Royal College of Psychiatrists in Scotland Short Life Working Group on Personality Disorders Andy Williams Consultant Psychiatrist in Psychotherapy, Personality Disorder and Homelessness Team, NHS GG&C

What is the working group for? Describe current state of play in Scotland Services for people with PD diagnosis, at all levels What training models are there? Produce a document from the college drawing on evidence and existing guidelines describing good practice Highlight the issue Within and between professional groups - Politically Publically

Why another document? PD – No longer a diagnosis of exclusion 2002 11 community pilot schemes NICE guidelines 2009 Meeting the challenge – making a difference 2014 Personality disorder in Scotland: demanding patients or deserving people? 2004 Integrated Care Pathways 2007 NHS QIS Matrix - a guide to deliver evidence-based psychological therapies in Scotland (revised 2015)

We have all these documents and guidelines to say what we should be doing; So….. Why are we still not doing it well?

Can we do something that adds something? How does current guidance fit with Scotland? What different views are there? How can these be bridged? Can we think across all PD diagnoses? How can guidance be relevant across organisations? Those who utilise services and their families Health Social work Police Third sector

Can we learn from other campaigns?

ADHD IN ADULTS - GOOD PRACTICE GUIDELINES Royal College of Psychiatrists in Scotland – May 2016 To provide psychiatrists with practical, evidence based guidance in managing adults with ADHD in mental health settings. To provide those involved in designing mental health services in Scotland a consensus view on how best to meet the needs of adults with ADHD. This guidance draws on evidence summarised in established documents including the NICE clinical guidelines

Maternal and early years’ mental health: a clinical and public mental health priority To promote education and awareness To campaign for service development in order to ensure the best possible mental health for women, their infants and families 2-year campaign to raise awareness, promote inter-agency working, identify areas of best clinical practice and break down barriers to effective care

Who is in our PD working group? SLWG Faculties RCPsych Experts by Experience MWC Academic Nursing Psychology Police AHPs PD Network

What have we done?

Scottish PD Service Survey Darryl O’Brien & Lorna Harris Based on the National Institute for Mental Health in England document ‘Personality Disorder: No longer a diagnosis of exclusion’ 2002 Services should be “Expert led” MDT, (multidisciplinary teams) Services should work on a hub and spoke model Offer specialist interventions along a bio-psycho-social approach Offer training and consultation Support the development of self help networks Manage risk with forensic services especially focusing on offending behaviour

Scottish PD Service Survey - what will it ask? What PD services currently exist across Scotland? How are these services organised and what is the extent to which they are integrated with general adult psychiatric services? What interventions do these services offer? What resources are available? To what extent are service users and carers involved in the planning and delivery of services? Are clinicians actively supported by health boards and managers to manage the risks?

Percentage of trusts with PD services in England   2002 2015 Trusts with Dedicated PD Services 17% 84% Trusts with Generic PD Services 40% 91% Trusts with No service for individuals with PD diagnosis 28% 9%

Scottish Personality Disorder Service Mapping Survey 2016 Repeat of English survey in Scotland 2016 10/14 Health boards responded plus Ayr Clinic 73% of Health Boards Representing 80% of population Only 2/10 boards identified specialist service for people with PD (one other board identified consultation/ teaching/ SV service) All other boards provide through generic mental health services 73% of health boards DO NOT have a designated lead for personality disorder

Percentage of trusts with PD services  England 2002 2015 Trusts with Dedicated PD Services 17% 84% Trusts with Generic PD Services 40% 91% Trusts with No service for individuals with PD diagnosis   28% 9% Scotland 2016 20% 100% 0%

What else are we doing? Scottish Government cross-party working group, 27th Sept 2016 Dr Tim Agnew, NHS Highland, Karen Addie, RCPsych and Expert by Experience Blog on RCPsychiS Website: Raising awareness; Raising expectations; Raising hope Meetings 

More help needed for neglected personality disorders, says psychiatrist 03/01/2017 What it feels like to… have borderline personality disorder 04/03/2017

How far have we got? A lot of talking Identifying current documents/ good practice guidelines Define principles which should underpin good care at all levels TRAINING survey Looking at interfaces Child and adolescent into adult services Police/ health interface How information and good practice is shared across interfaces

Discussions from last SPDN Day In your experience of care, what has gone well? Developing consistency of approach eg ICPs/ Co- location of services/ Shared formulation Staff training Availability of psychological therapies Communication within and between services Giving clear diagnosis and developing treatment plan

In your experience of care, what has not gone well? Inconsistent approach eg different teams with different approaches Not sharing diagnosis with patient Not enough specialist services/ Waiting times for specialist services/ postcode lottery Lack of training for staff Stigma – different attitudes between staff groups Lack of resources

Suggestions for change? Consistency across services/Link up better with voluntary sector / SW Clear strategy and leadership Education for staff Education for patients Can condition be re-named and re-framed?/Change PERCEPTION of PD amongst gen public, Health services, including within psychiatry

What are the PRINCIPLES for providing better services? Consistency Communication between services Respect Training for staff Reflective practice Compassion Long term approach – accept slow pace of change Hope Challenge stigma/ negative attitudes Patient involvement/ inclusion

What are the challenges of implementing change in services? Human politics: tensions between therapy modalities (egDBT/MBT) and professional groups (psychology/psychiatry) Lack of resources Lack of time to implement good care Institutional and individual resistance to change Staff attitudes/ stigma Lack of leadership/ vision Difficulty implementing a general approach that all staff groups sign up to Lack of knowledge/ education re PD

2016 SPDN Day – what you wrote….. Contribute to our discussions today Feed back information on training Post your 3 words 