1. Research: Thematic Analysis of staff views of guidance for working with borderline personality disorder in crisis and suicide prevention training. Kate Sloan Nurse Practitioner in Psychotherapy Scottish Personality Disorder Network

2. Thematic analysis of staff views Crisis presentations of patients with a diagnosis of borderline personality disorder Seeking help at points of emotional distress They in be seeking hospital admission At this point of crisis staff have to assess risk and act accordingly holding in mind the patient, systems we work within and more recently hold in mind how we influence HEAT targets

3. Guidance NICE 2009 Maintain a calm and non-threatening attitude Use empathy and open ended questions including validating statements to identify the onset and course of the current problems Seek to stimulate reflection about solutions Avoid minimising the persons stated reason for the crisis Refrain from offering solutions before receiving full clarification of the problems Seek alternatives to admission

4. STORM-Suicide Prevention Training Assessment Worksheet Crisis Management Worksheet Problem solving Worksheet Crisis Preventions Worksheet

6. Rational outline Patients experience high levels of distress resulting in seeking help as a result of self harm or when experiencing suicidality thoughts Patients may seek hospital admission to gain relief from distress which has created debate and controversy about its efficacy The prevalence within mental health population is reported at 50% not including co-morbid diagnosis In Scotland the ISD suggest recurrent admissions with a personality disorder diagnosis is 24.5% Local IHTT services have 14% with a diagnosis of EUPD

7. research questions What are the views of mental health practitioners who work within secondary care services that respond to crisis presentations, on both the practice guidelines and suicide prevention training outlined within the literature for patients diagnosed with EUPD What other interventions are utilised by mental health practitioners that are not included within the data collection tool and the rational for the interventions Does the guidelines within the literature support practitioners when seeking alternatives to admission How do the guidelines and training inform local practice guidelines

8. Methodology Qualitative- understanding the views and perceptions of the subjects Subject group - mental health staff who have to respond to crisis Data collection - focus group, capture the context engage a discussion Data collection tool - created a series of questions based on guidance and training Ethics - Sensitive clinical issue Data analysis - thematic analysis

9. Reliability and validity Reduce bias - how subjects are recruited, who facilitates the group, who transcribes Transparency - how data is managed Reduce researcher influence

11. The results Prevention of crisis The organisations role in managing crisis Maintaining the therapeutic alliance Managing risk of suicide - practitioners anxiety

12. Prevention of crisis Prevention Organisational systems adverse to therapeutic care Providing a consistent therapeutic experience Early intervention

13. Organisation Organisation role in managing crisis Problems within the system Do we have the resources

14. Maintaining the therapeutic alliance Therapeutic ruptures Development of knowledge and skills

15. Management of risk- practitioner anxiety Stopping suicide Doing the right thing

16. Collaborative joint crisis management plans Moran et al, 2010 Evidence based treatments Structured clinical management Theoretically informed model for daily clinical practice Agreed local guidance Access to specialist treatments

17. Strengths and limitations Did gather view and perspectives Not generalisable Fewer numbers than desired