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 2010 - 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
v
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
Group work
-case vignette
from various
view points
Lecture-type
overview
Considering
attitudes
about PD
59 people trained so far
Support workers
Nursing
Occupational therapy
Social work
Addictions counsellor
Inpatient staff
This training is best delivered to a multidisciplinary
group
I was guided toward further reading & research of
value
1 = Strongly disagree
2 = Disagree
The trainer(s) were helpful and responsive
3 = Don’t know
I feel I have a better understanding or PD now
What I have learned will be of practical use to me in
my work
The materials provided were easy to use and
understand
4 = Agree
5 = Strongly Agree
I understood the language and terminology used
The learning activities were at al appropriate level
for me to understand
Mode
The learning activities were stimulating & engaging
Mean
The content was interesting & engaging
The content was relevant to my profession
The content was too complex
The content was too simple
The content was clearing linked to learning
objectives
The learning objectives were not met
I understood the learning objectives
0
1
2
3
4
5
6
Multidisciplinary
cohort
Trainers helpful
and responsive
97% of additional
comments positive
3% offered suggestion of
small changes
Learning activities
and content
stimulating
Content
“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”
Delivery
“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”
“Relevant and put BPD into a
modern context. Challenged my
thinking”
“Relaxed delivery of information”
“The questions challenged your
pre-conceived ideas and
judgements”
“The pace was at the right
speed. Facilitators made the
training very “user friendly” and
amusing at times. Not too
complex – no jargon”
“Liked the factual information,
would have liked more in-depth”
“Down to earth and honest”
Interaction
“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
•
•
•
•
•
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?
...and the lows.
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, 333342.
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.