The Diagnosis of Personality Disorder Issues of Diversity & Equality Henderson Hospital

1. The Diagnosis of Personality DisorderIssues of Diversity & EqualityHenderson Hospital Objectives • Examine the diagnosis of personality disorder and patient profile. • Review some evidence of specialist treatment among the ethnically diverse patient groups. • Examine the NIMHE Policy Guidance on services needs for Personality Disorder patients. • Encourage feedback from participants on the way forward

2. Structure of Work shop on Personality Disorder and issues of equality & diversity 1. What is Personality Disorder? 15mins • The diagnosis Prevalence Patient profile 2. Relevant research and recommendations: • “Ethnic diversity and equality of access to specialist therapeutic community treatment of severe personality disorder” (R.Geraghty & F.Warren Psych. Bulletin 2003,27:453-456 ) 15mins 3. NIMHE Policy Guidance on Personality Disorder (DoH) 15mins Henderson Services - Assessment, TC ,Training,Consultation, Research. PG Certificate on Working with patients with PD & PDTDG’s online learning 4. The Way Forward: Summary • Question and answers –Explore possible solutions to meeting the needs of diverse patients with PD 15mins

3. What is Personality Disorder? Group Task Discuss with a partner for five minutes: • What is personality disorder? • Who gets personality disorder? • How is personality disorder treated? Group feedback Answers on flip -chart

4. Definition of Personality Disorder ( ICD-10 ) world health organisation 1992: “A severe disturbance in the charactereological condition and behaviouraltendencies of the individual, usually involving several areas of thepersonality, and nearly always associated with considerable personal and social disruption.” DSM-IV (American psychiatric association 1994) “ An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”

5. Prevalence of Personality Disorder among Ethnic Groups • Paucity of studies. Prevalence of ethnic minority unknown • Blacks over represented in coercive psychiatric services & prison. (Fernando et al 1998) • For data: DOH (1999) Raleigh V. (2000) CRE fact sheet (1999) • Prison male population: 82% white & 72% black • Prison Female Population: 72%white &78% black (Moran )

6. Defining the difficulties of PD • Enduring patterns of dysfunction, of emotional distress and behaviour. • Thinking - (ways of perceiving and interpreting self, other people, events). • Feelings (the range, intensity, changeability, and appropriateness of emotional response). • Interpersonal functioning (ways of relating to others). • Impulse control (ability to react to and manage impulses appropriately (Host)

7. Sub –Categories of PD Cluster A: Odd Eccentric - Paranoid, Schizoid, Schizotypal Cluster B: Dramatic, emotional, - Histrionic, Narcissistic, borderline, antisocial Cluster C: Anxious, fearful - Avoidant, dependent, Obsessive compulsive

8. Possible explanation for ethnic differences • Biases of assessment and diagnosis • Correlation of indices of socioeconomic deprivation • Staff attitude and biases in making diagnosis • Lack of access to existing services due to bias in assessment tools, cultural stereotypes and research

9. A Patient Profile • Co-morbidity and multiple diagnosis • Poor sense of Boundaries • Homelessness • Problems with identity –gender – sexuality – selfhood • Feelings of emptiness, aloneness, rejection • Violence and offending behaviours • Self harm and suicidality • Addictive behaviours –alcohol, drugs, gambling, spending, risk taking • Eating problems • Revolving door admissions

10. NIHME Policy Guidance onPersonality Disorder Personality Disorder: No longer a diagnosis of Exclusion NHS www.nimhe.org.uk

11. Policy Implementation Guidance • Existing Services • Staff Selection, supervision, education and training • Specialist services –MDT, Residential and Day Units • Forensic Services – Personality Disorder Centres

12. Henderson Services and treatment of Personality Disorder • Henderson Hospital • Henderson Outreach Service • Consultancy Assessment Training Research • PG.Cert. “Working with PD patients • Personality Disorder Training Development Group – Online Learning Environment

13. The Way Forward

14. References Cochrane, R and Sashidharan, S (1996) ‘Mental health and ethnic minorities: review of literature and implications for services, in Centre for Reviews and Dissemination Report 5, Ethnicity and Health Reviews of Literature and Guidance for Purchasers in the Areas of Cardiovascular Disease, Mental Health and Haemoglobinopathies. NHS Centre for Reviews and Dissemination, York: University York, 105-26. Cooke, D J et al. (1998). Psychopathy Across Cultures in Cooke, D.J. et al, (eds). Psychopathy: Theory, Research and Implications for Society, 13-45 (1998). Kluwer Academic Publishers. Printed in the Netherlands. CRE Fact Sheet: Commission for Racial Equality Fact Sheet (1999). London. Fernando, S. Ndegwa. D. Wilson, M. (1998). Forensic Psychiatry, Race and Culture. Routledge: London and New York.

15. Marsella, A.J., and Kameoka V.A. (1989). Ethno cultural issues in the assessment of psychopathology. In S. Wesler (Ed.), Measuring Mental Illness: psychometric assessment for clinicians. Washington DC: American Psychiatric Press. • Sainsbury Centre for Mental health (2002) Breaking the Cycles of Fear - A review of the relationship between mental health services and the African-Caribbean community. • Department of Health (1999). A systematic review of research relating to the MHA 1983. London: Department of Health. •  Marsella, A.J., and Kameoka V.A. (1989). Ethno cultural issues in the assessment of psychopathology. In S. Wesler (Ed.), Measuring Mental Illness: psychometric assessment for clinicians. Washington DC: American Psychiatric Press. • Sainsbury Centre for Mental health (2002) Breaking the Cycles of Fear - A review of the relationship between mental health services and the African-Caribbean community. • Department of Health (1999). A systematic review of research relating to the MHA 1983. London: Department of Health.

16. Koffman J, Fulop N J, Pashley D & Coleman K (1997). ‘Ethnicity and use of acute psychiatry beds: one-day survey in North and South Thames Regions’. British Journal of Psychiatry 171, 238-241. • Parkman S., Davies S., Leese M., Phelan M. and Thornicroft G. (1997). ‘Ethnic differences in satisfaction with mental health services amongst representative people with psychosis in South London’. PriSM Study 4, British Journal of Psychiatry 171 (supplement 3), 260-264. • Raleigh V.S. (2000). ‘Mental Health in Black and Ethnic Minorities: An Epidemiological Perspective’ in Kaye, C. & Lingiah, T. (Eds) (2000) Race, Culture and Ethnicity in Secure Psychiatric Practice: Working with Difference. London: JKP.