title: The social care component of multidisciplinary mental health teams: a review and national survey.
abstract: BACKGROUND
  The study reviewed the disciplinary composition of community mental health teams (CMHTs) and conducted a national survey of mental health providers in England and Wales to explore the determinants of the social care component of CMHTs.
  
  
  METHODS
  A comprehensive literature review and a national survey of NHS mental health Trusts in England and Wales.
  
  
  RESULTS
  The literature review showed that team composition was rarely well justified with regard to effectiveness, despite some evidence that greater professional diversity (i.e. inclusion of social workers) was associated with higher effectiveness. Forty-two mental health Trusts responded (53.2%) to the survey. There were no staffing differences between responding and non-responding Trusts. Social workers accounted for 19.3% of the staffing total. Nurses formed a third of the workforce and social support workers made up a further 10%. We found that there continues to be a shortage (compared to policy targets and previous research) of psychiatrists, psychologists and occupational therapists, whereas the numbers of nurses employed far exceeds their target numbers. Total staffing numbers appeared to be slightly higher in Trusts citing 'financial resources' as a determining factor of team composition. Despite being statistically non-significant, the 'financial resource' effect was of medium magnitude. Similarly, there was a non-significant but approaching medium-sized effect of higher numbers of social care support staff when guidance was cited as a rationale for CMHT composition. There was a non-significant (P = 0.076) medium magnitude (η(2)(p) = 0.067) trend towards higher staff numbers in more integrated trusts that did not cite financial resources as a driver of team composition.
  
  
  CONCLUSIONS
  If service recipients are to gain equal access to appropriately staffed services, further attention needs to be paid to supporting an adequately skilled multidisciplinary workforce. The workforce needs to be organised in a way that best provides for local needs rather than a service based largely on the existing supply of different professionals and disjointed workforce planning.
authors.affiliation: Mental Health Research Team, College of Medicine, Swansea University, Swansea, UK. s.evans@swansea.ac.uk
authors.forename: Sherrill
authors.initials: S
authors.lastname: Evans
authors.forename: Peter
authors.initials: P
authors.lastname: Huxley
authors.forename: Christine
authors.initials: C
authors.lastname: Baker
authors.forename: Jo
authors.initials: J
authors.lastname: White
authors.forename: Sally
authors.initials: S
authors.lastname: Madge
authors.forename: Steve
authors.initials: S
authors.lastname: Onyett
authors.forename: Nick
authors.initials: N
authors.lastname: Gould
mesh_terms: D003156:Community Mental Health Services / Q000458:organization & administration*; D017598:Efficiency, Organizational; D004739:England; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D009740:Nursing Staff / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D012944:Social Support; D012947:Social Work / Q000706:statistics & numerical data; D013222:State Medicine; D014852:Wales