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 September PD service proposal

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

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

Remit of the service Education Supervision Consultation

Education Leanne Gregory Clinical psychologist in training

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

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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 tailored to the needs of specific services.

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.

AIM: To improve services for those with PD by meeting the training needs of NHS, voluntary and private sector employees in D & G TAILORING: 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 Lecture-type overview Considering attitudes about PD Group work Group work -case vignette -case vignette from various view points

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

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

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

ContentDeliveryInteraction “I think it is relevant to all professions and others involved with BPD as it covered attitudes” “Content encouraged different discussion from different disciplines” “Has provided me with knowledge to work in a positive manner” “Relevant and put BPD into a modern context. Challenged my thinking” “The questions challenged your pre-conceived ideas and judgements” “Liked the factual information, would have liked more in-depth” “Easy to listen” “Very well presented and easily related to practice. Great to hear someone talk that is enthusiastic and positive and obviously knows subject inside out” “I liked the way it was delivered – easy to follow and remember info” “Relaxed delivery of information” “The pace was at the right speed. Facilitators made the training very “user friendly” and amusing at times. Not too complex – no jargon” “Down to earth and honest” “Points of view were heard from all disciplines” “Very interactive and plenty of opportunity for questions and discussion” “Felt very interactive even during presentation, plenty of opportunity for discussion. Group discussion very interesting, good balance between delivering information and discussion” “Nice to be with other professionals and listen to their experiences” “Very informative and interesting, like the interactive part”

9. The learning activities were at an appropriate level for me to understand “Would have liked more factual information” 16. This training is best delivered to a multidisciplinary group “May be beneficial to involve people with BPD and carers also” 17. What did you not like about the training? “More focus/round up from discussion, once out of character from the professions perspective” Additional comments/feedback “It would be great to have made it a full day with further focus on treatments available and how they can be implemented multi professionally. Focus on change being possible for people”

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

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

...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?

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

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, 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), 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,