Community mental health teams

Community mental health teams (CMHT) are one of the most common and long-established forms for delivering comprehensive mental healthcare. Their origins were both pragmatic (in the UK) and ideological (France and Italy), and they serve to ensure an effective multidisciplinary approach to the assessment and care of mental illness. In most countries they are restricted to the care of the severely mentally ill. This contribution covers their structure and staffing and relates it to their function. Most serve populations of 20 000–60 000 and contain psychiatrists, nurses and often social workers. Other disciplines include psychology and occupational therapy, and increasingly more specialist members (e.g. vocational counsellors). Staffing norms vary enormously but the UK proposals are outlined, along with mechanisms to establish thresholds and coordination of care. Leadership issues and the tensions between generic and specialist working are common in these teams. Effective internal communication and external liaison and clarity about an agreed operational policy are fundamental determinants of success.CMHTs are currently under criticism and many more specialized teams are being established. It remains to be seen to what extent they can be replaced and to what extent these specialized teams augment their persisting practice.