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Andrew Hill-Smith and colleagues explore the interplay of professional identities in child and adolescent mental health services
Abstract
Modern child and adolescent mental health services need better interdisciplinary understanding and awareness of possible interactional patterns, and this should be built into training initiatives.
This article describes four main professional identities (psychiatry, psychology, nursing and social work) and some of the many combinations of interaction that are possible. It has been observed that the Department of Health's guidance on new ways of working can cause friction among staff, and this should be managed by modernising our professional identities and understanding those of other practitioners.
Keywords
Multidisciplinary team, New Ways of Working for Psychiatrists, professional identity
GOOD MULTIDISCIPLINARY relationships are necessary to achieve high quality child and adolescent mental health services (CAMHS). Although the literature describes professional identities, to our knowledge possible interaction between them has never been covered. This article builds on the literature, crystallising views of four main professional identities in CAMHS: psychiatry, psychology, nursing and social work. It suggests positive professional interaction in concordance with the government's report New Ways of Working for Psychiatrists (Department of Health (DH) 2005).
New Ways of Working for Psychiatrists (DH 2005) brought about a step change in how professions are described and in how professionals work together. Generic skills are promoted to create a more flexible workforce with various professionals able to handle different tasks. In the literature there is concern about such change giving rise to a 'creeping genericism', which may be viewed as a threat to professional identity through the blurring of roles (Brown et al 2000).
Role boundaries
Paradoxically, however, rather than blurring roles this may lead to a sharpening of professional boundaries; 'demarcation' of roles has been advocated to avoid loss of identity at times of conflict (Lankshear 2003), and the British Psychological Society (2008) has favoured integration of psychologists into teams but not at the expense of the psychologists' unique identities.
Role confusion is not new: for example, in 2003, little agreement was reached regarding the responsibilities of child psychiatrists when team members were asked their views (Reder 2003). Others have found that anxieties about loss of identity may be overstated and that, given time, things settle down (Workman and Pickard 2008).