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 September 2010 - PD service proposal 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 • Treatment as usual – the gold standard • “Bottom up” model • No specialist therapy Remit of the service • Education • Supervision • Consultation Education • Leanne Gregory • Clinical psychologist in 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 v 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 tailored to the needs of specific services. 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. AIM: To improve services for those with PD by meeting the training needs of NHS, voluntary and private sector employees in D &G TAILORING: 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 59 people trained so far Support workers Nursing Occupational therapy Social work Addictions counsellor Inpatient staff This training is best delivered to a multidisciplinary group I was guided toward further reading & research of value 1 = Strongly disagree 2 = Disagree The trainer(s) were helpful and responsive 3 = Don’t know I feel I have a better understanding or PD now What I have learned will be of practical use to me in my work The materials provided were easy to use and understand 4 = Agree 5 = Strongly Agree I understood the language and terminology used The learning activities were at al appropriate level for me to understand Mode The learning activities were stimulating & engaging Mean The content was interesting & engaging The content was relevant to my profession The content was too complex The content was too simple The content was clearing linked to learning objectives The learning objectives were not met I understood the learning objectives 0 1 2 3 4 5 6 Multidisciplinary cohort Trainers helpful and responsive 97% of additional comments positive 3% offered suggestion of small changes Learning activities and content stimulating Content “I think it is relevant to all professions and others involved with BPD as it covered attitudes” “Content encouraged different discussion from different disciplines” “Has provided me with knowledge to work in a positive manner” Delivery “Easy to listen” “Very well presented and easily related to practice. Great to hear someone talk that is enthusiastic and positive and obviously knows subject inside out” “I liked the way it was delivered – easy to follow and remember info” “Relevant and put BPD into a modern context. Challenged my thinking” “Relaxed delivery of information” “The questions challenged your pre-conceived ideas and judgements” “The pace was at the right speed. Facilitators made the training very “user friendly” and amusing at times. Not too complex – no jargon” “Liked the factual information, would have liked more in-depth” “Down to earth and honest” Interaction “Points of view were heard from all disciplines” “Very interactive and plenty of opportunity for questions and discussion” “Felt very interactive even during presentation, plenty of opportunity for discussion. Group discussion very interesting, good balance between delivering information and discussion” “Nice to be with other professionals and listen to their experiences” “Very informative and interesting, like the interactive part” 9. The learning activities were at an appropriate level for me to understand “Would have liked more factual information” 16. This training is best delivered to a multidisciplinary group “May be beneficial to involve people with BPD and carers also” 17. What did you not like about the training? “More focus/round up from discussion, once out of character from the professions perspective” Additional comments/feedback “It would be great to have made it a full day with further focus on treatments available and how they can be implemented multi professionally. Focus on change being possible for people” 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... • • • • • Some of the staff The teams ongoing enthusiasm Seeing the improvement in some of the clients Being asked to get involved Hearts and minds • • • • • 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? ...and the lows. The future? • • • • • Supervision groups More education Service user and carer groups Therapy What else? – Help us decide! 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, 333342. 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.