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The Emotional Rollercoaster The setting up of a service. The Dumfries and Galloway Borderline Personality Disorder Service Dr Esther Mackenzie Leanne Gregory. The story so far. A long time age in a health board far far away... Personality disorder working group

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the emotional rollercoaster the setting up of a service
The Emotional RollercoasterThe setting up of a service

The Dumfries and Galloway Borderline Personality Disorder Service

Dr Esther Mackenzie

Leanne Gregory

the story so far
The story so far

A long time age in a health board far far away...

Personality disorder working group

September 2010 - PD service proposal

d g borderline personality disorder service
D&G Borderline Personality Disorder Service
  • What we don’t have:
    • Money!
  • What we do have:
    • 4 staff 1 day a week
    • Support from management
    • Some admin support
    • Lots of enthusiasm
    • A filing cabinet drawer
service model
Service model
  • Treatment as usual – the gold standard
  • “Bottom up” model
  • No specialist therapy
remit of the service
Remit of the service
  • Education
  • Supervision
  • Consultation
education
Education
  • Leanne Gregory
  • Clinical psychologist in training
service provision education and training
Service provision: Education and training

National Institute for Mental Health in England (NIMHE, 2003) –

Clinicians can be reluctant to work with people with PD:

Feel lacking in skills

Need training

Need resources for treatment

slide9

Westwood and Baker (2010) – further training and supervision needed to improve relationships between staff and service users.

D & G – Lack of training perceived as one of

the biggest challenges in work. 86%

interested in receiving training.

NIMHE (2003) – training

should be team focussed

and tailoredto the needs

of specific services.

slide10

Mental health nurses display

significantly higher levels of social distance when it comes to

services users with a BPD

diagnosis compared to those

with other mental health

difficulties (Westwood & Baker,

2010).

Service users with a BPD diagnosis attracted more negative responses from staff than those with a diagnosis of depression or schizophrenia (Markham et al., 2003).

Positive therapeutic relationships are well recognised to be associated with positive outcomes for services users.

Therefore, staff training which challenges negative attitudes and encourages consistent and positive relationships may have a significant impact on services user outcome.

slide11

AIM: To improve services for those with PD by meeting the training needs of NHS, voluntary and private sector employees in D & GTAILORING: Use various training methods to inform about PD in general, but also to stimulate discussion about:- Staff experiences of PD- Attitudes towards services users with a PD- Difficulties for people with PD when using services- Considering what can be done to improve services

Group work

-case vignette

from various

view points

Lecture-type overview

Considering attitudes

about PD

slide12
59 people trained so far

Support workers

Nursing

Occupational therapy

Social work

Addictions counsellor

Inpatient staff

slide14

1 = Strongly disagree

2 = Disagree

3 = Don’t know

4 = Agree

5 = Strongly Agree

slide15

Multidisciplinary cohort

Trainers helpful and responsive

Learning activities and content stimulating

97% of additional comments positive

3% offered suggestion of small changes

consultation and supervision
Consultation and Supervision
  • Invited in by teams
  • Can organise meetings
  • Provide a more objective perspective
  • Help teams think and reflect about what is going on
  • Provide tailored advice and support regarding management of clients
  • Easily understandable and accessible format
the highs
The highs...
  • Some of the staff
  • The teams ongoing enthusiasm
  • Seeing the improvement in some of the clients
  • Being asked to get involved
  • Hearts and minds
and the lows
...and the lows.
  • Some of the staff
  • Realising how much there is to do
  • How hard it is changing people’s attitudes
  • Deficiencies of the service
  • Hearts and minds?
the future
The future?
  • Supervision groups
  • More education
  • Service user and carer groups
  • Therapy
  • What else?
    • Help us decide!
references
References

Bowers, L., Carr-Walker, P., Allan, T., et al (2006). Attitude to personality disorder among prison officers working in a dangerous and sever personality disorder unit. International Journal of Law and Psychiatry, 29, 333-342.

Markham, D. & Trower, P. (2003). The effects of the psychiatric label ‘borderline personality disorder’ on nursing staff’s perceptions and causal attributions for challenging behaviours.  British Journal of Clinical Psychology, 42(3), 243-256.

National Institute for Mental Health in England (2003). Personality disorder: No longer a diagnosis of exclusion policy implementation: Guidance for the development of services for people with personality disorder.Department of Health

Skachill, M. & Jenkins, C. (2008).  Questionnaire on training needs and interest in personality disorder. Unpublished manuscript, NHS Dumfries and Galloway.

Westwood, L. & Baker, J. (2010). Attitudes and perceptions of mental health nurses towards borderline personality disorder clients in acute mental health settings: a review of the literature.  Journal of Psychiatric and Mental Health Nursing, 17, 657-662.