Clinical Psychologists' Experiences of Decision-Making in Community Mental Health Teams in Relation to Borderline Personality Disorder (Volume I).

This study sought to explore Clinical Psychologists’ experiences of decision-making in Community Mental Health Teams (CMHTs) in relation to clients with Borderline Personality Disorder (BPD). CMHTs are responsible for the care of an increasing number of people with mental health difficulties, including people with BPD. As a result, professionals within the CMHT are faced with more decisions to make in relation to the care of their clients. These decisions can have a considerable impact on the lives of clients. This presents an important area for research. Within the CMHT, the role of the Clinical Psychologist has widened; partly in response to the New Ways of Working documentation and recent changes in the Mental Health Act. Therefore, it was important to explore specifically Clinical Psychologists’ experiences of team decision-making. Seven Clinical Psychologists working in CMHTs were interviewed about their experiences. Interpretative Phenomenological Analysis was used to analyse the data. Three main themes emerged: a ‘pull’ towards the exclusion of clients with BPD, team dynamics, and the idealisation of a ‘good’ team. The results, understood through a combination of psychoanalytic and systems theories, suggest that decision-making is based largely on emotions and is characterised by inconsistency. There is a need for reflection, model-based decision-making and the nurturing of teams by the wider organisation in order for decision-making to be effective in meeting the needs of clients with BPD.