From policy to practice : the implementation of developmental community mental handicap teams in Nottinghamshire

Community mental handicap teams (CMHTs) are currently in vogue, although each of the constituent elements in their title: community; mental handicap; and team, are attracting much debate, hence these different concepts are explored. There is much variation between CMHTs in practice, one example being Notts where the CMHTs have been established uniquely with an explicit development role. This research is an empirical study of the first three CMHTs established in Notts and has two main foci: implementation and teamwork. Debates in the implementation field between the Bottom-up and Topdown models provide the backcloth for the unfolding of the CMHTs' establishment and development. These models are found to be too polarised and inflexible but a dimensions approach proves useful for overcoming the polarity without losing the insights of either model. Variation between the CMHTs in practice is partly accounted for by their different environments. Negotiation is a key element in the CMHTs' responses to their environments as teams carve out a niche for themselves in established structures and processes. This study examines the environments of the Notts CMHTs to understand how they have undertaken such negotiations. The CMHTs' internal dynamics are also studied, focusing on their experiences of co-operation. Particular aspects are studied in depth, for example, leadership, communication, conflict and· roles, and are shown clearly to inter-relate. Further, the models of co-operation employed by the teams are examined. Many theoretical models exist, and these are "tried" against the evidence, rather than trying to make the evidence fit the frameworks. A crucial question becomes: how is the work done, in an individualist or shared manner? A series of classifications is preferred to a composite measure because of differences within teams according to personnel and task. The distinction between teams and networks is seen as valid, with the question of identity emerging as a determining factor.