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INTRODUCTION
Multidisciplinary working in forensic mental health services
The promotion of collaboration between professions in the UK and elsewhere reflects a partnership ideal embodied in policy reforms designed to improve the responsiveness of health and social services to patient needs (Leathard, 2003). However, the partnership vision is driven more by conviction than by compelling evidence that collaboration can generate service improvements (Barr, 2000). Similarly, the literature on the value of professional collaboration in healthcare tends to be prescriptive and journalistic rather than analytic and evidentially based (Cott, 1998; Glasby and Lester, 2004). The idea of multidisciplinary teamwork raises a number of conceptual problems. The familiarity of the word 'team' masks its vague and variable meanings (Dingwall, 1980). The meaning of 'multidisciplinary' is similarly ambiguous. It is one of several overlapping terms employed to describe collaboration between professions. Usage of such terms has been described as 'murky' (McCallin, 2001, p. 421). A focus on the 'disciplinary' implies that collaboration can be achieved through the sharing of distinctive knowledge bases. But the processes through which synthesis might be accomplished, for example through mutual accommodation, tend to be taken for granted.
The case for multidisciplinary collaboration appears particularly compelling in relation to forensic mental health services (Wix and Humphries, 2005). It is often assumed that mentally disordered offenders, whose problems are multifaceted, will benefit from the coordinated contribution of a wide range of professionals as they progress from secure care to rehabilitation in the community (McGuire, 2002). For instance, Jones and Plowman (2005, p. 145) recommend discussion of the cases of offenders with mental health problems via 'a congregation of diverse understandings and explanations of harmful behaviour and the assessment of risk'. However, this optimistic view overlooks the potential for tensions to arise from differences in the interpretive frameworks which professionals bring to the task of collaboration, and downplays the impact of professional power differentials on the decision-making process (Onyett, 1997; Cott, 1997; Davies et al. , 2006). Processes of negotiation between members of different professions and their impact on patients remain little researched. In consequence, the effectiveness of multidisciplinary teams has not been demonstrated (Barker and Walker, 2000; Zarenstein and Reeves, 2000; McCallin, 2001; Glasby and Lester, 2004).
The present paper explores multidisciplinary teamwork from the perspective...