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Dr Ian Barkataki (Clinical lead/Clinical Psychologist)

Working with students with Personality Disorder and Risk: Developing the Student Health Emotion Regulation Pathway (SHERPA). Dr Ian Barkataki (Clinical lead/Clinical Psychologist) Dr Dominique Thompson (Director of Service/ GP) Students’ Health Service. Overview of Session. Background

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Dr Ian Barkataki (Clinical lead/Clinical Psychologist)

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  1. Working with students with Personality Disorder and Risk: Developing the Student Health Emotion Regulation Pathway (SHERPA) Dr Ian Barkataki (Clinical lead/Clinical Psychologist) Dr Dominique Thompson (Director of Service/ GP) Students’ Health Service Student Health Association Conference

  2. Overview of Session • Background • The Student Health Emotion Regulation Pathway (SHERPA) • Evaluation • GP Experience • Questions and discussion

  3. Context Ongoing mental health crisis in young people Observing shift towards increased mental health need, along with increasing complexity Increased pressure on NHS mental health services and higher threshold for entry Student Health Service GPs holding more responsibility, greater risk, and feeling limited in degree of input

  4. Students with Complex Psychological Needs Subgroup of students who present with mental health problems along with characteristics of: • Personality Disorder Diagnosis -Borderline/ Emotionally Unstable subtype • Self-harm • Suicidal ideation • Impulsivity and other risks

  5. Challenges for GPs working with this group in Student Health settings Time limitations Feeling unskilled Few widely regarded effective interventions Resource demand of this client group Lack of support and close liaison

  6. The Student Health Emotion Regulation Pathway (SHERPA)

  7. Designing the service Identifying needs of stakeholders Scoping existing practice and resource Consulting guidelines for best practice Putting together a realistic and achievable pathway Ensuring the effectiveness of the pathway

  8. Service Philosophy Evidence based (as much as possible) Continual improvement and evaluation Formulation driven rather than diagnostic Continuity of care and containment Highly trained and adaptable personnel motivated to work with this patient group Needs of the team are as important as that of the patients

  9. Assessment and Formulation • Risk and Impulsivity • Prior treatment • Medication and Physical Health • Goals of Treatment • Care Plan • Referral problem • Problem duration • Early family history • Interpersonal patterns • Current situation Formulation: explains the origins, underlying beliefs and reinforcing patterns of problems. Focus on maintenance of difficulties and other contributory factors.

  10. Emotion Regulation Skills Training Class Weekly psycho-educational class based on CBT and DBT principles Focus on learning skills and practising The class runs for 10 sessions across a university term Allows the facilitators to gauge motivation to engage in treatment, suitability to engage in group treatment and to monitor ongoing risk

  11. MentalisationPsychotherapy Group Weekly intervention for duration of academic year (30 weeks) Maximum of 8 patients Mentalisation based framework Co-facilitated by a member of the Student Counselling Service For participants, the group is a weekly 90 minute commitment Intake referred from the ER Group and Individual work

  12. Individual Psychological Intervention Formulation driven and tailored to the individual Approach draws from CBT, DBT and Schema Focussed approaches No specified time limit Flexible to the needs of the student or presenting risk

  13. Consultation and GP support Direct consultation with individual GPs Monthly GP peer support group, facilitated by SHERPA team and CMHT Psychiatrist Some provision for joint appointments with GPs and patients Liaison work with other services Discussion about readiness to engage with pathway

  14. Evaluation Quantitative measures of symptomatology Qualitative patient feedback and satisfaction. External objective indicators: GP use, A&E visits, suicide attempts, self harm episodes and attrition. GP Satisfaction with pathway.

  15. Evaluation

  16. Evaluation- Emotion Regulation Skills Class

  17. Emotion Regulation Class Data Statistically significant difference in the scores for DERS (M=1.68, SD=0.32) t(31)=4.23, p = <0.001 No statistically significant difference in the scores for Core, but move toward lower threshold CORE 10 clinical ranges: 0-10= Non clinical, 10-15= Mild, 15-20= Moderate, 20-25= Moderate to Severe, 25+ = Severe

  18. Individual Therapy: CORE 10 and DERS Scores CORE 10 clinical ranges: 0-10= Non clinical, 10-15= Mild 15-20= Moderate, 20-25= Moderate to Severe 25+ = Severe

  19. GP Experience

  20. Future Developments Team expansion Development of additional capability Integration with local Personality Disorder services Ancillary projects/ Grant funding

  21. Questions and Discussion

  22. Thank you for listening Ian’s email: ian.barkataki@gp-l81133.nhs.uk Dom’s email: dominique.thompson@me.com Twitter; @DrdomThompson Students' Health Service, University of Bristol Hampton House Health Centre Cotham, Bristol, BS6 6AU

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