Is reflective practice a good use of time in a medically-minded CMHT?

Catherine Lye and Simone Stedmon write.

Reflective Practice (RP) forms a fundamental part of Psychology training and is recommended by the Health and Care Professions Council (HCPC). Yet, we have not witnessed this practice formally extend to other health disciplines in our workplace. The divide between medical and psychological models has always existed within our Community Mental Health Team (CMHT), and previous attempts to engage them in psychological-minded practices, such as weekly mindfulness sessions, were met with limited success and enthusiasm.  

In March 2020 Covid-19 took hold and business as usual came to an abrupt halt. There was lots of stress, uncertainty and fear across all teams. In response to this, the Psychology team looked at how they could support their colleagues. An open-door policy and daily mindfulness sessions were offered, and for the first time weekly RP sessions were trialled.  

Initial interest was high and RP was very well attended by a broad range of disciplines, including management, Psychiatrists, CPNs, Social Workers and Health Care Support Workers. The team reported they felt united in their collected conversation about their personal worries and concerns for service provision. During this time, the attendees devised a range of RP guidelines, shaping the way it was delivered to best support the team.  

This level of engagement continued for a few weeks until the service settled into a new socially-distanced ‘business as normal’, with the added pressure of a sudden influx of referrals. From this point there was a rapid decline in weekly attendees at RP and it seemed the realities of the ‘old normal’ intruded, as staff prioritised the core clinical needs of their roles e.g. medication management. 

We observed, however, that some staff returned to RP sessions on occasion when they would often lead the discussion. This appeared to be when something poignant or significant had happened in their professional work. Following such sessions, individuals reported having space to explore and share their experience with peers was beneficial to both themselves, and their practice. This was confirmed when the Psychology team evaluated the CMHT perception of RP. Of those who responded, results were overwhelmingly positive, with the general consensus that staff found it beneficial, would like it to continue and would attend in future. Barriers to attendance included timing, clinical demands and assessments which they felt took precedence. 

We speculate that a major barrier is the prevalence of the medical model in the CMHT and RP is seen more as escapism from work as opposed to directly influencing clinical practice. Although we value the space and feel it united the team at a difficult time, with services stretched is RP a good use of time? Is it as important as we believe it to be? Based on staff feedback that RP enabled them to problem-solve and positively influence patient care, we believe it is. We are in agreement with the HCPC that RP is a valuable tool for service provision, and personal and professional development. There is a need to keep open a reflective space for staff, but we must listen and be flexible around staff demands. 

Moving forward, the Psychology team has decided to continue to provide RP sessions on a reduced monthly basis. We will approach these sessions with enthusiasm and a commitment to make them work and it will be interesting to see whether anything can halt the slide back into old ways. Now we’ve seen a small but temporary shift towards a psychologically engaged CMHT, can our small Psychology team make an enduring change to a traditionally medically-minded team? 

- Catherine Lye (Assistant Psychologist) & Simone Stedmon (STAR worker)

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