Evidence-based psychiatry within multi-disciplinary clinical teams

The paper by Lawrie et al (2001) and letter by Jha (2001) are of considerable interest and importance. The decision by the Royal College of Psychiatrists to introduce the Critical Review Paper as part of the MRCPsych Part II examination stimulated the Psychiatric Tutor and Trust Librarian of Barnet Community Healthcare NHS Trust (now part of Barnet, Enfield and Haringey Mental Health Trust and Barnet Primary Care Trust) to seek funding for posts of clinical librarians. Thames Postgraduate Medical and Dental Education (now the London Deanery) and the North London Consortium for Multi-professional Education (now the North London Confederation for Workforce Development) agreed to provide funding for 1.5 whole-time equivalent clinical librarians and equipment to support this proposal, over a period of 30 months.

The clinical librarians work with 14 multi-disciplinary clinical teams within the Trust. Arrangements differ from team to team but in all cases the clinical librarians visit the teams at their place of clinical work. Priority is given to quick provision of information to clinicians in relation to questions arising out of direct patient contact. Portable information (lap-top computers and CDs) and communication (mobile telephones) technology is used to support this project. All disciplines, not just doctors, are encouraged to make use of this service. The clinical librarians have trained clinical team members to formulate focused clinical questions, use the internet for work and search a collection of databases. Training on critical appraisal is being considered at present.

Trusts have a responsibility to support evidence-based clinical practice by consultants and other members of the multi-disciplinary team. Arguably, a clinical librarian/clinical information specialist should be a new member of the multi-disciplinary mental health team, in the same way that the psychologist, community occupational therapist, the secretary, the manager and others are. The addition of such a member to the team will greatly facilitate mastery of critical appraisal and other evidence-based clinical practice skills, through the routine use and continuous improvement of such skills.