The concept of a team implies that a team leader is recognized; a leader does not have to be an obviously dominant speaker and decision maker, and many successful team leaders 'lead from behind' to great effect and to everyone's satisfaction. The main reasons for having an agreed leader are, first, to keep discussions acceptably brief and to a practical timetable; second, to facilitate decisions between reasonable alternatives; and third, to arbitrate when insoluble disagreements arise between team members.

There are a number of settings within the mental health services in which there may be no need for the leader for everyday purposes to be a doctor. This occurs most frequently in special crisis intervention and emergency units, in rehabilitation units, and in services for those with mental retardation. However, members of such teams have to acknowledge that decisions about the presence of physical illness, and the need for medication or laboratory investigations, can only be made by a medically qualified person. The team then has to accept the authority of the doctor on these occasions because of the unique ethical and legal responsibilities that accompany a medical qualification.

In teams running an inpatient unit such as an acute admission ward, there is a clear need for the whole team to accept that medical and nursing members have free access to all the patients for purposes of physical examination, laboratory investigations, the administration of medication, and a variety of nursing procedures.

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