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The Emotional Rollercoaster The setting up of a service

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

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  1. The Emotional RollercoasterThe setting up of a service The Dumfries and Galloway Borderline Personality Disorder Service Dr Esther Mackenzie Leanne Gregory

  2. The story so far A long time age in a health board far far away... Personality disorder working group September 2010 - PD service proposal

  3. 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

  4. Service model • Treatment as usual – the gold standard • “Bottom up” model • No specialist therapy

  5. Remit of the service • Education • Supervision • Consultation

  6. Education • Leanne Gregory • Clinical psychologist in training

  7. 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

  8. v

  9. 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.

  10. 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.

  11. 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

  12. 59 people trained so far Support workers Nursing Occupational therapy Social work Addictions counsellor Inpatient staff

  13. 1 = Strongly disagree 2 = Disagree 3 = Don’t know 4 = Agree 5 = Strongly Agree

  14. Multidisciplinary cohort Trainers helpful and responsive Learning activities and content stimulating 97% of additional comments positive 3% offered suggestion of small changes

  15. 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

  16. 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

  17. ...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?

  18. The future? • Supervision groups • More education • Service user and carer groups • Therapy • What else? • Help us decide!

  19. 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. 

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