Psychiatric professionalism, multidisciplinary teams and clinical practice

McQueen, Daniel, St John-Smith, Paul, Ikkos, George, Kemp, Philip, Munk-Jørgensen, Povl and Michael, Albert (2009) Psychiatric professionalism, multidisciplinary teams and clinical practice. European Psychiatric Review, 2 (2). pp. 50-56. ISSN 1758-1354

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There is increasing recognition of the importance of idiographic patient factors and values in the causation of and recovery from mental illness. The increasing understanding of the complexity of psychiatric disorders, together with the increasing diversity of values in society and new ways of planning and funding psychiatric services, demand changes in psychiatric professionalism. In this article we consider the range of knowledge, skills, expertise and values (professionalism) that is needed. We review evidence regarding optimal functioning of multidisciplinary teams (MDTs). We also describe what is required of psychiatrists to deliver clinical care, lead teams, take clinical responsibility and work in a range of MDTs. Psychiatric disorders are characterised by the interplay of biological, social and psychological factors. 1 The individual and his or her environment profoundly shape psychiatric illness. This causes difficulty identifying separate disease processes. 2 Mental illness is defined by a variety of concepts, but none covers all conditions. 3 Judgement is required to separate the abnormal from the normal. Individuals vary in where they draw these lines. Social class, education, culture and beliefs may influence these judgements. Diagnosis is predictive and pragmatically informative. Diagnosis also has social and psychological consequences, including stigma. Diagnosis per se is insufficient for optimal clinical decision-making. Experienced clinicians rely on a wide array of patient preferences, characteristics and values in deciding management. 4 A psychiatric formulation describes the uniqueness of the patient's problems (i.e. the predisposing, precipitating, perpetuating and protective factors from biological, psychological and sociological perspectives). This includes genetics, life history from conception to the present, trauma to the brain and mind, psychosocial development, early relationships, current family, work and social networks and the patient's values. Gene–environment interactions have greater explanatory power than social and genetic factors considered in isolation. Degeneracy is a ubiquitous feature of biology whereby the same function can be performed by different mechanisms leaving the organism relatively resistant to single-gene errors unless constrained by the environment. 5 Therefore, to understand mental illness we need a syncretic bio–psycho–social model. This contains proximate mechanisms (causation and development) and ultimate mechanisms (evolution and function). • Causation (mechanism) includes immediate stimuli, meanings, learning and the neurochemical substrate. • Development (ontogeny) considers how behaviour is influenced by early experience and how it changes with age. • Evolution (phylogeny) – how did the behaviour evolve? • Function (adaptation) – what evolutionary advantage does the behaviour confer? 6 Evolution provides an overarching theoretical framework that permits the integration of these different levels of explanation. 7 In humans personal meaning is crucial (see Figure 1). As a result of this complexity of psychiatric disorders, a single viewpoint can seldom provide complete understanding. 8 Psychiatric professionalism has developed to manage this complexity and uncertainty. The diverse views of different multidisciplinary team (MDT) members can assist in understanding this complexity.

Item Type: Article
Subjects: Groups & Organisations > Occupational Groups
Health and Medical Sciences > Patient Care
Psychological Therapies, Psychiatry, Counselling > Psychiatry
Department/People: Children, Young Adult and Family Services

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