Changing Roles of Mental Health Clinicians in Multidisciplinary Teams

Multidisciplinary teams have been used for decades in many mental health settings, including community mental health centers and psychiatric inpatient units. Even so, most psychiatrists did not use affiliated health professionals in their offices, and these nonphysician providers tended to have relatively little autonomy. However, during the past several years, the roles of nonphysician providers have expanded, especially in outpatient settings. The growth of their activities has been fueled by a desire by payers, especially managed care companies, to decrease costs as well as by recognition of their expertise in several areas, including brief psychotherapies.

By assisting with many of the duties traditionally assumed by psychiatrists, such as initial data collection and examination, allied health providers can improve the cost-effectiveness of mental health care as well as the financial viability of mental health care organizations. In these systems, physicians are increasingly assuming the roles of decision maker and supervisor of other members of the treatment team.

The role of the psychiatrist changes when he or she is part of a multidisciplinary team, although as the team leader the physician remains responsible for the quality of care delivered to patients. Some team members may have more knowledge in specific areas—for example, a social worker may have more knowledge about family therapies than a psychiatrist—but the physician must oversee a biopsychosocial assessment and coordinate treatment. Psychiatrists must focus on their unique skills that allow them to increase the "value for cost" of multidisciplinary teams (2).