dynamics. ACTIVITY THERAPY Although activity therapies are not considered a core mental health discipline , the mental health care team will not be complete without them. The discipline that make the activity therapies include occupational therapy, recreational therapy, music therapy, rehabilitation counseling , educational therapy and patient library services(bibliotherapy). With in these specialties other therapies may also provided , such as dance therapy, drama therapy, art therapy, horticulture therapy and manual art therapy. The activity therapist are required to have at least a bachelor degree in their field. A masters degree is required to enter in to art therapy. Although each form of activity therapy has specific focus , they share the principle that it is helpful to the emotionally disturbed persons to be engaged in the activity that focus on the object outside the self. The concept of object relation is fundamental in activity therapy. This concept not only the materials used in the therapy but also the setting , the therapist and the other participants. Occupational therapist- occupational therapists goes through specialized training. He has a pivotal role by using manual and creative techniques to asses the interpersonal process of the patient. Patients are help to develop skill in the area of their choice and become independent economically. If occupational therapy is planned well, it is very significant in the treatment and recovery of the patient. The therapist focused on the vocational skill and activities of daily living to raise the self concept of the patient. Recreational therapist-recreational therapist plans activities to stimulates muscle coordination, interpersonal relationship and socialization. Recreational and occupational therapies are always need based Diversion play therapist- makes observation of the client or child during his play. The behaviors of the child while playing, the types of the toys and his reaction towards the calling, beating or throwing are the

focus of attention. The therapist explore the childs behavior and relates the conditions like phobia, child abuse , separation or any other condition. Creative art therapist- an arts graduate encourages the patient to express his work freely with colors. The therapist analyze the use of bright colors leading to light and fading colors which have a meaning , live figures drown by the patient . Analysis will help in bringing the repressed feeling of the patient to a conscious mind. The following five goals are common to all activity therapies in a mental health setting. To provide activities for the structured normal activities of daily living.- activities are designed to help the clients deal with their basic problems. To assist in diagnostic and personal evaluation- this can be done through the observations of the clients as they participate in activities. To enhance psychotherapy and other psychotherapeutic measures-the activity provided for the client often provides a non verbal means for the client to express and resolve the feelings being discussed verbally in other setting. Inter personal relationship established between the client and the therapist provides another vehicle for the provision of corrective emotional experiences. To assist the client in making transition from the sick role to becoming a contributing member of the society To assist the client to develop skill in relating and interacting with others in a cooperative manner. PSYCHIATRIC CASE MANAGEMENT Case management is both a treatment intervention and a delivery method that has become increasingly necessary for individuals whose need are complex and long term such as those with a serious persistent mental illness. The case managers role is based on the belief that to be successful in community the clients needs continuity of care that is accessible and comprehensive. Because hospital stays are becoming shorter with the discharged clients still needing varying degrees and types of care a worker is needed on whom the client can depend to get various types of care. Case manager can and do have professional preparations in any one of the four core mental health disciplines. Case management practice

differs widely, it is generally agreed that the five core component of case management are1. client identification and out reach 2. assessment 3. service planning 4. monitoring of service delivery 5. advocacy Services delivered to the clients in a variety of formats, and are available 24 hours a day and 7 days a week. OTHER PSYCHIATRIC PARA PROFESSIONALS Psychiatric nursing aids / attendants High school educational level. They are given training on the job. They assist in maintaining the therapeutic environment and provide care under supervision. Auxiliary personnel Are volunteer house keepers or clerical staff who come in contact with the patient . they should be given in service education to interact with the patient therapeutically. ECT technicians These technicians goes through a training period of six to nine months . their role is to prepare the ECT machine and other article and give ECT under the supervision of a psychiatrist or anesthetist. Clergy manReligious persons from different religions may be asked to come to the hospital unit once a week so that the patient can have a spiritual discussion or make a confession if he or she desires.

ROLE OF NURSE- AS A MULTIDISPLINARY TEAM MEMBER.


In most of the settings, the nurse is a member of an inter disciplinary team. These team function collaboratively to provide comprehensive care that may include general medical care , substance abuse services, psych therapy , medication management , access to entitlements, and other needed therapies or assistance. Each member brings specialize knowledge to the treatment process, there by enhancing assessment and management.
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Team also include the client and his or her family . Collaboration implies that members work towards a common goal and shire responsibilities for out come of care. Learning to provide appropriate care. The mental health care providers must explore their own thoughts and feelings , follow guide lines and standards of care , search for effective interventions , measure client outcomes and if needed design interventions. Nurses new to the field of psychiatric mental health nursing are likely to discover certain feelings , fears and impressions that may hamper their effectiveness with clients and the family. Understanding the clients view of mental health care. Clients seeking mental health care are often frightened , relieved or anxious about what will happen to them. They may feel that the treatment will dehumanize them or that providers will overmedicate or not listen to them. They may be suspicious about the process of receiving mental health care . they must be believed that nurses and other mental health professionals will solve their problems for them and may expect to play a passive role while an expert cures them. Nurses and other mental health professionals are responsible for clarifying these misconceptions and providing straight forward information about the importance of client participation. Managing stress and burnout Nurses who enter the psychiatric field frequently are motivated by a sense of altruism , that is they are working with a desire to contribute to something to the society. Although the work has an innately humanitarian purpose , it also has stressor that induce nurses to feel fear and anxious. The behavior of the client represent the range of human disturbances from violent, hostile or aggressive to bizarre , regressed, or dependent. How nurse deal with these behavior reflects their personal values and experiences as well as their success in the field. Nurses may feel ashamed of their reactions to disturbances in clients or feel that their responses are unprofessional , and hide or deny their feelings. Learning to acknowledge , express and deals with feelings is as important for nurses and other mental health professionals as it is for their clients. In fact nurses role model for their clients how to cope with feelings in appositive way.
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Cooperation and collaboration with the whole group As a team member nurse has the responsibility to coordinate the activities of various disciplines. In some settings nurses are the team leaders and they are the responsible persons to provide a conducive environment to the patients. She has to cooperate well with other disciplines to provide better and standardized care tom the clients.

Reference
1. Taylor CM. Essentials of psychiatric nursing. 14th edn. London . 2. 3.

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Mosby publishers 1994. Mohr WK. Psychiatric mental health nursing. New York . 6th edn . Lippincot Williams and Wilkins. 2006. Reynolds W and Cormack D. Psychiatric and mental health nursing theory and practice. 1st edn. London. Chapman and Hall publishers. 1990 Kapoor B. Text book of psychiatric nursing. 1st edn. New Delhi. Kumar publishing house. 2006 Bhatia MS. A concised text book of psychiatric nursing. 3rd edn. New Delhi . CBS publishers . 2006

MULTIDISCIPLINARY TEAM ROLE OF THE NURSE

Submitted to: Mrs. Blessy Prabha Valsaraj Assistant Professor Department of mental health nursing MCON, Manipal University Submitted by: Jincy Jose 070504002 MCON , Manipal University Submitted on: 29-09-2007