{"id":30817,"date":"2016-03-10T06:00:00","date_gmt":"2016-03-10T14:00:00","guid":{"rendered":"http:\/\/www.goodtherapy.org\/blog\/?p=30817"},"modified":"2024-02-05T17:26:01","modified_gmt":"2024-02-05T22:26:01","slug":"why-collaboration-is-essential-in-mental-health-care","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/why-collaboration-is-essential-in-mental-health-care-0310164","title":{"rendered":"Why Collaboration Is Essential in Mental Health Care"},"content":{"rendered":"

\"GoodTherapyA colleague of mine, a psychiatric nurse, was working alongside a psychiatrist<\/a> who would often be insistent about his intention to change a patient\u2019s 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. \u201cNo, doctor,\u201d she urged. \u201cJust because he\u2019s had an increase in psychotic symptoms does\u00a0not\u00a0<\/em>mean we need to increase his risperidone<\/a>. He\u2019s been on meth all week. We need to prioritize getting him off of the drugs he\u2019s been using before we start changing his meds!\u201d<\/p>\n

The psychiatrist hadn\u2019t seen the bigger picture, had been operating with a kind of clinical tunnel vision out of habit<\/a>, and her boldness to voice her perspective broadened\u00a0his<\/em>, ultimately increasing the quality of the care for the patient. The doctor, for his part, was responsive and did not change the patient\u2019s medication regimen as he had intended.<\/p>\n

What Does It Look Like to Promote a Collaborative Care Environment?<\/h2>\n

Collaborative care involves the\u00a0sharing of perspective<\/em>, 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<\/a> and a psychiatrist, the spirit of the collaboration is necessarily the same\u2014that 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\u2019s treatment, as collaboration is\u00a0essential<\/em>, not elective. We each naturally and necessarily engage in our work with people from different angles.<\/p>\n

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When the therapist shares the angle of the therapist, the psychiatrist\u2019s perspective widens. When the psychiatrist shares the angle of the psychiatrist, the therapist\u2019s perspective widens.<\/p>\n

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\u2019t we? In our mind\u2019s 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\u2014not in order to look away from it, but to see it better within a larger whole and in truer proportion.<\/p>\n

Therapists, therapeutic case managers, psychologists, psychiatrists, and other mental health clinicians best serve people when they share perspective and responsibility in meeting people\u2019s needs and ensuring therapeutic progress toward established treatment goals.<\/span><\/p>\n

The horizon of the present is being continually formed, in that, as the philosopher Hans-George Gadamer contended, \u201cwe 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.<\/p>\n

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.<\/p>\n

Each case presented will typically either qualify as a “consultation” or an “update.” Clinicians usually have only about 15 minutes to staff cases. Here\u2019s how I encourage clinicians to approach clinical staffing and, essentially, all forms of collaborative care:<\/p>\n

    \n
  1. Tell the story (brief): <\/strong>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.<\/li>\n
  2. Identify concerns (robust): <\/strong>Share clear and present concerns. Use clarifying statements, such as, “I am concerned because __________.” Express particular observations, such as, \u201cI have noticed __________.\u201d Ask specific questions, such as, \u201cWhy do you think __________?\u201d Strike a tension between curiosity and clarity. If you fail to bring clarity and direction to a consult, time will waste away.<\/li>\n
  3. Tie services together (summary): <\/strong>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.<\/li>\n<\/ol>\n

    A Caution to All Clinical Professionals<\/h2>\n

    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.<\/p>\n

    We all have our blind spots, and we all get stuck in ruts of routine and habit. And details learned about people\u2019s lives ever tempt therapists, psychiatrists, and the like toward distraction. There is a distinct difference between a personality<\/a> and a person, a diagnosis<\/a> and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.<\/p>\n

    Effective mental health treatment should always aim to treat the person\u2014the whole<\/em> person. A collaborative mental health treatment approach should enhance communication of relevant evaluative and ongoing therapeutic feedback, increase clinicians\u2019 adherence to a person\u2019s treatment plan, and reduce risk, frequency of crises, and unnecessary emergency room visits and inpatient stays.<\/p>\n

    It is important for\u00a0all 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 <\/em>occur. Therapists, therapeutic case managers, psychologists<\/a>, psychiatrists, and other mental health clinicians best serve people when they share perspective and responsibility in meeting people\u2019s needs and ensuring therapeutic progress toward established treatment goals.<\/p>\n","protected":false},"excerpt":{"rendered":"

    When mental health clinicians work together to achieve desired treatment outcomes, everybody wins. Here are some of the hallmarks of collaborative care.<\/p>\n","protected":false},"author":2385,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[542],"tags":[31,579],"class_list":["post-30817","post","type-post","status-publish","format-standard","hentry","category-featured-articles","tag-psychotherapy-practice","tag-for-therapists"],"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/30817","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/2385"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=30817"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/30817\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=30817"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=30817"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=30817"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}