The National Personality Disorder Development Programme

1. The National Personality Disorder Development Programme Personality: People and Pathology 2005 - 6

2. Two Government publicationsNational Institute for Mental Health for England (NIMHE)

3. Government money: community pilot services • Crumbs from the DSPD table • Personality disorder: the “DSPD” units • £128m • For a few hundred people • > £100,000 per case per year • Personality disorder: community programme • £18m • For ~5% of the population (3,000,000 people) • Equals £6.60 each case per year (or 33p per head of population) • Training: overall • £2m in 2004-5 • Divided equally between 8 NIMHE regional development centres • £250K for 14 MHTs PLUS all other agencies …does not go far

4. Requirements of the new pilot services • Deliberate variety of approaches • All involve many stakeholders • Working together to provide new type of service • Service users help in planning • Care pathways approach • Very strong control over finances & governance • Emphasis on evaluation, outcome & dissemination • Results in 2005-7

5. Location of the new pilot services • 2004-2007 • At least 1 per NIMHE region • Learning from diversity • 4 “big ones” • 4 new day TCs • 2 managed networks • 2 DBT-based • 2 predominantly SU-led • 1 “early intervention”

6. The Thames Valley new pilot services • 3 hubs – Reading, Oxford and Bucks • Various satellites • Numerous partners • 4 tier model • Working without county boundaries • TV-wide functions: recruitment, induction, training, staff support, evaluation, XBX input, awareness training, service advocacy

7. Government money: training • Major deficit of training in this area • Not solely the province of health • Not forensic • Pump-priming funding: £2m in 2004-5 • £250K for SE total

8. Four “network courses” in SE Kent: Maidstone base Thames Valley: Oxford base Hampshire and Isle of Wight: Southampton base Surrey & Sussex: Brighton base

9. Ten Essential Shared Capabilities • =update of CPF + mapping for WD • shift in culture in services towards Choice, person-centeredness and mental health promotion is a key imperative • were significant gaps in pre and post qualification training of all professional staff in their ability to deliver the MHNSF and the NHSP • Being rendered helpless rather than helped by service use • embedded in induction and continuing professional /practitioner development

10. Essential Shared Capabilities • Working in Partnership. • Respecting Diversity. • Practising Ethically. • Challenging Inequality. • Promoting Recovery. • Identifying People’s Needs and Strengths. • Providing Service User Centred Care. • Making a Difference. • Promoting Safety and Positive Risk Taking. • Personal Development and Learning.

11. What this course IS • Across different agencies • Suitable for all levels of experience • To build a network of interested practitioners • To become aware of how other people in other settings deal with what we call “PD” • Weaving strands together from different agencies • Visionary, holistic, provocative • To change attitudes and practice

12. What this course IS • Hearing a wide spread of theory relating to PD • Suitable for all levels of experience • To build a network of interested practitioners • To cascade awareness “wide and thin” • Hopefully be accreditable for recognised qualifications in the future • To change attitudes and practice

13. What this course IS NOT • A training in therapy • “Do it, tick the box, move on” • Just a series of lectures • Us spoon feeding you • An afternoon off

14. From different agencies MH Other health services Other statutory servicess Voluntaries …for sharing best practice From different locations Berkshire – with its 6 localities Oxfordshire Buckinghamshire … for support and help with snags Developing a network of “PD Agents”

15. AWARENESS TRAINING Different staff groups Geographical spread Agent’s agency Various formats With service user input Feedback SERVICE ADVOCACY NETWORKS In localities Involving all interested parties Putting case where needed Support from TV & NIMHE The tasks of “PD Agents”

16. mental health services Primary care A&E probation prisons 1 year PD network course police Voluntary organisations Social services housing

17. mental health services Qualification A&E probation Further training prisons 1 year PD network course PD agents police Voluntary organisations Social services housing

18. Feedback from year 1 Thames Valley • ‘A very human approach – I left feeling more sympathetic to clients.’ • ‘It felt less like “us versus them”’ • ‘A very useful, even inspiring, opening up of our thinking about ‘madness’ treatment, personal freedom and responsibility’. • ‘I learned a lot about working with PD in the work discussion groups’ • ‘A useful alternative to traditional care provision’ • ‘Inspiring’ • ‘Insight into others contact with clients helped in reducing feelings of isolation’

19. PD Treatment Facilities (few and far between) XBX pool

20. PD Treatment Facilities XBX pool Dynamic teams Input into course philosophy, structure and content mental health services Qualification Primary care A&E probation Further training prisons 1 year PD network course PD agents police Voluntary organisations Social services housing

21. PD Treatment Facilities Service advocacy XBX pool Dynamic teams Seminars, conferences, short courses, workshops, etc Input into course philosophy, structure and content mental health services Qualification Primary care A&E Awareness cascade probation Further training prisons 1 year PD network course PD agents police Voluntary organisations Social services housing

22. Development of new services MH managers PD Treatment Facilities commissoners Service advocacy Policymakers XBX pool Dynamic teams Seminars, conferences, short courses, workshops, etc Input into course philosophy, structure and content mental health services Qualification Primary care A&E Awareness cascade probation Further training prisons 1 year PD network course PD agents police Voluntary organisations Social services housing

23. Development of new services MH managers PD Treatment Facilities commissoners Service advocacy Policymakers XBX pool Dynamic teams Seminars, conferences, short courses, workshops, etc Input into course philosophy, structure and content mental health services mental health services A&E Qualification Primary care A&E housing Awareness cascade probation police Further training prisons 1 year PD network course probation PD agents police prisons Primary care Social services Voluntary organisations Voluntary organisations Social services Interested recruits housing

24. From care pathways to career pathways • So this develops a network of PD Agents • Who are professionals already employed in relevant services • So it’s all very well for them… • …but what about the XBXs?

25. Career Pathways Blue boxes = TVi county services Yellow boxes = TVi servonly; bright= employees) Grey boxes = Non-TVi services T4 (member of a county service next steps group) Other (having received recognised therapy outside TVi) Vol MT WTC (pre 2005 ex-member of Winterbourne TC with planned leaving at least 6 months previously) move-on group) TR Vol Int SA SA SA STARS membership (Support, Training and Recovery System) Vol Volunteer Ad Advertisment MT Meet the Team Int Interview Vol TR Therapist Reference PR Professional Reference NOTES: XSUs (or anyone beyond) can do training, service advocacy or other consultation alone or with either PD Agents or PD team staff. They can do supervision with PD Agents or PD team staff XSU (eX- Service User) SA Signed Agreement C Vol Contract AR (Associate Researcher) MT CQ Int Clinical Qualification C NOTES: “Contract” includes all normal NHS requirements such as CRB check, occupational health and job description Ad MT Other freelance training work etc PR Ad Int PR C Int Other qualifications for research work etc TR (Team Researcher)

26. Career Pathways (2) NOTES: XBXs (or anyone beyond) can co-facilitate Tier 1 and Tier 4 groups, and carers groups, with PD Agents or PD team staff. Participation in TVi Training, supervision six monthly individual reviews is required. Vol Volunteer Ad Advertisment MT Meet the Team Int Interview TR Therapist Reference XBX (eXpert By eXperience) PR Professional Reference SA Signed Agreement ATT (Assistant Team Therapist) C Contract Ad MT Int PR C CQ Vol Clinical Qualification Int Ad C CQ MT DW (Development Worker) Int CQ NOTES: “Contract” includes all normal NHS requirements such as CRB check, occupational health and job description PR C TT (Team Therapist) Other training for voluntary sector work etc Higher therapist posts etc Blue boxes = TVi county services Yellow boxes = TVi servonly; bright= employees) Grey boxes = Non-TVi services

27. Summary 3 special features of training model: • Ex-service (XBX) user development (dynamic teams & career pathways) • Awareness cascade (all areas and agencies) • Advocacy networks (grass roots: XBXs and clinicians)