An investigation into staff experiences of working in the community with hard to reach severely mentally ill people.

Several studies have evaluated the effectiveness of community mental health services by
measuring economic viability and client outcomes. Whilst some surveys have
emphasized the pressures experienced by mental health staff in the community, none
have elicited details of these pressures, how staff cope and what qualities and structures
might be more or less effective. This study attempts to understand how mental health
staff deal with the emotional impact of working with people suffering from severe mental
illness in the community.
Observation of and interviews with staff from mental health teams in the community were
carried out. Using grounded theory, emerging themes were clustered together and ideas
drawn from systems and psychoanalytical theories were used to develop an
understanding of how the teams worked and whether there were particular personal
attributes that staff possessed which help them carry out such work and, what
organisational structures enhance these qualities. Although an important measure of the
competence and efficiency of these teams is their impact on their patients, this study
does not focus on patient outcomes nor does it elaborately scrutinise the overall
effectiveness of the teams; instead it focuses on staff and attempts to explore what
facilitates them to cope with the emotional demands of this work.
Three different types of community teams were studied; an Outreach Team for Homeless
Mentally III people (OHT), an Assertive Outreach Team [AOT], and a 'standard'
Community Mental Health Team (CMHT). Clients of the three teams varied in the
severity of their illnesses and thus the intensity of their needs. The specific skills needed
were found to be different in the three teams: those in the OHT were persistence and
tolerance of high levels of risk with their most chaotic and damaged clients; in the AOT it
was the ability to share skills in the team and develop all the professional skills necessary
to maintain people out of hospital; whilst in the CMHT it was the ability to cope with
working individually with larger client caseloads, to organise and coordinate community
resources.

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