Staff experiences of working in adult community mental health teams: contemporary perspectives from a system under pressure

Context: Community mental health teams (CMHTs), a service within the National Health Service (NHS), provide evidence-based treatments for moderate to severe mental health difficulties. Neither intended nor designed, CMHTs emerged in the 1990s after the closing of the asylums. As a nationally adopted system of care, they lack a solid evidence base. Aim: This study aims to investigate the functioning of CMHTs from the perspectives of the staff who work in them. The study examined staff experiences of working in a CMHT, before considering their perspectives on whether, and to what extent, the CMHT was able to achieve its stated aims. Method: The study used a qualitative design. Semi-structured interviews were conducted with 17 members of staff working at one CMHT in Essex. The sample was comprised of six medics, six psychologists and five care coordinators. Reflexive thematic analysis was used to analyse the data. As one way of exploring the transferability of the findings, additional group interviews were carried out with staff members working at another CMHT in Essex. Results: The results revealed an overwhelmingly negative experience of working in CMHTs. Staff felt emotionally drained and physically exhausted, and experiences of moral distress were frequent. While staff generally acknowledged the systemic pressures they worked under, they broadly felt CMHTs were failing patients. In particular, CMHTs were felt to flounder under the number of referrals they received, and the service was seen as struggling to meet the relational needs of patients. Discussion: The results present an urgent need to reform the health service to improve staff wellbeing in CMHTs. CMHTs appeared to have reached a homeostasis whereby they function well to process and discharge referrals. However, staff felt that the system failed to meet the relational needs of its patients, and staffs’ desire to provide relationship-based care.