Accomplishing team: Teamwork and categorisation in two community mental health teams

This paper describes the social organisation of two newly-formed community mental health teams, examining their differing relationship with team psychiatrists and the resulting constitution of team activities. Different ways of accomplishing 'team' had consequences for the ways mental illness was categorised and the target population for services was framed. The attendance or non-attendance of psychiatrists at team meetings, and the framing of meetings as 'allocation' or 'review', critically affected the nature of teamwork. One team took advantage of the absence of the psychiatrist to resist the bureaucratic framing of its task as 'allocation' and gained some autonomy by delaying acceptance of 'inappropriate' patients onto caseloads. The second team met regularly with its psychiatrist and was allowed a voice in the 'review' of cases, but discussions and decisions fell largely under the control of the dominant professional. Transcripts of team meetings are analyzed to show how the two teams develop divergent discursive repertoires, which are then deployed in the categorisation of patients. The team who meet without the psychiatrist attempt to control their workload by developing a relatively exclusionary definition of serious mental illness which excludes the 'worried well', while the other team take a more inclusive approach.