1. 3 July 2017
Working with students with Personality Disorder and Risk: Developing the Student Health Emotion Regulation Pathway (SHERPA)
Dr Ian Barkataki (Clinical lead/Clinical Psychologist)
Dr Dominique Thompson (Director of Service/ GP)
Students’ Health Service
Student Health Association Conference

2. Overview of Session Background
The Student Health Emotion Regulation Pathway (SHERPA)
Evaluation
GP Experience
Questions and discussion

3. Context
Ongoing mental health crisis in young people Observing shift towards increased mental health need, along with increasing complexity Increased pressure on NHS mental health services and higher threshold for entry Student Health Service GPs holding more responsibility, greater risk, and feeling limited in degree of input

4. Students with Complex Psychological Needs
Subgroup of students who present with mental health problems along with characteristics of:
Personality Disorder Diagnosis -Borderline/ Emotionally Unstable subtype
Self-harm
Suicidal ideation
Impulsivity and other risks

5. Challenges for GPs working with this group in Student Health settings
Time limitations Feeling unskilled Few widely regarded effective interventions Resource demand of this client group Lack of support and close liaison

6. The Student Health Emotion Regulation Pathway (SHERPA)

7. Designing the service
Identifying needs of stakeholders Scoping existing practice and resource Consulting guidelines for best practice Putting together a realistic and achievable pathway Ensuring the effectiveness of the pathway

8. Service Philosophy
Evidence based (as much as possible) Continual improvement and evaluation Formulation driven rather than diagnostic Continuity of care and containment Highly trained and adaptable personnel motivated to work with this patient group Needs of the team are as important as that of the patients

10. Assessment and Formulation
Referral problem
Problem duration
Early family history
Interpersonal patterns
Current situation
Risk and Impulsivity
Prior treatment
Medication and Physical Health
Goals of Treatment
Care Plan
Formulation: explains the origins, underlying beliefs and reinforcing patterns of problems. Focus on maintenance of difficulties and other contributory factors.

11. Emotion Regulation Skills Training Class
Weekly psycho-educational class based on CBT and DBT principles
Focus on learning skills and practising
The class runs for 10 sessions across a university term
Allows the facilitators to gauge motivation to engage in treatment, suitability to engage in group treatment and to monitor ongoing risk

12. Mentalisation Psychotherapy Group
Weekly intervention for duration of academic year (30 weeks)
Maximum of 8 patients
Mentalisation based framework
Co-facilitated by a member of the Student Counselling Service
For participants, the group is a weekly 90 minute commitment
Intake referred from the ER Group and Individual work

13. Individual Psychological Intervention
Formulation driven and tailored to the individual
Approach draws from CBT, DBT and Schema Focussed approaches
No specified time limit
Flexible to the needs of the student or presenting risk

14. Consultation and GP support
Direct consultation with individual GPs
Monthly GP peer support group, facilitated by SHERPA team and CMHT Psychiatrist
Some provision for joint appointments with GPs and patients
Liaison work with other services
Discussion about readiness to engage with pathway

15. Evaluation Quantitative measures of symptomatology
Qualitative patient feedback and satisfaction.
External objective indicators: GP use, A&E visits, suicide attempts, self harm episodes and attrition.
GP Satisfaction with pathway.

16. Evaluation

17. Evaluation- Emotion Regulation Skills Class

18. Emotion Regulation Class Data
No statistically significant difference in the scores for Core, but move toward lower threshold
Statistically significant difference in the scores for DERS (M=1.68, SD=0.32) t(31)=4.23, p = <0.001
CORE 10 clinical ranges: 0-10= Non clinical, 10-15= Mild, 15-20= Moderate, 20-25= Moderate to Severe, 25+ = Severe

19. Individual Therapy: CORE 10 and DERS Scores
CORE 10 clinical ranges:
0-10= Non clinical, 10-15= Mild
15-20= Moderate, 20-25= Moderate to Severe 25+ = Severe

20. GP Experience

21. Future Developments Team expansion
Development of additional capability
Integration with local Personality Disorder services
Ancillary projects/ Grant funding

22. Questions and Discussion

23. Thank you for listening
Ian’s
Dom’s
Students' Health Service, University of Bristol
Hampton House Health Centre
Cotham, Bristol, BS6 6AU