Why Collaboration Is Essential in Mental Health Care

Therapist works on paperwork while talking on the phone.A colleague of mine, a psychiatric nurse, was working alongside a psychiatrist who would often be insistent about his intention to change a patient’s medication regimen before they even had an opportunity to see the patient together. She recalled that on one such occasion, she boldly interrupted the psychiatrist as he reported his clinical perspective and intentions. “No, doctor,” she urged. “Just because he’s had an increase in psychotic symptoms does not mean we need to increase his risperidone. He’s been on meth all week. We need to prioritize getting him off of the drugs he’s been using before we start changing his meds!”

The psychiatrist hadn’t seen the bigger picture, had been operating with a kind of clinical tunnel vision out of habit, and her boldness to voice her perspective broadened his, ultimately increasing the quality of the care for the patient. The doctor, for his part, was responsive and did not change the patient’s medication regimen as he had intended.

What Does It Look Like to Promote a Collaborative Care Environment?

Collaborative care involves the sharing of perspective, not necessarily an agreement of perspective. While collaboration in treatment between a nurse and a psychiatrist may in some ways look different than that between a psychotherapist and a psychiatrist, the spirit of the collaboration is necessarily the same—that in our work with people, we naturally and inevitably bring with us our own toolbox of experience, perspective, knowledge, and skills. And to the extent we resign ourselves to treatment in a vacuum, we neglect the person’s treatment, as collaboration is essential, not elective. We each naturally and necessarily engage in our work with people from different angles.

When the therapist shares the angle of the therapist, the psychiatrist’s perspective widens. When the psychiatrist shares the angle of the psychiatrist, the therapist’s perspective widens.

Think of perspective as standing in a place and looking out over a horizon. As we move about, so changes our available horizon and, thus, our perspective, and yet we are able to take the previously seen horizons with us, aren’t we? In our mind’s eye, in our understanding, we integrate them into our inner map. To acquire a horizon means that one learns to look beyond what is close at hand—not in order to look away from it, but to see it better within a larger whole and in truer proportion.

Therapists, therapeutic case managers, psychologists, psychiatrists, and other mental health clinicians best serve people when they share perspective and responsibility in meeting people’s needs and ensuring therapeutic progress toward established treatment goals.

The horizon of the present is being continually formed, in that, as the philosopher Hans-George Gadamer contended, “we have continually to test our prejudices, and in so doing, adjust our understanding.” This sort of humility is fundamental to good psychotherapeutic and medical treatment.

The purpose of clinical staffing is to aid in service planning, consult on issues of safety and risk, discuss developmental concerns, collaborate on behavior and mental health assessment, address concerning family and social dynamics, consider referral options, and share critical case updates.

Each case presented will typically either qualify as a “consultation” or an “update.” Clinicians usually have only about 15 minutes to staff cases. Here’s how I encourage clinicians to approach clinical staffing and, essentially, all forms of collaborative care:

  1. Tell the story (brief): Just as the case record documentation should provide a narrative of services rendered, the introduction of a person in a clinical staffing should similarly provide context. Facilitate talk about engagement in services, home and social dynamics, relevant historical considerations, psychological profile, academic, vocational, and/or behavioral functioning, and recent events that may be relevant to any concern.
  2. Identify concerns (robust): Share clear and present concerns. Use clarifying statements, such as, “I am concerned because __________.” Express particular observations, such as, “I have noticed __________.” Ask specific questions, such as, “Why do you think __________?” Strike a tension between curiosity and clarity. If you fail to bring clarity and direction to a consult, time will waste away.
  3. Tie services together (summary): It is your responsibility to end discussion about a person by providing specific feedback. Try to summarize any recommendations and clarify the who and what of any follow-up to result from the staffing.

A Caution to All Clinical Professionals

Psychological knowledge and jargon are dangerous, often standing between well-intentioned clinicians and effective mental health treatment. Curiosity always runs the risk of gossip. Clinical case consult groups scattered across our fair land meet frequently and are filled with far too much clutter, too often driven by curiosity rather than care. Jargon and gossip increase tone deafness in clinicians.

We all have our blind spots, and we all get stuck in ruts of routine and habit. And details learned about people’s lives ever tempt therapists, psychiatrists, and the like toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

Effective mental health treatment should always aim to treat the person—the whole person. A collaborative mental health treatment approach should enhance communication of relevant evaluative and ongoing therapeutic feedback, increase clinicians’ adherence to a person’s treatment plan, and reduce risk, frequency of crises, and unnecessary emergency room visits and inpatient stays.

It is important for all mental health providers to be well connected to and collaboratively engaged with multidisciplinary networks to ensure the most effective and integrated treatment that can occur does occur. Therapists, therapeutic case managers, psychologists, psychiatrists, and other mental health clinicians best serve people when they share perspective and responsibility in meeting people’s needs and ensuring therapeutic progress toward established treatment goals.

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  • Larry

    Larry

    March 10th, 2016 at 10:42 AM

    It really is too bad that more providers will not get on board with a more collaborative approach to providing health and mental health care services.I think that there is this fear that someone is trying to undermine their decision making abilities or second guess them. Either way this is never going to be beneficial to a patient unless the providers are all willing to work together as a team to make informed and beneficial decision for the patient.

  • Elspeth

    Elspeth

    March 10th, 2016 at 10:26 PM

    Two points:
    1. As long as psychiatrists are paid vastly more than any other member of the team, they will always consider their own point of view as equally vastly the more valid.
    2. I can recall being called into ‘case conference’ on my last visit to a psych ward many years ago. I felt like I needed a lawyer, or at least a ‘representative’. 12 of them, one of me, and I was the only one whose views didn’t count. I expressed this to a nurse afterwards and she said ‘but we’re all on your side, dear’. How utterly patronising. All the various professions have their own view of the situation, how about listening to mine? They’re the experts on various aspects of mental health problems, I’m the expert on what it is like to be me.

  • Patricia M

    Patricia M

    March 11th, 2016 at 7:18 AM

    I wish that more providers would work together more. I think that just talking or communicating with each other about their patients, while a little more time consuming, would provide such better care for their patients. Or got a like a more medical home practice where all of the information is available.

  • sloane

    sloane

    March 12th, 2016 at 8:59 AM

    We see in geriatric care all the time things that can happen when the doctors are not all talking to and working with one another. I get it that a patient should be able to be in charge of their own health, but really when they get to a certain age they can’t be expected to always do that responsibly. They forget, they have no idea what kinds of drug interactions there could be and there is not always an advocate there to speak for them. that is what their physicians are supposed to do and one of the best ways for them to do that is to actually talk with one another about the patient’s care plan.

  • snow

    snow

    March 14th, 2016 at 10:01 PM

    Are we treating those people, with so called mental issues, as infants? Where does the role of the individual responsiblity play in this suggestion of collaboration in mental health care?

  • Violet

    Violet

    March 15th, 2016 at 10:14 AM

    The patient should always have a say so in their health care, but you know there will be times when someone could be incapacitated or unable to make clear decisions for themselves. At that time it could be very helpful to have informed family members as well as medical providers who can work together to ensure that this person receives proper treatment.

  • Jenna

    Jenna

    March 17th, 2016 at 11:29 AM

    If it is so important then why are there still so many doctors who are still digging in their heels with a refusal to do it?

  • Blake Griffin Edwards

    Blake Griffin Edwards

    March 17th, 2016 at 4:15 PM

    Snow, Collaboration with clients is essential and foremost in treatment. My article was not about the need for collaboration with clients. It was calling out the multidisciplinary communication gap that often exists.

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