Dr John D McGinley: Psychology Director The State Hospitals Board For Scotland BPS Representative Forensic Network Board Professional Governance Panel of BPS UNDERSTANDING PERSONALITY DISORDER Behind the label of personality disorder there is a personality - Behind which is a person Diagnosis is characterised by confusion and lack of agreement. Where understanding is required, fear has emerged. Heather Castillo 2003

MH (Care and Treatment) (S) Act Mental disorder mental illness personality disorder learning disability 2.Medical treatment prevent worsening alleviate symptoms available 3.Significant risk to person or safety of others Compulsion necessary 5.Impairment of ability to make decisions about treatment (civil application only)

Personality Disorder Assessment Clarify diagnosis and comorbidity Clarify diagnosis and comorbidity Identify treatment needs and care planning Identify treatment needs and care planning Formulation of person’s profile Formulation of person’s profile Functional links with extremes of behaviour: dangerousness and criminality Functional links with extremes of behaviour: dangerousness and criminality Justification for pathways – criminal justice and mental health disposals Justification for pathways – criminal justice and mental health disposals Professional governance: ethical: audited: accredited: training: supervision: research Professional governance: ethical: audited: accredited: training: supervision: research

Wellbeing, Recovery and Rehabilitation Mental health Physical health Intellectual development Emotional and Spiritual development Citizenship: Rights, responsibilities and risks Person Care &Treatment in Forensic Settings

FORENSIC MENTAL HEALTH SERVICES MANAGED CARE NETWORK Care Standard 2 Organisations will have in place an infrastructure that delivers a range of generic and specialist treatments, and interventions that supports persons’ recovery, meets appropriate and social care needs of persons and fulfils the multidisciplinary treatment plans.

Understanding Personality Disorder People with personality disorders are treated as part of core services in mental health and forensic settings British Psychological Society Recommendation 1.

Understanding Personality Disorder British Psychological Society Recommendation 2. Service developments require the skills of clinical and forensic psychologists as clinical leaders

Understanding Personality Disorder British Psychological Society Recommendation 3 Staff in health and social care, education, criminal justice and voluntary sector require some level of training ranging from basic awareness to specialist training.

Understanding Personality Disorder British Psychological Society Recommendation 4 Structured assessments are essential to Treatment based on client’s needs

Understanding Personality Disorder British Psychological Society Recommendation 5 People with personality disorders need a multi - disciplinary and multi - agency service

Understanding Personality Disorder British Psychological Society Recommendation 6 People with personality disorders are treated as part of core services in mental health and forensic settings

Understanding Personality Disorder British Psychological Society Recommendation 7 Personality disorder is a problem that affects individuals across the lifecycle: to identify problems early, good communication between agencies is essential.

Understanding Personality Disorder British Psychological Society Recommendation 8 Clinical supervision is essential to maintain the emotional health of staff.

Understanding Personality Disorder British Psychological Society Recommendation 9 Urgent need for good quality research to inform service development.

Understanding Personality Disorder British Psychological Society Recommendation 10 The views of service users should inform service developments.

“no longer a diagnosis of exclusion” Person distressed by a personality disorder, whether primary or co-morbid condition, deserves consideration under mental health legislation for care and treatment When assessing the impact of a mental disorder, in all circumstances, all persons being assessed should be screened for personality disorder

Maladaptive and inflexible thinking: Schema Focused Therapy Poor integration of concept of self or others: Psychodynamic Therapy Attachment and emotional developments: Psychodynamic Therapy Reformulation in collaboration: Cognitive Analytic Therapy Skills training: Cognitive Beh. Therapy Therapeutic alliance and validation: Dialectical Beh. Therapy Motivational engagement: Cognitive Beh. Therapy Meeting person’s needs: Psychotherapeutic eclecticism

Higher attrition rates Poorer outcome More clever psychopath! Service “abusers” rather than “users” Untreatable Alienation: disliked patients Split the team! Challenge assumptions

Hope and developments Service users stories of hope New century re-birth of hope and raising expectations Hearing voices networks See me Proud of our experience Improving alliance with service users Improved assessment procedures Developing effective treatment paradigms Collaborative relationships – practitioner (the expert by training) and service user (the expert by experience)

Person Focus Needs led – idiopathic Holistic - context (family) Readiness - capacity – motivation Contract – engagement Complexity – formulation Feedback – understanding Wellbeing recovery - maintenance

Care pathways via National Networks Maintenance of treatment outcomes: national forensic network Integrate care pathways: national forensic network Standardised treatments through levels of security: national forensic network Standardise training and competencies: national forensic school Accreditation of treatments: national forensic network

Personality Disorders: Clinical Governance Guidelines Royal College of Psychiatrists Council Report CR 71, February 1999 It is the responsibility of psychiatrists to offer treatment where ever possible Improve teaching of psychiatry trainees Prioritise limited capacity of psychiatric services Develop preventive interventions in child and adolescent services Develop clearer definition of treatment goals Ensure multidisciplinary cooperation

Dr John D McGinley: Psychology Director The State Hospitals Board For Scotland BPS Representative Forensic Network Board Professional Governance Panel of BPS UNDERSTANDING PERSONALITY DISORDER Behind the label of personality disorder there is a personality - Behind which is a person Diagnosis is characterised by confusion and lack of agreement. Where understanding is required, fear has emerged. Heather Castillo 2003