Community Mental Health Teams (CMHTs)
Health: have you been affected by the recession? We
would welcome your views.
- Mental health services are
undergoing a great deal of change and development at
- In many areas, the
traditional Community Mental Health Team is being re-structured
into new specialist teams, so please do bear this in mind when
reading this leaflet. Information on the new service teams should
be available from your local NHS mental health trust.
This leaflet is for anyone who has been
referred to a Community Mental Health Team (CMHT) - and for
their friends and family. It describes why we have CMHTs, how they
work, who works in them and what they do. The information here is most
relevant for the UK. CMHTs exist in other countries, but may be
organised in different ways.
Why do we have CMHTs?
Most mental health problems don't need a
psychiatrist. Your GP can give you support, prescribe
antidepressants or refer you to a counsellor or psychotherapist.
However, if your problems are more complicated, your GP may want to
refer you to a CMHT.
Many things can cause mental health problems
- physical or mental illness, past experiences, difficult
relationships, drug and alcohol problems or stresses like
unemployment. Relationships can become difficult and you may find
it harder to deal with the various problems of life. So - you
may need help with a number of different areas to get over a mental
health problem, including:
- emotional problems
- relationship problems
- money and benefits
- work, or something rewarding and useful to
- getting back your self-confidence.
No one, however well trained, can do all
these things well. So, mental health professionals work in
teams, usually of between 8 to 16 people. Each team has
several types of workers with different knowledge and skills. They
will each understand how the others work and will understand how to
tackle problems together.
Who might you meet in a CMHT?
In many areas of the UK, you will most often
see a mental health worker. They can be
from a number of different professional backgrounds (see below) but
will all aim to develop a trusting, respectful and helpful
relationship with you.
They can help by:
- working with you to keep an eye on any
changes in your behaviour, feelings and thinking
- being someone to talk to
- developing your strengths
- working to find answers to your current
- helping you to become more
You may be seen on your own, in a group with
other people or, sometimes, with your friends or family. Mental
health workers share a number of important skills, but
can also use their more specialist professional skills when
needed. These professions include:
A psychiatrist is a medical
doctor with special training in mental illnesses and emotional
problems. Each team has a consultant who has completed their
professional training. If you need to take medication, they will be
responsible for arranging this. They may also have trained in
psychotherapy. There may also be an “associate specialist” or
“staff grade” doctor, who will have trained in psychiatry but who
has not become a consultant. They often work with a doctor doing
further training in psychiatry – a “specialty trainee” or
“specialist registrar”. See our leaflet on 'Psychiatrists: what to expect'
Community Psychiatric Nurse (CPN)
CPNs work outside hospitals and visit
clients in their own homes, out-patient departments or GP
surgeries. They can help you to talk through problems and give
practical advice and support. They can also give medicines and keep
an eye on their effects. Nurse therapists have had extra training
in particular problems and treatments, such as eating disorders or
Like other members of the team, social
workers help people to talk through their problems, give them
practical advice and emotional support and provide some
psychological treatments. They are able to give expert
practical help with money, housing problems and other
Occupational Therapist (OT)
Occupational therapists help people to get
back to doing the practical things of everyday life. They may help
- to work out what you can and cannot do
- with advice on where you could or should
- to find things to do that you want to
- to re-build your confidence
- to become independent.
This can be through doing practical things
in a relaxed environment, or talking with other people in
Clinical psychologists have a degree in
psychology. During another 3 years training in clinical
psychology they work with clients and learn how to give
psychological treatments. They will usually meet regularly with you
for a number of sessions to talk through how you are feeling,
thinking and behaving. Although cognitive
behavioural therapy is a common approach, clinical
psychologists may use psychodynamic and behavioural
psychotherapies. They also help other members of the team to work
psychologically with their clients.
Pharmacists train for five years to become
specialists in medicines. They can give expert advice to doctors
and nurses and talk to patients and carers about medications.
The Team Manager
The team manager will usually be a
senior nurse or social worker. They often do not see clients
themselves. They are responsible for:
- the practical details of running the
- how the team works with other parts of the
health service and other organisations
- helping the team to develop
- making sure that the team has high
standards of practice.
Approved Mental Health Professional
The Approved Mental Health Professional will
usually be a social worker, but can be any member of the CMHT. They
have had further training for assessing if someone needs to be
taken to hospital using the Mental Health Act. They cannot decide
to admit someone to hospital on their own, but will usually need
the agreement of 2 independent doctors.
In a way, every person who works in a
hospital unit, day centre, or hostel is a member of the team.
Receptionists and secretaries make the team run smoothly and are
responsible for much of the atmosphere of the service. You may find
that you get to know them quite well. However, they are not usually
involved in any decisions about your care.
Other staff who work directly with
These can include outreach workers, mental
health workers, benefits workers, support workers, recovery
workers, vocational therapists, arts therapists and
psychotherapists. More and more, staff without a professional
qualification are also working with such teams because of their
special knowledge and skills. These include people who have had
mental health problems, advocates, and workers from day centres or
housing organisations. Specialist old age psychiatry teams may
include other professionals such as speech therapists or
physiotherapists. These workers may also see people in their own
How does the team
Where does it work?
The team may have a base, like a clinic, where they can see
clients. They will also work in a whole range of other places -
out-patient clinics, GP surgeries, day-centres, hostels and
people's own homes.
Working with you
All the team members will understand the
distress that goes with mental illness. They can all offer
psychological support, encouragement and practical help.
At regular team meetings, staff discuss how
best to help their clients. They try to make sure that they have a
clear picture of your difficulties and strengths. They can then
plan the right help with you. Staff work closely together and learn
a lot from each other. You may find that nurses can deal with many
social problems and that occupational therapists and social workers
know something about medication. This also means that, if your
key worker is away, there will usually be someone
around who knows something about you.
Will I meet the whole team?
You won't have to see the whole team, although you may see one
or two different people at first. The team will then decide who
should work with you. You will usually see just one person at a
The key worker/care coordinator
One of the team members would usually be your key worker – it
is often a social worker or nurse. This should be a helpful
and supportive partnership. Your key worker should:
- get to know you
- learn about your difficulties
- find out how you see your problems
- know about your strengths
- discuss any plans with you
- give counselling, information and
- make sure that everybody is working
- make sure that you have a clear
“care plan” about how you are going to be
The different parts of your help or
treatment are written down in the care plan. This should
- the problem (or problems)
- any risks involved
- your strengths
- what needs to be done to help you
- who should be doing what
- your views – you should have a copy.
If you need to see the team for a while, you
may be put on the Care Programme Approach (CPA). This means that
there is a meeting every few months with everyone who is involved
in your care plan. You should be invited to this meeting, but
you don't have to come if it makes you too anxious.
What if I don't get on with my key
If you can tell your key worker what the problem is, you may be
able to sort it out together. If you can't do this, you will need
to talk to the team manager. If they can't sort out the
problem, you may need a different key worker.
What about confidentiality?
Members of a CMHT have to keep your information confidential in
the same way as other doctors and health-care staff. But
- They will share information about you with
other members of the team so that they can give you the best
- They will not usually give information to
people outside the team without your permission.
- They will need to be able to talk to your
GP and any other doctors whom you are seeing.
- Secretaries and receptionists do not have
access to most of the information that the professional staff do,
but will know some details about you.
If you are worried about confidentiality,
check it out with one of the team - so you can be clear about who
knows what, and why they need to.
Can relatives and friends become
Families and carers are usually concerned and want to help.
Families often need support and encouragement. Many teams provide
information for families and hold regular support groups. A
CMHT may want a family to be involved, but are still bound by
medical confidentiality. So, they will usually ask your permission
to give information about you to your family. At the same
time, families have to live and cope every day with problems. A
CMHT should ask you about what you are happy for your family to
know, and what you do not want discussed with them. For further
information on carers issues, see the information produced by
the College's Partners in Care campaign
What about advocates?
An advocate can help you to ask questions
and get your message across to professionals. He or she can go to
meetings with you. They are not usually part of the mental health
team, but will be employed by a voluntary organisation or another
part of the health service.
Will I be offered the choice of pills or
This will depend both on what
the team thinks would be most helpful and on what you would prefer.
It isn't usually a simple choice of either pills or counselling.
Most people need the chance to talk though their problems and feel
understood, and most CMHT staff have counselling skills of varying
degrees. Sometimes there may be a worker, often a clinical
psychologist who does just counselling or psychotherapy. Many
people get help from both medication and talking treatments.
How does my GP fit in?
Community mental health teams and GPs should
work closely together. After CMHT staff have seen you, they will
send your GP a letter to tell him or her about their assessment of
your problems and what they suggest should be done. Your GP will
often prescribe regular medications for you. Unless you are
admitted to hospital, your GP remains responsible for the rest of
your medical care. If you are admitted to hospital, your GP will be
kept informed of your progress and the discharge plan. When you are
in hospital, the psychiatrist will be responsible for your medical
What if I have a problem with a CMHT?
If you cannot sort the issue out with the
member of staff involved, contact the team manager. If you are not
happy with what they say, you can make an official complaint to. If
you are still not happy, you can make an official complaint to the
health trust, Community Health Partnership or Health Board
(depending on where you live in the UK) which is
responsible for that particular CMHT. All trusts should have a
clear way of dealing with complaints.
In the UK, there is now a range of more
specialist CMHTs, including:
- Home treatment
- Crisis intervention
- Early onset psychosis
- First episode psychosis
- ABT (assessment and brief treatment)
- Continuing care
- Assertive Outreach
They share most of the CMHT features
described above, but deal with a particular set of problems.
What can I expect in my area?
Teams in different areas may be quite
different. Some CMHTs concentrate on helping people who have severe
and long-lasting mental illness. They may not be able to provide
much in the way of counselling services for people with less severe
depression or anxiety problems. If you are not happy with the
services available, your Independent Complaints Advocacy Service
(in Wales, the Community Health Council) may be able to take
it up with the local Health Authority.
This factsheet was produced by the RCPsych's Public Education
Editorial Board. Series Editor: Dr Philip Timms..
© May 2011. Due for review in May 2013. Royal
College of Psychiatrists. This factsheet may be downloaded, printed
out, photocopied and distributed free of charge as long as the
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