Multidisciplinary team functioning and decision making within forensic mental health.

Area of Science:

• Forensic Psychiatry
• Healthcare Management
• Qualitative Research

Background:

• Multidisciplinary team (MDT) meetings are crucial for patient care coordination in forensic hospitals.
• Understanding the dynamics within these meetings is essential for improving service delivery.
• Previous research has not fully explored the operational aspects of MDT meetings in secure forensic settings.

Purpose of the Study:

• To investigate the operational dynamics of multidisciplinary team (MDT) meetings within a forensic hospital in England.
• To identify factors influencing decision-making processes during MDT meetings.
• To assess the extent and nature of service user involvement in MDT meetings.

Main Methods:

• A mixed-methods approach was employed, combining qualitative interviews with professionals and service users.
• Video observations of MDT meetings and documentary analysis were conducted.
• Data from 142 staff and 30 service users were analyzed using grounded theory and ethnographic constant comparison techniques.

Main Results:

• MDT meeting decisions are significantly shaped by the professional and personal values, assumptions, and power dynamics of team members.
• Service user involvement in MDT meetings is often marginalized, a phenomenon linked to historical psychiatric paternalism.
• Direct video observations provided unmediated insights into meeting conduct, complementing subjective interview accounts.

Conclusions:

• Effective MDT working necessitates clear aims, defined responsibilities, and actionable implementation plans.
• There is a critical need to enhance service user empowerment by granting them greater responsibility and influence in their care decisions.
• Future research should focus on the nuances of professional-service user interactions, language, and strategies for active service user involvement in MDT meetings.