Case study: using team formulation on an acute mental health inpatient ward | R&I News

Case study: using team formulation on an acute mental health inpatient ward

By Katherine Berry

Team formulation is regularly used to better understand a service user’s difficulties and needs. It is a multidisciplinary approach which considers social, cultural, and biological factors. Crucially, it also considers the service user’s history and how they make sense of their experiences. It can be beneficial when staff feel stuck in their approach to working with a service user. It can encourage more creative thinking and help staff develop more empathetic and optimistic attitudes towards service users. However, our current understanding of the efficacy and merits of different models of team formulation – of which there are many – is limited. 

Using a cognitive behavioural model of team formulation, we recently worked with a 59-year-old male with long-standing mental health problems to better understand how the process works in practice. During his admission, “William” presented as verbally abusive, intrusive, and sexually inappropriate. At times, his behaviour was controlling and intimidating towards other service users, while at other times he could establish good rapport. Staff were becoming frustrated. This had led to them using inconsistent approaches with William. As a result, staff had requested a team formulation meeting to inform their care planning. 

The team formulation meeting was facilitated by a psychologist and five members of staff were involved – an occupational therapist, two support workers, an activity worker, and William’s named nurse. While it is best practice to involving service users in the process, this may not always be possible. One of the main purposes of the team formulation was to increase staff empathy and understanding towards him. It was felt that a team formulation would benefit William by improving the quality of care provided for him despite his reluctance to engage in the process himself. 

The process involved: 

  • Understanding William’s needs and the challenges of working with him 

  • Identifying Williams’ strengths, interests and values – and recognising positive qualities which had sometimes been overlooked when staff were feeling stressed 

  • Identifying the strengths of the team 

  • Learning about William’s life experiences from childhood and into adulthood, his relationships, and experiences of mental health services, and understanding how these experiences may impact on his beliefs about himself and others 

  • Thinking about William’s triggers and ways of coping 

Following this, the team were able to put together a new support plan to help William feel safer on the ward. Key to this was a consistent team approach to working with William. While William’s behaviour remained challenging, the team felt better equipped to respond to William. Staff could picture William’s difficulties in childhood and early adulthood, and felt that they had a greater understanding of his behaviours. This understanding could be important in fostering greater empathy and warmth towards service users like William, and in improving staff and patient relationships in inpatient settings. 

You can read the case study here

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