I write in response to the letter from Neelam & Williams. Reference Neelam and Williams1 The authors are responding to the paper by Singhal et al, Reference Singhal, Garg, Rana and Naheed2 who elicited the views of service users and providers with regard to separate consultant teams for in-patients and out-patients. Neelam & Williams described the use of a third team - the crisis resolution home treatment team (CRHTT), saying that this team performs a vital role in the period between discharge from the in-patient team and the patient being sufficiently well for safe and effective transfer into the community mental health team (CMHT).
The most consistent theme that emerged from Singhal et al's study was the difficulties in continuity of care and maintaining the therapeutic relationship when patients moved from the in-patient to the CMHT. It seems rather bizarre that Neelam & Williams contend that the problem can be ameliorated by introducing yet a third team into the discontinuity between in-patient and out-patient care. Neelam & Williams note that patients often asked to remain permanently under the care of the CRHTT and it seems probable that these patients are seeking a return to the more traditional model of continuity of care from one single team.
I write as a trainee psychiatrist who has worked only in generic psychiatric teams that care for patients whether they are in-patients or living in the community. In my experience, these teams provide high-quality care and encounter no difficulties in continuity and maintaining therapeutic relationships. Perhaps an advocate of New Ways of Working 3 could explain to me the advantages of an ever-increasing ‘specialist team’ approach as opposed to the ‘one patient, one team’ model?
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