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Community Mental Health Team (CMHT)

People with OCD will usually initially be treated and supported by their GP, however, in most cases; OCD can be too serious and complex for your GP, so you are most likely to be referred for treatment to your local Community Mental Health Team (CMHT).  This is a team of mental health professionals who support people with mental health problems living in the community.

CMHT’s can offer medication, basic counselling or other mental health treatments like Cognitive Behavioural Therapy (CBT). Because the team is made up of many different professionals from different fields, they can also help with a whole range of other issues or difficulties such as relationships, employment, emotional problems, housing, money and benefits, getting back your self-confidence and problems with everyday living, and providing support to carers too.

Because of the complexity of these different needs, mental health professionals work in teams, the Community Mental Health Team. Each team has several types of workers with different knowledge and skills. They will each understand how the others work and will understand how to tackle problems together.

The CMHT may include:

  • psychiatrists
  • social workers
  • psychologists
  • community mental health nurses
  • occupational therapists, counsellors
  • mental health workers
  • outreach workers

Once you have been referred, someone in the CMHT will assess you to see whether the team can help you and, if so, what kind of treatment and support might help you.  Most CMHT’s work against a treatment model called ‘stepped care’ which means that patients get the lowest intensity intervention appropriate for your needs, moving up a step if the problem is not resolved.

The Stepped Care Model.

The treatment found to be the most effective in successfully treating OCD is Cognitive Behavioural Therapy (CBT). Due to restraints on some CMHT’s, you may be offered alternative treatments, but you are entitled to request, and receive CBT which is the recommended treatment for OCD.

The CMHT usually work out of an office or clinic, but sometimes will be based at your local GP surgery, but are also willing to work in different places with you, such as in your own home, and this can be crucial later during the therapy process if your OCD requires exposure exercises at home.

When you first start to see someone in the CMHT you will usually have one-to-one meetings, although group CBT is sometimes offered. You should also be able to reach someone on the telephone outside of standard office hours, so you may also be given details for your local Crisis Team. Most areas have a mental health crisis team. These teams are made up of psychiatric nurses, social workers and support workers and are available 24 hours a day, seven days a week and respond to a crisis within four hours wherever possible to provide support and short-term help until the CMHT is available or the help is no longer needed.

Most people referred to a CMHT are also assigned a keyworker (or care co-ordinator) from within the team. Your keyworker's job is to make sure that you are getting all the support and treatment that you need, and that the different people involved in your care, including your GP know what is happening. Your keyworker can, and should help you by:

  • working with you
  • learn about your difficulties
  • discuss any plans with you
  • make sure that everybody is working together properly
  • being someone to talk to
  • developing your strengths
  • working to find answers to your current problems
  • helping you to become more independent.
  • make sure that you have a clear understanding about your ‘care plan’ about how you are going to be helped.

The different parts of your treatment are written down in what is usually called a ‘care plan’, or sometimes it will be called a ‘treatment plan’, this should include:

  • the problem (or problems) that you want to resolve
  • your strengths
  • that needs to be done to help you recover
  • who should be doing what
  • your views on the treatment plan

You should always be offered a copy of this treatment plan and review it regularly with your keyworker.

If you don’t get on with your keyworker, and you feel comfortable in explaining this to your keyworker, hopefully you can resolve it and find a way forward together, but sometimes it may be that you need to talk to your GP or the CMHT team manager and arrange for a different keyworker.

Mental health workers with the CMHT share a number of important skill sets, but can also use their more specialist professional skills when needed. These professions include:

Psychiatrist
Psychiatrists are medically qualified doctors who have completed six years in medical school learning about physical health care as well as mental health problems. They then spend several more years specialising in the diagnosis and treatment of mental illness, working as ‘senior house officers’, ‘specialist registrars’, ‘staff grades’, ‘associate specialists’, ‘specialist trainee registrars’ or 'hospital practitioners' in mental health wards, psychiatric outpatient clinics, and CMHTs.

A psychiatrist mainly deals with the physical aspect of mental health, for example if you need to take medication, they will be responsible for arranging this.

Psychiatrists also often work closely with psychologists and counsellors, who could discuss your thoughts and feelings and work out coping strategies with you.

Clinical Psychologist
Clinical psychologists have a degree in psychology. 

Clinical psychologists differ from other psychologists in the fact that they have undergone at least three years extra training, although counselling psychologists also undergo extensive postgraduate training and work in CMHTs alongside clinical psychologists. Assistant psychologists have an undergraduate degree and are supervised by either a clinical or counselling psychologist.

Most clinical psychologists will be knowledgeable enough to make an initial diagnoses of OCD, and/or depression or other anxiety disorders and increasingly, psychologists focusing their attention on those who are severely unwell, in addition to supporting others within the team to deliver psychological treatments for OCD, such as CBT. They will usually meet with you regularly for a number of sessions to talk through problems and find ways of solving them using CBT techniques and may also act as your key worker.

Counsellors
Counsellors provide a 'talking therapy' where you will be invited to talk about your thoughts and feelings; the counsellor will then discuss with you ways of coping. Counselling can also be provided by:

  • community mental health nurses
  • psychotherapists
  • psychologists
  • social workers
  • occupational therapists

It is important that if you are being treated by a counsellor that you check they are providing you with Cognitive Behavioural Therapy rather than counselling, and that they have sufficient training and understanding of CBT and OCD.

Community mental health nurses
Community mental health nurses are registered nurses who are trained in mental health and can:

  • talk to you about ways to cope
  • give long-term support to you in the community
  • give some medication

Community Psychiatric Nurse (CPN)
CPNs work outside hospitals and visit clients in their own homes, out-patient departments or GP surgeries. They can help you to talk through problems and give practical advice and support. Nurse therapists have had extra training in particular problems and treatments, such as OCD and CBT.

Social Worker
Like other members of the team, social workers help people to talk through their problems, give them practical advice and emotional support and provide some psychological treatments.  They are able to give expert practical help with money, housing problems and other entitlements.

Occupational Therapist (OT)
Occupational therapists help people to get back to doing the practical things of everyday life. They may help you:

  • to work out what you can and cannot do
  • with advice on where you could or should live
  • to find things to do that you want to do
  • to re-build your confidence
  • to become independent.

The Team Manager
The team manager will usually be a senior nurse or social worker but they usually are no longer treating patients. They are responsible for:

  • the practical details of running the team
  • how the team works with other parts of the health service and other organisations
  • helping the team to develop
  • making sure that the team has high standards of practice.

Members of a CMHT have to keep your information confidential in the same way as other doctors and health-care staff, but your case will often be discussed with other members of the team in order for them to make decisions about the best way to help you. They will not usually give information to people outside the team without your permission.

Can relatives and friends become involved?
Families and carers are usually concerned and want to help, and living with someone with OCD can be just as hard than having OCD ourselves, so families often need support and encouragement too. Many CMHTs provide information for families may want a family to be involved at some stages in the treatment process, but will always need your permission before speaking to a family member. A CMHT member should ask you about what you are happy for your family to know, and what you do not want discussed with them.

How does my GP fit in?
CMHT and GPs should be working closely together. After CMHT staff have seen you, they will send your GP about their assessment of your problems and what they suggest should be done. Usually your GP remains responsible for the rest of your medical care and may be asked by the CMHT to prescribe medication for you, so it is important the CMHT and GP are communicating with each other.

Between them, the GP and the CMHT are there to help and support you on your road to recovery, but should things go wrong, it is important you communicate that with them so that together you can find a way forward. But, if the problem is still not resolved please don’t hesitate to contact OCD-UK for further advice and help.

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