Who is a part of the team?

All psychiatrists work in teams, large or small. Most UK psychiatrists have grown up working in large teams, and the intrinsic complexity of these teams tends to go unnoticed because of familiarity. However, anyone who has struggled to explain the workings of a Community Mental Health Team (CMHT) to a bewildered medical student quickly realises that there is nothing straightforward about teamwork in psychiatry.

One of us is a member of a CMHT that comprises nineteen people, all based in a building within the community it serves. There is office space for members of other teams, and there are close working relationships with teams based elsewhere. Box 5.1 sets out the membership of these three concentric circles of staff and specialist teams. It takes a lot of effort and organisation, together with a sophisticated understanding of systems and team dynamics, to ensure that such a complex configuration of professionals functions smoothly and appropriately. Fortunately the primary responsibility for this rarely lies with the psychiatrist.

Many psychiatrists, for example, in the UK private sector and office-based practitioners in North America, work in much smaller teams (sometimes just the psychiatrist and a secretary/receptionist). We would suggest that attention to teamwork is no less important in these very small teams than in larger ones. Indeed, the problems in a large team caused by a dysfunctional team member pale into insignificance compared to the problems caused by a bad working relationship between an isolated psychiatrist and his secretary.