PERSONALITY DISORDER Managed Regional Clinical within a Development Clinical within a Development Network Programme Network Programme

(i) What is a managed clinical network?  “A set of autonomous organisations come together to reach goals that no one organisation can reach separately.”  Leeds Mental Health Trust  Community Links  Touchstone  Survivor Led Crisis Service  M H Advocacy Group  West Yorkshire Probation

(ii) What does the MCN do? AIMS TO:  Work effectively with individuals who present with personality disorder, complexity of need and significant risk issues.  Support others across agencies to work effectively with people who present with personality disorder and who seek or require input from their services.

We offer:  CONSULTATION  ASSESSMENT AND FORMULATION  FUNCTIONAL GROUPWORK  CARE CO-ORDINATION  TRAINING

(iii) How do we do it? Theoretical framework of W John Livesley: “helping people to develop a coherent sense of self or identity, and the capacity for effective relationships”.

Applied General Therapeutic Strategies  Build and maintain a collaborative relationship  Maintain a consistent treatment process  Establish and maintain a validating treatment process  Build and maintain motivation for change.

Through Five Phases of Treatment  Safety and managing crises  Containment  Control and regulation  Exploration and change  Integration and synthesis

The Managed Clinical Network Narratives in crisis Working agreement User Led Crisis Service Probation Therapists Care Co-ordination Accommodation Occupational Therapist Health Support Workers Consultation Resource Pack Training MH Advocacy Voluntary Sector Consultation Phased assessment process Training Consultation Shared Care protocols Functional Groupwork Programme Clinical Supervision Psychological thinking Training The Allotment and engagement strategies Quarterly Forum Occupation and Social Inclusion service User focussed conference Involvement group newsletter

(iv) What have we learned?  All community mental health teams refer, and on average each clinician has 5 on caseload with personality disorder  66% of referrals are female  Referrers’ perception of need differs for males and females  People offered assessment complete the process and value autobiographical narrative as outcome  Staff in other services are working well, but require support to undertake the work  Consultation and training have been well received  Commissioners are supportive of the MCN model and its impact upon out of area placements.

Within a Regional Development Programme? Policy Guidance Capability Framework DSPDForensic Pilots High Support Hostels Community Pilots Regional Training InvolvementNSCAG funds Capacity Plans LIT Autumn Assessments

SUMMARY OF YORKSHIRE PROGRAMME – PERSONALITY DISORDER 2007 SERVICES  Independent secure/non-secure  Medium secure assessment/treatment  Clinical pathway/gatekeeping  Women’s High Support  Managed Clinical Network  Day Therapeutic Community/Functional Groupwork

1 Development of Clinical Services 2 Development of evaluation of effectiveness and impact 3 Development of core service standards 4 Development of commissioning arrangements 5 Developing meaningful user involvement 6 Workforce skills development 7 Managing the mainstream – IMPACT, CHANGE 8 Multi-agency Strategy