Lesson 5 - Working Within the MDT
1. Introduction
Mental health care is rarely delivered effectively by one professional working alone.
Patients may have difficulties involving mood, anxiety, emotional regulation, physical health, medication, relationships, education, employment, housing, safeguarding and social circumstances.
No single professional is likely to have all of the expertise required to address every part of that picture.
This is why multidisciplinary team working is central to modern mental health care.
The multidisciplinary team is usually referred to as the MDT.
An MDT brings together professionals with different skills and areas of expertise so that care can be considered from several perspectives.
Depending on the service an MDT may include:
Psychiatrists.
Mental health nurses.
Nurse prescribers.
Psychologists.
Occupational therapists.
Social workers.
Pharmacists.
General practitioners.
Assistant practitioners.
Case workers.
Support workers.
Peer support workers.
Administrative staff.
Other specialists depending on the needs of the patient.
The exact composition varies between services.
The purpose is not simply to have lots of professionals involved.
The purpose is to combine their knowledge so that care is safer, more coordinated and more useful to the patient.
This lesson is particularly important for case workers and assistant practitioners.
You may not be the professional making the final diagnostic or prescribing decision but you may hold information that substantially changes that decision.
You may be the person who notices that someone has stopped eating.
You may discover that a patient who appears well during a psychiatric appointment is spending the rest of the week in bed.
You may hear about medication adverse effects before the prescriber does.
You may notice that a person's recovery plan is not working in everyday life.
Your observations therefore matter.
Good MDT working requires you to know what information you should contribute, how to communicate concerns clearly and when to seek help.
It also requires understanding that responsibility for care is shared appropriately rather than being carried by one practitioner.
The NHS England Mental Health Personalised Care Framework published in July 2026 reinforces this approach. It emphasises coordinated personalised care with a named worker while making clear that the wider multidisciplinary team retains responsibility for the quality, effectiveness and safety of treatment.
This lesson builds directly on the previous lesson about the role of the case worker.
That lesson focused on what the case worker does.
This lesson focuses on how that role connects with everyone else.
2. Learning Outcomes
By the end of this lesson learners should be able to:
Explain the purpose of multidisciplinary team working in mental health care.
Describe the broad contribution of different professionals within an MDT.
Understand the distinct contribution of the case worker or assistant practitioner.
Communicate clinically relevant information clearly and efficiently to other members of the team.
Understand the importance of shared care plans, documentation, role clarity and professional respect.
Recognise when disagreement, uncertainty, deteriorating risk or gaps in care require escalation.
3. The Lecture
What Is a Multidisciplinary Team?
A multidisciplinary team brings together professionals from different disciplines to contribute to the assessment, treatment and support of a patient.
Each profession looks at the person through a slightly different lens.
A psychiatrist may particularly consider diagnosis, mental state, risk and medical treatment.
A psychologist may focus on psychological formulation and psychological treatment.
An occupational therapist may consider function, activities, routine, independence and participation in meaningful occupations.
A social worker may contribute expertise relating to social circumstances, safeguarding, family systems and statutory responsibilities.
A nurse may monitor mental state, medication, physical health and ongoing clinical care.
A pharmacist may provide expertise around medicines, interactions and medication safety.
A case worker may understand how the person is functioning between formal clinical appointments and how the care plan translates into everyday life.
None of these perspectives is complete on its own.
A useful way of thinking about the MDT is:
Different professionals.
Different expertise.
One patient.
One coordinated plan.
Why MDT Working Matters
Consider a patient experiencing depression.
The psychiatrist may prescribe an antidepressant.
The psychologist may work on negative beliefs and avoidance.
The occupational therapist may help rebuild routine and activity.
The case worker may support the person to begin leaving the house and monitor progress.
The GP may monitor physical health.
A social worker may help address housing difficulties.
The treatment becomes stronger because several relevant areas are being addressed.
Now imagine these professionals do not communicate.
The psychiatrist believes the patient is taking medication.
The case worker knows the patient stopped it two weeks ago because of nausea.
The psychologist believes the patient is gradually returning to work.
The occupational therapist knows they have actually been dismissed.
The GP has identified significant weight loss but nobody in the mental health team knows.
Everyone is working.
But the care is not coordinated.
That is not effective MDT working.
MDT working therefore requires more than having multiple professionals involved.
It requires communication.
The Patient Should Remain at the Centre
One risk of MDT working is that the patient becomes the subject of professional discussion rather than an active participant in their own care.
Professionals may begin saying:
“We think they should do this.”
“The psychologist thinks that.”
“The psychiatrist wants this.”
“The case worker is doing that.”
The person can disappear from the discussion.
Recovery-oriented MDT working should keep asking:
What matters to the patient?
What are their goals?
What do they understand about the plan?
What have they agreed to?
What concerns do they have?
What is actually helping?
NICE describes shared decision-making as a collaborative process in which the person and healthcare professional work together to reach decisions about care.
The MDT provides expertise.
The patient provides expertise about their own life.
Good care requires both.
The MDT Is Not a Hierarchy of Importance
Different professionals have different levels of authority for particular decisions.
For example, prescribing decisions must be made by appropriately qualified prescribers.
Formal diagnostic decisions may require suitably trained clinicians.
Complex safeguarding or legal decisions may require specific professional expertise.
However, this does not mean that one profession's observations are always more important than another's.
Imagine a consultant psychiatrist reviews a patient for 30 minutes.
The patient appears settled.
The case worker has seen them three times during the week and has noticed rapid deterioration.
The case worker says:
“He presented well in today's appointment but this is very different from what I've been seeing throughout the week.”
That information matters.
Professional hierarchy should never prevent relevant information being communicated.
A junior or non-registered member of staff can notice something important that a senior clinician has not seen.
Patient safety depends on being able to say so.
Know the Roles Within Your Team
One of the first things a new case worker should understand is:
Who does what?
Who supervises me?
Who reviews medication?
Who can assess significant changes in mental state?
Who deals with safeguarding concerns?
Who provides psychological treatment?
Who manages physical health concerns?
Who should I contact urgently?
Who should I contact if the usual clinician is unavailable?
Who manages administrative issues?
Who is responsible for coordinating the care plan?
Knowing the team structure prevents delays.
A case worker should not discover who the duty clinician is for the first time during a crisis.
The Psychiatrist
The psychiatrist is a medically qualified doctor specialising in mental health.
Depending on their role they may contribute to:
Psychiatric assessment.
Diagnosis.
Differential diagnosis.
Mental state assessment.
Risk formulation.
Medication decisions.
Physical health considerations relevant to psychiatric treatment.
Capacity assessment.
Complex clinical formulation.
Coordination of treatment.
Advice to other professionals.
The case worker should bring relevant observations to the psychiatrist rather than attempting to make medical decisions independently.
For example:
Useful information:
“Since starting the medication he reports significant restlessness and says he cannot sit still.”
Less useful:
“I think he definitely has akathisia and the medication needs reducing.”
The first communicates relevant information.
The second makes a prescribing conclusion which may lie outside the case worker's role.
Mental Health Nurses and Nurse Prescribers
Mental health nurses may contribute to:
Assessment.
Monitoring mental state.
Risk assessment.
Medication administration or monitoring.
Physical health.
Psychoeducation.
Care planning.
Recovery work.
Family involvement.
Coordination of care.
Some nurses hold additional prescribing qualifications.
A nurse prescriber may therefore have authority to prescribe within their competence and role.
The case worker should understand who within the service can answer particular clinical questions.
Psychologists
Clinical or counselling psychologists may contribute to:
Psychological assessment.
Psychological formulation.
Psychological therapy.
Consultation.
Staff supervision.
Understanding patterns of behaviour and relationships.
Neuropsychological work in some settings.
Case workers may sometimes support strategies recommended by psychologists.
For example, a psychologist may develop a behavioural activation plan.
The case worker may support the patient to put that plan into practice.
This does not make the case worker the psychologist.
It means the intervention is being implemented collaboratively.
Occupational Therapists
Occupational therapists focus particularly on how health difficulties affect a person's ability to engage in meaningful activities.
This can include:
Self-care.
Daily routine.
Education.
Employment.
Leisure.
Social participation.
Independence.
Environmental adaptations.
Case workers often work closely with occupational therapists because both roles may involve understanding day-to-day function.
The difference is that occupational therapists have specific professional training in occupational assessment and intervention.
Social Workers
Social workers may contribute expertise around:
Social circumstances.
Safeguarding.
Family relationships.
Housing.
Community resources.
Statutory responsibilities.
Social care needs.
Legal frameworks.
Advocacy.
Social difficulties are often closely connected to mental health.
For example, anxiety may be difficult to treat if the person is facing eviction.
The social context therefore belongs within the clinical picture.
Pharmacists
Clinical pharmacists may provide expertise around:
Medication.
Interactions.
Adverse effects.
Medication reconciliation.
Monitoring requirements.
Safe prescribing.
Adherence.
Patient information.
Case workers should not attempt to replace pharmacy or prescribing expertise.
If a medication question is outside your competence pass it to someone appropriately qualified.
General Practitioners
GPs may contribute important information about:
Physical health.
Long-term conditions.
Medication.
Previous medical history.
Blood results.
Wider healthcare.
Family history.
Primary care treatment.
Communication between mental health services and primary care is particularly important where psychiatric medication affects physical health or when physical illness may contribute to psychiatric symptoms.
Case Workers and Assistant Practitioners
The case worker often contributes information that other members of the MDT cannot easily obtain.
They may know:
What the person's week actually looks like.
Whether agreed strategies are being used.
Whether routines have improved.
Whether they are eating.
Whether they are leaving the house.
Whether relationships have changed.
Whether they are engaging with education or work.
Whether symptoms appear different between appointments.
Whether practical barriers are stopping treatment.
Whether family members have noticed changes.
Whether the patient's goals have changed.
This means the case worker often acts as a bridge between the care plan and everyday life.
Administrative Staff Are Also Part of Safe Team Working
Administrative staff are sometimes excluded from discussions about multidisciplinary care.
However, administrative processes can significantly affect patient safety.
Administrative staff may notice:
Repeated missed appointments.
Unusual messages.
Urgent requests.
Failures to book follow-up appointments.
Repeated difficulties obtaining prescriptions.
Messages from distressed relatives.
Referral problems.
They are not expected to clinically assess these issues.
They need clear systems for escalating them.
A safe service depends on clinical and administrative systems working together.
Information Must Move Through the Team
Think about information as something that needs to travel.
Patient tells case worker.
Case worker recognises significance.
Case worker documents information.
Case worker actively tells relevant clinician when necessary.
Clinician reviews.
Care plan changes if required.
New plan is communicated back to team and patient.
If any link fails there can be a gap in care.
For example:
Patient reports significant adverse effect.
Case worker documents it.
Nobody tells prescriber.
Prescriber does not read note for several days.
Medication continues.
The case worker technically recorded the information.
The system still failed.
Important information must be actively communicated.
Documentation Is Not the Same as Communication
This deserves emphasis.
Writing something in a clinical record does not necessarily mean the relevant clinician will see it promptly.
Routine information can often be documented for later review.
Urgent information needs active escalation.
A useful question after documenting something important is:
“Who needs to know this and when?”
If the answer is:
“The prescribing clinician needs to know today.”
then simply placing the information in the notes is insufficient.
What Information Should You Bring to the MDT?
Not every detail of every interaction needs presenting.
The aim is clinically relevant information.
Useful areas may include:
Changes in mental state.
Changes in risk.
Changes in functioning.
Medication concerns.
Significant adverse effects.
Changes in sleep.
Changes in appetite.
Substance use.
Social changes.
Safeguarding concerns.
Engagement.
Progress towards goals.
Barriers to treatment.
Family or collateral information.
Changes from baseline.
What is helping.
What is not helping.
The question is:
“Does this information affect our understanding of the patient or their care?”
If yes, it is probably worth communicating.
Avoid Information Dumping
A common problem in MDT meetings is presenting every detail chronologically.
For example:
“I saw him Monday. He said he had cereal then went out. On Tuesday his mother rang. Wednesday he watched television…”
The clinically important information may become lost.
Instead summarise.
For example:
“His daily routine has improved and he is leaving the house most days. However, over the last week his sleep has reduced significantly and his mother reports increasing irritability.”
The relevant clinical pattern is immediately clear.
Lead With the Important Information
If you are worried about something say it early.
Do not spend five minutes giving background information before saying:
“And then he told me he planned to kill himself.”
Start with:
“I am concerned because he has disclosed a suicide plan today.”
Then provide the relevant background.
This helps the clinician recognise urgency immediately.
The SBAR Framework
A useful framework for communicating within the MDT is SBAR.
SBAR stands for:
Situation.
Background.
Assessment.
Recommendation or Request.
Situation
What is happening now?
For example:
“I am concerned about a significant deterioration in Emily's mental state.”
Background
What does the clinician need to know?
“Emily has been receiving treatment for depression and was relatively stable at her review last week.”
Assessment
What have you observed?
“Over the last three days she has remained in bed for most of the day, has eaten very little and today disclosed thoughts of taking an overdose.”
Recommendation or Request
What do you need?
“I think she requires urgent clinical assessment today.”
The case worker does not need to provide a medical diagnosis.
They need to communicate clearly.
Be Clear About What You Know and What You Do Not Know
Good MDT communication distinguishes between:
What the patient said.
What you observed.
What someone else reported.
What you think might be happening.
For example:
“The patient states that she has taken her medication every day.”
is different from:
“She has definitely taken all medication.”
Similarly:
“Her mother reports that she has not slept for three nights.”
is different from:
“She has not slept for three nights.”
The source of information can sometimes matter.
Clinical accuracy requires us to distinguish fact, report and interpretation.
Disagreement Within the MDT
Professionals will not always agree.
One clinician may think a patient is improving.
Another may be worried.
One professional may recommend increasing support.
Another may think support should reduce.
A psychologist may understand a behaviour through one formulation.
A psychiatrist may consider a medical explanation.
Disagreement is not necessarily a sign that the team is failing.
Different perspectives are one reason MDTs exist.
The important question is how disagreement is managed.
Healthy MDT disagreement involves:
Respect.
Curiosity.
Evidence.
Clear reasoning.
Listening.
Focus on the patient.
Willingness to reconsider.
It should not involve:
Personal attacks.
Professional rivalry.
Dismissing someone because of seniority.
Discussing disagreements inappropriately with the patient.
Ignoring unresolved safety concerns.
Speaking Up
Case workers sometimes worry about challenging senior clinicians.
Imagine a consultant says:
“He seems much better.”
You know that during three contacts this week the patient has been deteriorating.
You should say so.
A respectful response might be:
“He did appear settled today. I am still concerned because his presentation during the rest of the week has been different. He has stopped leaving the house and yesterday disclosed suicidal thoughts.”
That is not being disrespectful.
That is contributing clinically relevant information.
Good teams need staff who can speak up.
Escalating When You Remain Concerned
Sometimes you raise a concern and still feel it has not been adequately addressed.
Do not assume that once you have told someone your responsibility ends.
If you believe there remains a significant unresolved safety concern follow the service escalation pathway.
This may mean:
Clarifying whether the clinician understood the concern.
Contacting another appropriate senior clinician.
Using the duty or on-call system.
Following safeguarding procedures.
Using emergency pathways where necessary.
CQC Regulation 12 requires services to assess and mitigate risks and specifically requires appropriate collaboration where responsibility for care is shared or transferred.
Patient safety takes priority over professional discomfort.
Professional Respect
Every profession brings a different contribution.
A healthy MDT avoids comments such as:
“They're only a support worker.”
“The psychiatrist doesn't understand real life.”
“The psychologist always overcomplicates things.”
“Nursing doesn't understand medication.”
These attitudes undermine collaboration.
Instead ask:
“What expertise does this person bring?”
Professional respect does not mean agreeing with everything.
It means recognising that different disciplines contribute different knowledge.
Avoid Professional Silos
A silo occurs when one professional group works largely in isolation from others.
For example:
The medication plan sits with psychiatry.
The psychological plan sits with psychology.
The social plan sits with social work.
Nobody connects them.
The patient then receives several separate plans.
Good MDT working aims for one coherent care plan.
Medication may support psychological work.
Psychological work may support social recovery.
Social stability may improve medication adherence.
Everything interacts.
This reflects the biopsychosocial model taught earlier in the course.
One Patient Should Not Have Five Different Plans
A patient may receive advice from several professionals.
Problems arise when these messages conflict.
One clinician says:
“Rest when you feel anxious.”
Another says:
“Try not to avoid anxiety-provoking situations.”
A case worker says:
“Call us whenever you feel distressed.”
A psychologist says:
“Use the coping plan before contacting the team.”
The patient is left confused.
The MDT should clarify:
What are we trying to achieve?
What should the person do?
What should professionals do?
What constitutes an emergency?
When should support increase?
When should independence be encouraged?
Consistency is particularly important for patients experiencing emotional dysregulation.
Care Plans Should Be Shared and Understandable
A good care plan should answer practical questions.
What difficulties are we addressing?
What matters to the patient?
What are the current goals?
What treatment is being provided?
Who is responsible for each part?
What should the patient do if difficulties increase?
What should staff do?
What are the important risks?
When should the plan be reviewed?
NHS England's current personalised care framework centres on a personalised care and support plan, a person responsible for the plan, regular review and responding when circumstances or outcomes change.
A care plan that exists only in the electronic record but is not understood by the patient or staff is of limited value.
The MDT and Recovery-Oriented Care
MDTs can unintentionally become focused entirely on problems.
A typical discussion can sound like:
Still depressed.
Still anxious.
Not attending.
Medication not working.
Family concerned.
Poor sleep.
A recovery-oriented MDT should also ask:
What has improved?
What strengths can we use?
What does the patient want?
What matters to them?
What are they managing?
What is the next meaningful step?
A patient is more than a list of symptoms and risks.
The MDT and the Biopsychosocial Model
The MDT is one practical way of applying the biopsychosocial model.
Consider someone experiencing severe depression.
Biological information might include:
Family history.
Sleep.
Medication.
Physical health.
Psychological information might include:
Self-critical thinking.
Avoidance.
Loss of confidence.
Social information might include:
Relationship breakdown.
Unemployment.
Debt.
Isolation.
Different professionals may hold different pieces of this picture.
The MDT brings them together.
The MDT and Emotional Dysregulation
Team consistency is particularly important where patients experience emotional dysregulation.
Imagine a person who repeatedly contacts the service when distressed.
One worker provides an hour of reassurance.
Another says they should not call.
Another offers an urgent appointment.
Another tells them to use their coping plan.
The service itself becomes unpredictable.
This can increase distress and reinforce unhelpful patterns.
The MDT should agree a coherent approach.
For example:
Acknowledge distress.
Assess significant changes in risk.
Encourage agreed coping strategies.
Maintain clear contact boundaries.
Escalate if specific thresholds are reached.
Review repeated crises in supervision.
The aim is not rigidity.
It is predictability.
Team Formulation
Some teams develop shared formulations.
This means the team agrees a working understanding of:
What the person's difficulties are.
What may have contributed to them.
What triggers deterioration.
What maintains difficulties.
What strengths exist.
What professional responses help.
What professional responses make things worse.
This can be particularly useful when staff have different reactions to the patient.
For example, one practitioner may feel extremely protective.
Another becomes frustrated.
Another believes the person needs more independence.
A shared formulation can help the team understand why these reactions are occurring and develop a consistent approach.
The Patient's Voice in MDT Discussions
Where appropriate patients should know what is being discussed about their care.
Services vary in whether patients attend formal MDT meetings.
Even when they do not attend the meeting their views should still be represented.
Before discussing the patient ask:
What have they said they want?
What are they worried about?
What have they agreed to?
What do they think is helping?
After significant MDT decisions the patient should usually receive an understandable explanation of the plan.
Avoid saying:
“The MDT has decided.”
without explanation.
This can feel like a mysterious group making decisions behind closed doors.
Where appropriate say:
“The team discussed what you've told us about the medication and your concerns about sleep. The plan is…”
Then explain the reasoning.
Families and Carers Within the Wider Team
Families and carers may be important sources of information and support.
They may notice changes that professionals do not see.
A parent might report that their child has stopped sleeping.
A partner might notice increasing alcohol use.
A family member might identify medication problems.
However, confidentiality and consent remain important.
Information can often be received from family members even when the patient has not consented to information being disclosed back to them.
Case workers should follow local policy and seek senior advice when uncertain.
Do not tell a family member:
“I can't speak to you because we don't have consent.”
if they are trying to provide important information.
You may be able to listen without disclosing confidential information.
External Professionals
The MDT may extend beyond the organisation.
Depending on the patient this can include:
The GP.
School.
College.
University.
Social care.
Community organisations.
Pharmacy.
Drug and alcohol services.
Eating disorder services.
Crisis services.
Inpatient services.
Housing services.
Employment support.
The voluntary sector.
NHS England's community mental health model emphasises integrated, whole-person care across mental health, primary care, social care and community services.
The patient's care may therefore involve a network rather than one physical team.
Transitions Are High-Risk Points
Communication becomes particularly important when care changes.
Examples include:
Hospital discharge.
Transfer between services.
Moving from child to adult services.
Changing clinician.
Moving area.
Transfer between private and NHS care.
Shared care with primary care.
Discharge from specialist services.
Information can easily be lost at these points.
CQC Regulation 12 specifically requires services to work with other people and organisations when responsibility for care is shared or transferred so that timely planning protects health, safety and welfare.
Case workers should be particularly alert during transitions.
Do Not Assume Someone Else Has Done It
A common cause of clinical error is:
“I thought someone else was doing that.”
Examples include:
Everyone assumes someone told the GP.
Everyone assumes someone booked follow-up.
Everyone assumes someone checked the blood results.
Everyone assumes someone updated the safety plan.
Everyone assumes someone called the family.
Clear allocation matters.
Instead of:
“Someone should contact the GP.”
the plan should be:
“Sarah will contact the GP today.”
Clear ownership reduces gaps.
Closed-Loop Communication
Closed-loop communication means confirming that important information has been received and acted on.
For example:
Case worker sends urgent concern to clinician.
Clinician acknowledges receipt.
Clinician confirms action.
Case worker understands the outcome relevant to their role.
This is safer than sending an email and assuming it has been seen.
For urgent clinical information ask:
Has someone received this?
Who is dealing with it?
What do I need to do next?
Meetings Are Not the MDT
The phrase MDT is sometimes used to mean:
“We have an MDT meeting on Wednesday.”
The meeting is only one part of MDT working.
Real MDT working happens throughout the week.
Phone calls.
Messages.
Clinical records.
Supervision.
Handover.
Shared plans.
Informal consultation.
Urgent escalation.
The patient should not have to wait until Wednesday because that is when the formal meeting happens.
How to Prepare for an MDT Meeting
Before presenting a patient consider:
Why are we discussing them?
What has changed?
What progress has occurred?
What is the patient's perspective?
Is there a safety concern?
Is there a specific question for the team?
What decision is needed?
For example:
Poor presentation:
“I thought we should discuss Michael.”
Better presentation:
“Michael's anxiety is improving but he has developed significant daytime sedation since the medication increase and is struggling to attend work. He states he would like to continue medication if possible. I would like the prescriber to review the adverse effects.”
The second gives the team something useful to consider.
How to Present a Patient Concisely
A useful structure is:
Who is the patient?
Why are they involved with the service?
What has changed?
What is going well?
What is not going well?
What is the current risk?
What does the patient want?
What decision or advice do you need?
This helps prevent discussions becoming unnecessarily long.
Know When Not to Wait for the MDT Meeting
Urgent problems should never be saved for a scheduled meeting.
Do not wait until tomorrow's MDT if today the patient has:
Disclosed a suicide plan.
Developed possible psychosis.
Developed possible mania.
Seriously self-harmed.
Become acutely confused.
Experienced a serious medication reaction.
Disclosed significant abuse.
Made serious threats towards another person.
Escalate immediately according to service procedure.
Psychological Safety Within the Team
Staff need to feel able to ask questions.
A case worker should be able to say:
“I don't understand this plan.”
“I haven't been trained to do that.”
“I think this patient is deteriorating.”
“I made an error.”
“I am worried.”
“I need supervision.”
Teams become unsafe when staff are afraid of looking inexperienced.
Nobody knows everything.
A safe culture values appropriate uncertainty.
The MDT and Supervision
Formal supervision and MDT working are related but different.
The MDT focuses primarily on the patient's overall care.
Supervision also focuses on the practitioner's work.
Supervision might explore:
How the interaction affected you.
Whether you maintained boundaries.
Whether you are becoming over-involved.
Whether you understood the care plan.
Whether you need further training.
Whether a recurring pattern requires formulation.
Do not rely on the MDT meeting as a substitute for individual supervision.
Managing Conflict Professionally
Sometimes colleagues will disagree strongly.
Professional disagreement should remain professional.
Avoid:
Arguing in front of patients.
Criticising colleagues to patients.
Sending emotionally reactive messages.
Creating alliances against another professional.
Discussing confidential issues with uninvolved staff.
Instead:
Clarify the clinical issue.
Present the evidence.
Ask the other person's reasoning.
Identify what remains unresolved.
Escalate through appropriate professional channels where necessary.
The question should remain:
“What is safest and most helpful for the patient?”
If You Think a Colleague Has Made a Mistake
Do not ignore it because they are more senior.
First clarify.
You may have misunderstood.
For example:
“I just wanted to check the medication plan because my understanding from the note is 20mg but the patient says they were told 40mg.”
This is respectful and specific.
If there is a genuine safety problem make sure it is addressed.
Professional respect does not require silence.
If You Make a Mistake
Tell someone promptly.
Do not hide it.
Do not change records to conceal it.
Do not hope nobody notices.
The earlier the team knows the sooner harm can be prevented or reduced.
Good MDT working includes openness about errors and near misses.
The Case Worker as the Link Between Appointments
One of the greatest strengths of the case worker role is continuity.
Formal clinical appointments may occur every few weeks or months.
The case worker may have more regular contact.
This allows you to notice trajectories rather than snapshots.
For example:
Week 1: mildly withdrawn.
Week 2: stopped seeing friends.
Week 3: stopped attending college.
Week 4: spending most of day in bed.
Week 5: suicidal thoughts.
Each change may appear small on its own.
Together they describe clear deterioration.
The case worker can bring that trajectory to the MDT.
A Worked Clinical Scenario
Consider Daniel who is 27 and is receiving treatment for depression.
The psychiatrist reviewed him two weeks ago and increased his antidepressant.
A psychologist is working with him on behavioural activation.
His case worker sees him weekly.
At today's appointment Daniel says the medication has made him feel restless.
He is pacing frequently.
He states:
“I feel like I need to keep moving all the time. I can't sit through a film anymore.”
He is also sleeping less.
What should the case worker do?
The case worker should gather useful information.
When did the restlessness begin?
How severe is it?
Does it appear related to the medication change?
Is it affecting sleep or functioning?
Has there been any change in mood?
Is there any increase in suicidal thinking?
The case worker should then communicate the concern to the prescribing clinician.
They should not independently decide to reduce the medication.
The MDT contribution might be:
“Daniel reports significant new restlessness since the medication increase. He describes feeling unable to sit still and I observed him pacing throughout today's appointment. His sleep has also reduced. I think this needs medication review.”
That is a clinically useful contribution.
Another Worked Scenario
Consider Rachel who is 18 and experiences emotional dysregulation.
Her care plan states that she should use agreed coping strategies before requesting additional contact unless there has been a significant change in risk.
One case worker follows the plan.
Another repeatedly offers additional appointments whenever Rachel becomes distressed.
Rachel begins contacting the second practitioner increasingly often.
What is the MDT issue?
The problem is not simply Rachel's behaviour.
The team response has become inconsistent.
The MDT needs to review:
What is the agreed formulation?
What support is appropriate?
What constitutes increased risk?
How should contact be managed?
What should all staff communicate?
Consistency protects both Rachel and the staff.
A Third Worked Scenario
Consider Marcus who is 40 and has schizophrenia.
During formal reviews he reports that everything is fine.
His case worker notices that he has stopped showering, is eating very little and no longer attends his usual community group.
Marcus says:
“I'm fine. Nothing's wrong.”
Should the case worker simply accept this?
No.
The patient's view remains important.
However, the functional deterioration is clinically relevant.
A useful MDT update would be:
“Marcus states that he feels well but there has been a marked change in functioning. He has stopped attending his community group, appears not to be maintaining personal care and reports eating only once most days. This is different from his usual baseline.”
The clinician can then determine whether further assessment is required.
A Practical Framework: TEAM
A useful framework for MDT working is TEAM.
T – Tell the Right Person
Consider who needs the information.
Medication concern?
Prescriber.
Safeguarding concern?
Safeguarding pathway and senior clinician.
Significant mental state deterioration?
Appropriate clinical reviewer.
E – Explain Clearly
Describe:
What happened.
What changed.
Why you are concerned.
What the patient says.
What you observed.
A – Agree Responsibility
Be clear about:
Who is doing what?
When will it happen?
What is your role?
What happens next?
M – Monitor and Communicate
Continue observing.
Document appropriately.
Report further changes.
Make sure urgent information does not disappear into the record.
4. Clinical Perspective
Clinical Pearls
The MDT Is a System, Not a Meeting
Good multidisciplinary working happens throughout the patient's care rather than only at scheduled meetings.
Your Observations Matter
Do not assume that information is unimportant because you are not the most senior clinician.
Describe Before You Interpret
Clear behavioural observations often provide more value than diagnostic speculation.
Change From Baseline Is Clinically Important
Tell the team when someone appears significantly different from usual.
Urgent Information Needs Active Communication
Documentation alone is not enough.
Say What You Need
When contacting a clinician make it clear whether you are:
Providing information.
Seeking advice.
Requesting review.
Escalating an urgent concern.
Clarify Responsibility
“Someone should do this” is not a plan.
Consistency Matters
Different professionals should avoid giving contradictory messages where possible.
Disagreement Can Be Helpful
Different perspectives may improve care if disagreement is respectful and focused on evidence.
Seniority Does Not Override Safety
If you remain seriously concerned speak up and follow the escalation pathway.
Practical Tips for Everyday Practice
Before seeing patients know:
Who is in the clinical team.
Who supervises you.
Who can prescribe.
Who provides urgent clinical assessment.
Who deals with safeguarding.
How to contact the relevant clinician.
What to do outside normal arrangements.
When communicating with the MDT:
Start with the most important information.
Be specific.
Describe changes.
Separate observation from interpretation.
Include the patient's perspective.
State whether there is a risk concern.
Say what action you are requesting.
Confirm urgent information has been received.
Before an MDT discussion ask:
Why am I bringing this patient?
What has changed?
What is improving?
What is getting worse?
What does the patient want?
What is the current risk?
What question do I need the team to answer?
After an MDT discussion ask:
What was decided?
Who is responsible?
What do I need to do?
Does the patient know the plan?
Does the care plan need updating?
When will this be reviewed?
Common Pitfalls and Misconceptions
“The MDT Means the Weekly Meeting”
No.
The meeting is only one component of multidisciplinary working.
“The Consultant Makes Every Decision so My Opinion Doesn't Matter”
Different decisions require different professional expertise.
Your clinical observations remain valuable regardless of your professional grade.
“If I Put It in the Notes Someone Will See It”
Urgent information requires active communication.
“I Told Someone so My Responsibility Is Finished”
If the concern remains unresolved you may need to escalate further.
“Everyone Knows the Plan”
Never assume this.
Check.
“Everyone Will Know Who Is Doing It”
Again, never assume.
Agree responsibility explicitly.
“Different Professional Opinions Mean the Team Is Dysfunctional”
Not necessarily.
Good MDTs use different perspectives to improve clinical understanding.
“The Patient Doesn't Need to Know What the MDT Discussed”
Patients should usually understand decisions affecting their care and be involved in care planning wherever possible.
“Families Cannot Tell Us Anything Without Consent”
You can often receive information without disclosing confidential patient information in return.
Seek senior advice if uncertain.
“I Should Agree With the Senior Clinician”
You should remain respectful but raise relevant concerns.
Patient safety matters more than professional hierarchy.
Advice for Newly Qualified Practitioners
You may initially feel intimidated in MDT discussions.
You do not need to speak like a psychiatrist.
You do not need complicated terminology.
You need clear information.
Instead of:
“I think the patient is demonstrating a significant affective deterioration secondary to psychosocial factors.”
you could say:
“Over the last week she has stopped going to work, is staying in bed most of the day and has begun saying that she feels hopeless. This is different from how she presented last week.”
That is clinically useful.
If you do not understand what has been agreed ask.
For example:
“Can I clarify what you would like me to monitor before the next review?”
or:
“What should I do if this happens again?”
or:
“At what point would you like me to contact the clinical team urgently?”
Good MDT working depends on clarity.
You are not expected to know automatically what another professional is thinking.
Situations Requiring Escalation
Seek senior clinical advice or follow urgent service procedures when there is:
New or increasing suicidal thinking.
Suicidal intent or planning.
Significant self-harm.
Increasing risk to other people.
New psychotic symptoms.
Possible mania.
Acute confusion.
Significant deterioration in mental state.
Severe emotional dysregulation outside the current care plan.
Serious medication adverse effects.
Significant medication errors.
Severe intoxication.
Suspected significant substance withdrawal.
Serious deterioration in physical health.
Severe reduction in food or fluid intake.
Significant self-neglect.
Safeguarding concerns.
Possible abuse or exploitation.
Significant concerns about capacity or consent.
A major change from usual functioning.
Important disagreement within the MDT where a safety concern remains unresolved.
A failure of communication that may place the patient at risk.
Uncertainty about who currently holds clinical responsibility.
Any situation where you believe the current care plan is no longer safe or appropriate.
If the first clinician you contact cannot be reached and the concern is urgent follow the service escalation process rather than simply waiting.
5. Summary
Multidisciplinary working brings together different professional perspectives around one patient.
The purpose is not simply to have several professionals involved.
The purpose is coordinated care.
Different MDT members contribute different expertise.
The psychiatrist may contribute medical and diagnostic expertise.
Psychologists contribute psychological assessment and formulation.
Nurses contribute assessment, monitoring and ongoing care.
Occupational therapists contribute expertise around functioning and meaningful activity.
Social workers contribute expertise around social circumstances and safeguarding.
Pharmacists contribute medication expertise.
GPs contribute wider medical and primary care information.
Case workers contribute important observations about day-to-day functioning and implementation of the care plan.
Administrative staff also contribute to safe systems and communication.
Good MDT working requires:
Clear roles.
Shared information.
Shared goals.
Clear responsibility.
Good documentation.
Active communication.
Respect between professionals.
Patient involvement.
Consistent care plans.
Appropriate escalation.
The case worker's role is not to know everything.
It is to know what they have observed.
Know what has changed.
Know who needs to hear it.
Know when it is urgent.
Know what part of the care plan they are responsible for.
A useful framework is TEAM:
Tell the right person.
Explain clearly.
Agree responsibility.
Monitor and communicate.
Most importantly:
The MDT should not become several professionals working separately around the same patient.
It should function as one coordinated system of care.
6. Further Reading
NHS England Mental Health Personalised Care Framework
The Mental Health Personalised Care Framework: The Modern Care Programme Approach was published by NHS England in July 2026.
It is highly relevant to this lesson because it describes how care for people with severe mental health problems should be personalised, coordinated and reviewed.
The framework emphasises:
A personalised care and support plan.
A named person within the service responsible for coordinating the plan.
Regular review.
Responding when needs, risks or outcomes change.
Importantly, the named worker does not carry responsibility for care alone. The wider multidisciplinary team retains responsibility for the safety, effectiveness and quality of treatment.
NHS England Community Mental Health Framework
The Community Mental Health Framework for Adults and Older Adults promotes integrated whole-person mental health care.
It describes community mental health services working across traditional boundaries and integrating mental health, primary care, social care and community support.
This is particularly relevant to the biopsychosocial and recovery-oriented approach taught earlier in this course.
NICE NG197: Shared Decision Making
NICE NG197 provides guidance on making shared decision-making part of everyday healthcare.
It emphasises collaborative decisions between patients and professionals rather than care being designed entirely by professionals.
CQC Regulation 12: Safe Care and Treatment
Regulation 12 requires providers to deliver care safely and to assess and mitigate risks.
It is particularly relevant to MDT working because where responsibility for care is shared or transferred the provider must work with other people and organisations to ensure timely planning and safe care.
CQC also states that relevant information should be shared appropriately when care is provided across different services.
Relevant NICE Guidance
NICE NG225: Self-harm: assessment, management and preventing recurrence.
This is relevant to multidisciplinary assessment, risk management and coordinated care for people who self-harm.
NICE CG178: Psychosis and schizophrenia in adults: prevention and management.
This illustrates the importance of multidisciplinary care involving pharmacological, psychological, physical health and social interventions.
NICE CG78: Borderline personality disorder: recognition and management.
This provides particularly useful guidance about coordinated care, team communication, supervision and maintaining consistent approaches in complex emotional presentations.
NICE NG53: Transition between inpatient mental health settings and community or care home settings.
This is useful for understanding why coordinated information sharing becomes particularly important during transitions between services.
Recommended Books
Psychiatric Interviewing: The Art of Understanding by Shawn Christopher Shea
This provides useful advanced reading on gathering clinically relevant information and communicating psychiatric findings.
Motivational Interviewing by William R Miller and Stephen Rollnick
This supports collaborative approaches to conversations about change.
Personal Recovery and Mental Illness by Mike Slade
This provides useful background to recovery-oriented care and maintaining the patient's own goals within multidisciplinary treatment.
Cognitive Behavior Therapy: Basics and Beyond by Judith S Beck
This provides useful background for understanding psychological interventions that case workers may sometimes support within a wider MDT treatment plan.
Patient and Public Resources
The NHS Mental Health website provides accessible information about mental health services and treatment.
The Royal College of Psychiatrists provides patient and carer information about psychiatric conditions and treatments.
Mind and Rethink Mental Illness provide accessible information about mental health, patient rights, support and navigating services.
7. Knowledge Check
Question 1
What is the main purpose of multidisciplinary team working?
A. To ensure every patient sees as many professionals as possible.
B. To allow different professionals to work independently on different parts of the patient's care.
C. To combine different professional expertise into coordinated patient care.
D. To allow the most senior clinician to make every decision.
Correct answer: C.
The purpose of an MDT is to combine relevant expertise so that assessment and treatment are coordinated.
Answer A is incorrect because unnecessary professional involvement can make care more fragmented rather than better.
Answer B describes silo working rather than multidisciplinary working.
Answer D incorrectly assumes that MDT working means transferring all responsibility to the most senior clinician.
Different professionals have different responsibilities and expertise.
Question 2
A psychiatrist reviews a patient and states that they appear significantly improved.
The case worker has seen the patient several times during the week and knows that they have stopped attending college, remain in bed most of the day and disclosed suicidal thoughts yesterday.
What should the case worker do?
A. Say nothing because the psychiatrist is more senior.
B. Wait until the next case worker appointment.
C. Clearly communicate the deterioration and suicidal thoughts to the psychiatrist.
D. Independently change the patient's treatment plan.
Correct answer: C.
The case worker holds important information that may substantially alter the clinical assessment.
Professional seniority should not prevent relevant safety information being communicated.
Answer A could contribute to unsafe care.
Answer B creates unnecessary delay.
Answer D exceeds the case worker's role.
The correct response is to communicate clearly and allow the appropriate clinician to review the plan.
Question 3
Which is the most useful MDT update?
A. “He's not doing very well.”
B. “He's difficult at the moment.”
C. “Over the last week he has stopped attending work, is sleeping approximately 12 hours each day and reports that his mood has become significantly lower.”
D. “I think something is wrong.”
Correct answer: C.
The third response provides specific information about change in functioning, sleep and mood.
Answers A, B and D are vague.
Good MDT communication allows another professional to understand what has actually changed.
Question 4
A case worker documents that a patient has developed suicidal intent in the clinical record.
What should they do next?
A. Nothing because the information is now documented.
B. Assume the psychiatrist will read the note later.
C. Actively escalate the concern according to service procedures.
D. Wait until the weekly MDT meeting.
Correct answer: C.
Urgent clinical information needs active communication.
Documentation is important but it does not guarantee that someone will see the information promptly.
Answers A and B rely on passive communication.
Answer D could result in a dangerous delay.
Question 5
What does SBAR stand for?
A. Safety, Behaviour, Assessment and Risk.
B. Situation, Background, Assessment and Recommendation.
C. Symptoms, Baseline, Actions and Review.
D. Situation, Behaviour, Action and Recovery.
Correct answer: B.
SBAR stands for Situation, Background, Assessment and Recommendation.
It provides a simple structure for communicating clinical information.
For a case worker the final element can also be thought of as the request:
“What do I need the clinician to do?”
The other answers contain clinically relevant concepts but are not the SBAR framework.
Question 6
A patient is receiving different advice from several members of the team about what they should do when anxious.
What is the best response?
A. Each professional should continue using their own approach.
B. The patient should decide which professional to follow.
C. The MDT should clarify the formulation and agree a consistent approach.
D. The case worker should choose which professional is correct.
Correct answer: C.
Contradictory professional responses can confuse patients and may reinforce difficulties.
The MDT should agree what the overall care plan is trying to achieve and provide reasonably consistent messages.
Answer A maintains fragmentation.
Answer B unfairly places responsibility for professional disagreement on the patient.
Answer D places the case worker in a position outside their role.
Question 7
During an MDT meeting a senior clinician states that a patient is safe to continue with routine follow-up.
The case worker remains concerned because the patient disclosed a detailed suicide plan shortly before the meeting but this information appears not to have been understood.
What should the case worker do?
A. Accept the decision because the clinician is senior.
B. Clearly restate the information and if significant concern remains unresolved follow the service escalation pathway.
C. Discuss the disagreement with the patient and ask them which professional they agree with.
D. Wait several days to see what happens.
Correct answer: B.
Patient safety takes priority over hierarchy.
The first step should be to ensure that the senior clinician has understood the relevant information.
If a significant safety concern remains unresolved the practitioner should follow the appropriate escalation pathway.
Answer A may result in important information being missed.
Answer C is inappropriate and risks undermining the team.
Answer D may create unacceptable delay.
Question 8
Which statement about MDT responsibility is most accurate?
A. The named case worker becomes responsible for every aspect of the patient's care.
B. The psychiatrist carries all responsibility for everything that happens.
C. Different professionals hold responsibilities within their roles while care should remain coordinated across the team.
D. Nobody holds individual responsibility because the MDT is collectively responsible.
Correct answer: C.
MDT working involves shared and coordinated care but individual professionals remain responsible for actions within their own roles.
NHS England's current personalised care framework makes clear that the named worker may coordinate care while the wider team retains responsibility for overall quality, effectiveness and safety.
Answer A creates inappropriate over-responsibility for the named worker.
Answer B ignores the responsibilities of other professionals.
Answer D incorrectly suggests that team working removes individual accountability.
Question 9
A patient's mother telephones the case worker and states that the patient has not slept for three nights and has become unusually agitated.
The patient has not consented to information being shared with their mother.
What is the most appropriate response?
A. Refuse to listen because there is no consent.
B. Listen to the information without necessarily disclosing confidential patient information in return and escalate concerns as appropriate.
C. Give the mother full details of the patient's treatment because she contacted the service.
D. Ignore the information because collateral reports are unreliable.
Correct answer: B.
Confidentiality relates to information being disclosed about the patient.
It does not necessarily prevent professionals from receiving relevant information from relatives.
The information described may be clinically significant and should be considered appropriately.
Answer A may result in important information being lost.
Answer C breaches confidentiality unless there is an appropriate basis for disclosure.
Answer D dismisses potentially useful collateral information.
Question 10
Which statement best summarises effective MDT working?
A. Every professional works independently and submits their findings at the end of treatment.
B. The most senior professional directs everyone else.
C. Different professionals contribute their expertise within clear roles while sharing relevant information and working towards a coordinated plan centred on the patient.
D. All professionals should perform the same tasks so there are no gaps.
Correct answer: C.
Effective MDT working combines different areas of expertise rather than attempting to make every professional interchangeable.
Relevant information should be shared.
Responsibilities should be clear.
The patient's goals and preferences should remain central.
Answer A describes fragmented care.
Answer B confuses multidisciplinary working with hierarchy.
Answer D misunderstands the purpose of professional roles.
The central principle of this lesson is:
Good MDT working is not about everybody doing everything.
It is about everybody understanding their contribution.
Knowing what others contribute.
Sharing the information that matters.
Agreeing who is responsible for what.
And making sure that the patient experiences one coordinated system of care rather than a collection of disconnected professionals.
