2. DSM-5 diagnostic criteria for borderline personality disorder (APA, 2013) A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1 – Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5 2 – A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 3 – Identity disturbance: marked and persistently unstable self-image or sense of self 4 – Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5 5 – Recurrent suicidal behaviour, gestures or threats or self-mutilating behaviour 6 – Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days) 7 – Chronic feelings of emptiness 8 – Inappropriate intense anger or difficulty controlling anger, (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9 – Transient, stress related paranoid ideation or severe dissociative symptoms. Note: DSM-5 diagnoses as ‘borderline personality disorder‘ ICD-10 diagnoses as ‘emotionally unstable personality disorder‘. MBT developed using DSM criteria.

3.  4 Wards within a Unit  28 Beds per Ward  Mixed Sex  Patients aged 18 – 65  Also 14 – 18 year olds in one ward  Staff on Shift Patterns  An accident and emergency for mental health  A melting pot of diagnoses and disorders

4.  Evidence-based and developed Specifically for BPD  Mentalizing is how we implicitly and explicitly interpret the actions of oneself and others  Empathy as a foundation  The Not Knowing Stance  Provide Alternative Perspectives  Restrained Imagination - Aims to encourage patients and staff to see themselves from the outside, others from the inside  Common sense view of the mind  Cost-effective

5.  BPD accounts for estimated 20% of psychiatric inpatients  Associations with frequent and lengthy admissions  BPD carries a diagnostic baggage and a negative staff perception  No studies on staff perceptions of MBT  MBT studies limited to specialised settings  MBT Skills Training is a new and compact two day workshop

6.  Ethical and R&D approval  Purposive sampling of staff nurses, across 4 acute mental health wards, who had completed MBT Skills Training  50% participation – 9 from 18  2 x Focus Groups with a neutral facilitator  Semi-structured topic guide  Thematic analysis – 3 cycles of coding

7.  Staff Perceptions on BPD Inpatient Care  Impact on Staff  Impact of MBT Skills Training  Clinical Supervision  Changed Perceptions of BPD

8.  Inpatient Environment  BPD Behaviour on a Ward  BPD Effect on the Ward  Admission Pattern  Ability to Work Effectively with BPD

9.  Personal Distress  Uncomfortable Emotions  Negative Perceptions

10.  Empathy  Use of MBT  Changes in Staff  Benefits of MBT  MBT Limits

11.  Attendance  Benefits of Group CS  One to One Clinical Supervision  Informal Clinical supervision

12.  Yes!  An understanding of reasons behind behaviour  Awareness of the impact of feelings of abandonment  More empathy towards people with BPD

13.  BPD is extremely challenging for staff nurses in acute mental health  Staff experience significant personal distress  MBT gives staff a ‘secret weapon’  Clinical Supervision provides support, reassurance and ‘ammunition’  Staff had a better understanding of BPD and more empathy as a result

14.  All staff nurses attend MBT Skills Training  MBT is offered as part of the pre-registration nursing programme  Group Clinical Supervision is offered weekly and within protected time  Further research into MBT skills training and inpatient care of BPD

16. Any Questions? daniel.warrender@nhs.net