A Systemic IPA Study exploring the communication-experiences of team members in an NHS Child and Adolescent Mental Health Team during an MDT Case discussion

Communication in NHS Multi-Disciplinary case discussions is meant to bring together a variety of disciplines to consider an individual’s mental health needs. Communication in multi-disciplinary case discussions has been researched from different angles, but only limited empirical research has been conducted in relation to MDT communication. Within this practice-based study, a case discussion in a Child and Adolescent Mental Health Service was video-recorded and formed the ground for participant interviews. The study aimed to understand more about practitioners’ experiences of case discussion communication within their MDT case discussion and their views on what contexts impact the exchanges. One CAMHS team was filmed during one case discussion. The video was used to allow participants an observational perspective on their case discussion and the experience of being part of the case discussion. The contributions within the semi-structured interviews constitute the data for this study. I used an IPA analysis method, combined with systemic research methods, to extract insights from participants' contributions relating to how team members experienced the MDT case discussion communication. Results in this systemic, constructivist study show that participants saw their communication as influenced by factors relating to organisational -, team-, relational- and identity- contexts. Results show that communication between the different disciplines in the team was experienced as allowing a variety of influences; however, directed through guidelines medical model thinking and diagnosis practice was experienced as central. With less time pressure and less risk, communication allows for more varieties in perspectives, more uncertainty in positions taken, more reflective elements; with higher risk and less time, communication becomes more focussed on diagnosis and planning action; difference between perspectives is then less negotiated, but decided through hierarchical structures. Whilst multi-disciplinary exchange is valued and experienced as enriching, it comes with challenges when aiming to synthesise difference within hierarchical structures. When conceptualising MDT communication as multi-cultural exchange, Bateson’s schismogenesis concept is applicable and offers a basis for considering helpful and less helpful cultural rituals of the different disciplines if synthesis is the aim. Above findings inform future research and practice and the study concludes with suggestions and ideas that could be applied to work towards multi-disciplinary communication that synthesis different perspectives into holistic formulations, despite hierarchical organisational structures.