The Emotional Rollercoaster The setting up of a service
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The Emotional Rollercoaster The setting up of a service The Dumfries and Galloway Borderline Personality Disorder Service Dr Esther Mackenzie Leanne Gregory
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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 - PowerPoint PPT Presentation
Transcript of The Emotional Rollercoaster The setting up of a service
The Emotional RollercoasterThe setting up of a service
The Dumfries and Galloway Borderline Personality Disorder
Service
Dr Esther MackenzieLeanne Gregory
The story so far
A long time age in a health board far far away...
Personality disorder working groupSeptember 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 skillsNeed trainingNeed 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 thosewith 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 -case vignette from various view points
59 people trained so far
Support workersNursingOccupational therapySocial workAddictions counsellorInpatient staff
I understood the learning objectives
The learning objectives were not met
The content was clearing linked to learning objectives
The content was too simple
The content was too complex
The content was relevant to my profession
The content was interesting & engaging
The learning activities were stimulating & engaging
The learning activities were at al appropriate level for me to understand
I understood the language and terminology used
The materials provided were easy to use and understand
What I have learned will be of practical use to me in my work
I feel I have a better understanding or PD now
The trainer(s) were helpful and responsive
I was guided toward further reading & research of value
This training is best delivered to a multidisciplinary group
0 1 2 3 4 5 6
ModeMean
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
Content Delivery Interaction
“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!
ReferencesBowers, 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, 333-342.
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.
