Severe mental illness: Managing the boundary of a CMHT

A qualitative methodology was used to investigate the process through which a multi-disciplinary Community Mental Health Team focused its services on people with severe and enduring mental health problems. Different team members' perceptions of what constitutes severe mental illness, of the interpretation and implementation of the prioritisation process, and of the impact of this on the functioning of the team were explored. The team appeared to use the term 'severe mental illness' (SMI) in two contrasting ways. First, as a strict medical category serving the function of an effective gate criterion for prioritising referral access to the team and secondly as a descriptive term used to guide its clinical practice and informed by the team's broader perception of what constitute severe and enduring mental health problems. The co-existence of these two differing perceptions of SMI resulted from, and further contributed to, the tension between the team's need to manage referral pressure, comply with strategic demands, and its members' clinical experience and valued practice. A range of idiosyncratic practices had evolved in the process of accepting and allocating referrals to manage this tension. These were perceived to have had an important effect on case-load composition, on the clinical work conducted, and on inter-professional relationships in the team. discussed in the context of CMHTs' competing tasks of efficiently managing a service delivery while effectively attending to the complexity of the needs of people with severe mental health problems.