Diagnosing mental health teams

Individuals can only thrive in teams that are well-defined, functional and mentally healthy. Therapist Michael O'Sullivan describes what a happy team looks like and how to build one.

In my previous blogs I have talked about how mental health professionals can look at their own mental health. In doing this, staff can hopefully begin to work more effectively with others with problems. However, also know that any changes the individual worker makes can only be effective if the teams that they work in have good mental health.

A way of testing the health of a team, whether in the mental health sector or other fields, is to use a BART analysis. BART stands for Boundaries, Authority, Role and Task. It’s a tool derived from the Tavistock Institute of Human Relations (a not-for-profit organisation that applies social science to contemporary issues and problems). 

Boundaries will be anything which limits our work: from the boundary of time to the physical boundary of the workplace.

Authority is what we are “authorised” to do by virtue of our training. Doctors are “authorised” to prescribe medicine whilst other professions are not.

The role is both the job role itself - which enables that authority - and the informal roles we occupy. Some may see themselves as the “wise head” or the “joker” of the team. 

The tasks are the specific jobs we do within our work.

If there is clarity in all of the above, then the team should have no problems. However, this is rarely the case. Teams find themselves in problems due to a lack of clarity. The boundaries of our work may not be clear and we may end up taking work home. We may, through work pressure, begin to step outside of our formal role and “authorise” ourselves to do work we are not qualified to do. When there is a lack of clarity we can feel out of control and overwhelmed, which is a threat.

Maladaptive strategies for coping with the ‘threat’ that is feeling overwhelmed

The psychodynamic therapist Wilfred Bion spoke about Basic Assumption Groups. In CBT language, Basic Assumptions are those maladaptive coping strategies that groups under threat use. Basic Assumption Dependency occurs where a team paralysed by fear depends on a “leader” to deal with the threat.

• See also: Harnessing your own feelings as a mental health professional to help someone with depression
• See also: How to make a decision when you’re depressed

Basic Assumption pairing occurs where two or more members of the team may offer a solution which delays the threat. In individuals this is procrastination. For teams this is often about conveying more and more meetings.  Basic Assumption fight or flight is when the threatened team puts up barriers to any outside communication.

As with all maladaptive coping strategies, the behaviours provide short term relief but do not solve longer term problems. These strategies preclude the possibility of real communication.

How do we begin to work with this? We can start by recognising that it is going on. A BART analysis can highlight where lack of clarity is causing problem. The team’s Threat System is the four fifths of the iceberg beneath the surface of the team.

Mental health problems have many ingredients and teams can only begin to tackle these through climbing out of their silos and talking to one another. Mechanisms such as Schwartz Rounds tackle the fears which lie behind the Basic Assumption and can be a useful way for individual workers to begin to “lower the mask”.

Michael O'Sullian is a cognitive behavioural therapist and author.