Improving Access to Psychological Therapies for individuals with a Personality Disorder

1. Improving Access to Psychological Therapies for individuals with a Personality Disorder Providing services for the treatment seeking population Identifying strategies for engaging with the treatment reluctant population Working within the current economic position

2. What direct therapies does IMPART provide? • Fully programmatic and adherent Dialectical Behavioural Therapy • Cognitive Behavioural Therapy adapted for Personality Disorder • Mindfulness Based Cognitive Therapy • Mindfulness skills group • Managing Emotions group (in-patient) • Motivational Interviewing • Psychoeducational groups (anxiety, anger, healthy lifestyle) • Supporters (carers) evenings • Supporters (carers) DBT skills workshops

3. Improving Access means inclusivity IMPART works with: 8 of the 10 DSM-IV Personality Disorders* Older adults mild learning disabilities co-morbid substance abuse high risk * The clinical and business case for ASPD has been developed and is being discussed with leadership and commissioners

4. Primary PD Diagnosis

5. IMPART Direct Provision 10.7 wte staff 2010 – 2011 1245 Open cases [13.1 wte]2011 – 2012 921 Open cases 6m of IAPT 177 new referrals accepted 374 discharged cases 602 open cases 22 – average caseload

6. Indirect provision • Training on working effectively with PD Mental Health Services Psychiatric Liaison and A&E staff Housing workers Social Services Child protection services Probation Magistrates GPs Health visitors

7. Improving Access needs robust pathways Mental Health Psychology Departments Primary Care GP Weekly Psychology Referrals Panels* Local Authority IMPART Criminal Justice Fewer assessments Reduced waiting times CAMHS

8. Engaging with the treatment reluctant population In-patient IMPART Therapist assessments facilitating pathways to community treatment motivational enhancement psychoeducation and coping skills staff support groups ward based DBT skills groups

9. Working within the current economic position Providing the case for redeployment of resources 2010-2011 660 less bed days 4 ISA returns Cost savings: £443,765 Mental Health Costs Return of OAT contracts Reduction in ISA placements Reduction in bed days Social Care Costs Increasing employment Stabilizing housing Reducing children in care 30% SU gained employment or education during treatment

10. Measuring Outcomes IAPT Dataset PHQ-9 IAPT employment status WSAS (Work and Social Adjustment) EQ-5D (Quality of Life) WEMWBS (Warwick-Edinburgh Mental Well Being Scale) SAPAS (Standardized Assessment of Personality) Rates of self harm and suicide attempts Service utilization IMPART dataset SCID I and II Staxi (Speilberger Anger Scale) Christo (modified drug/alcohol) Treatment history (one year)

14. Challenges faced by IMPART Demands to see individuals with ASPD Care coordination – pressures on the system Requests for more training /consultation/supervision Continual restructuring – disrupted care pathways Managing a wait list – high risk clients

15. Key Deliverables • psychological therapy – across PDs • training package - ‘Recognizing and Working with PD’ • Handbook - ‘Setting up an IMPART’ • Consultation service for Trusts developing IAPT SMI (PD) services • Increasing access for difficult to engage population • South Asians • Mothers with BPD • High comorbidity

16. IMPART Open Day Tuesday 9th April, 2013 9:30am-4:30pm Ford Sports Centre, Aldborough Rd S, Ilford, Essex IG3 8HG - near Newbury Park Tube Station RSVP – john.liverpool@nelft.nhs.uk; 0300 555 1213

17. I want to live, I want to die. A silent tear, I need to cry. A pain so deep, so ragged and raw, it feels like an open infected sore. Help is at hand, it is there for you. Learn to trust, and let it through, to have a future free from pain, and a life worth living once again. I need you IMPART and the group. The things you teach are starting to root into little buds, starting to shoot. Soon a tree I will see, and future on the horizon of where I want to be. JM 2012