Tough Gig

The toughest role on an ACT team is that of team leader.  Dealing with supervision, Jugglingtraining, scheduling, troubleshooting and a multitude of other tasks gives the team leader the longest, most complex job description.  The team leader undoubtedly has a tougher task than the ACT psychiatrist and as a result of course gets paid commensurately more – NOT!

Perhaps the most important role of the team leader is to set the underlying direction for the team.  Is our team focused on long term recovery or are we more focused on medication treatment and stabilization?

Years ago I attended a session at an ACTA conference (yes, I have an unresolved grief thing over losing ACTA) where the presenter was talking about the most important quality an ACT team leader needs.  She spoke of how openness to innovation was the most needed quality.

This is fascinating to me.  ACT is a very prescriptive model, after all there’s a manual for how to set up a team and tools to measure fidelity to the model. PACT Manual Cover Yet openness to innovation was a critical quality.  I agree with this. I’ll write more on this need to be open to innovation in a coming blog.

I have an observation about a team leaders’ background prior to taking the role (which I know may spark some criticism).  I think there may be a difference for someone coming from a nursing background versus a social work /psychology or related field.

It’s tough to undo the effects of years of training.  I think psychiatrists are generally conservative – not politically but in terms of not questioning the constructs that underlie what we do. I don’t remember a big emphasis on innovation during my training (maybe I missed that lecture).

I wonder if nurses get their views shaped by training in systems like hospitals, that emphasize hierarchy – doctors write ‘orders’ and nurses carry these out.  I don’t think social work students are ever taught – nor should they be – the importance of taking orders from physicians.

Does this matter?  I think nurses who move into the role of team leader may have more of a challenge to not go the ‘medical model’ route rather than maintaining a recovery orientation.  I think it’s harder for docs and nurses to maintain an openness to innovation – to finding what works for clients and for staff – after their years of training.

I suspect my bias is obvious. While I strongly support using medication  (see blog Recovery, Meds and When) and support the use of forced treatment (see my blog Forcing Treatment)these should be tools used to help individuals in their recovery, never goals in themselves. The big picture should always be on recovery.

And I know there is one role that is tougher than that of team leader, that of being a person with severe and persistent mental illness, the individuals for whom ACT exists to serve.

Let me know what you think.

Shalom Coodin MD

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