Introduction

Effective CAMHS are based on multidisciplinary working. Although such working is a fundamental strength of practice, it can cause division and discord if there is not a clear understanding of its nature and tensions. The egalitarian models of multidisciplinary teams in the 1970s have moved on. The roles of CAMHS members are defined not only by their professional training but also by their individual interest, development and expertise. A well-functioning team can be stronger than the sum of its parts, but requires commitment from individuals to a team ethos and to recognise the professional skill, experience and interest of other disciplines. As with families, boundaries and roles need clarity, communication needs to be open, and an ability of members to contain anxiety is essential. Child and adolescent mental health services differ from each other both in numbers and in disciplinary composition. Successful team working depends on a systemically informed approach to team dynamics, as well as personal and professional relationships. In moving away from a doctor-led, illnessbased model, the central issue is that of the integration of all disciplines in a fashion that values, legitimises and supports both the parts and the whole (Box 8.1).

Integration as a principle has become core to government policy for the welfare of children, and the provision of the CAMHS modernisation grant to Local Authorities and health providers was dependent on integrated services and joint commissioning. This principle is based on the belief that the outcomes for the child will be better; however, the precise mechanisms by which this occurs has been less clearly articulated. Now that many CAMHS have embraced a multidisciplinary team, the ongoing task is to find a way to respect the richness of the disciplines while enabling forums and dialogue for differences to be aired. Fuggle (personal communication, 2008) suggests the need for a coherent framework that can address three levels – integration of explanatory models, integration of treatment delivery, and organisational integration to support the first two levels.