1. 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

2. 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

3. 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)

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

5. 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

6. Can we learn from other campaigns?

7. 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

8. 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

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

10. What have we done?

11. 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

12. 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?

13. 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%

14. 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

15. 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%

17. 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 

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 2016 SPDN Day – what you wrote…..
Contribute to our discussions today
Feed back information on training
Post your 3 words 