the national personality disorder development programme

The National Personality Disorder Development

Programme

Personality: People and Pathology2005 - 6

Two Government publicationsNational Institute for Mental Health for England (NIMHE)

Government money: community pilot services

• Crumbs from the DSPD table• Personality disorder: the “DSPD” units

– £128m– For a few hundred people– > £100,000 per case per year

• Personality disorder: community programme– £18m– For ~5% of the population (3,000,000 people)– Equals £6.60 each case per year

(or 33p per head of population)

• Training: overall– £2m in 2004-5– Divided equally between 8 NIMHE regional development centres– £250K for 14 MHTs PLUS all other agencies …does not go far

Requirements of the new pilot services

• Deliberate variety of approaches

• All involve many stakeholders• Working together to provide

new type of service• Service users help in planning • Care pathways approach• Very strong control over

finances & governance• Emphasis on evaluation,

outcome & dissemination• Results in 2005-7

• 2004-2007 • At least 1 per NIMHE

region• Learning from diversity

– 4 “big ones”– 4 new day TCs– 2 managed networks– 2 DBT-based – 2 predominantly SU-led– 1 “early intervention”

Location of the new pilot services

• 3 hubs – Reading, Oxford and Bucks

• Various satellites• Numerous partners• 4 tier model• Working without

county boundaries• TV-wide functions:

recruitment, induction, training, staff support, evaluation, XBX input, awareness training, service advocacy

The Thames Valley new pilot services

• Major deficit of training in this area

• Not solely the province of health

• Not forensic• Pump-priming

funding: £2m in 2004-5

• £250K for SE total

Government money: training

Four “network courses” in SE

Thames Valley: Oxford base

Hampshire and Isle of

Wight: Southampto

n base

Kent: Maidstone

base

Surrey & Sussex: Brighton base

Ten Essential Shared Capabilities

• =update of CPF + mapping for WD

• shift in culture in services towards Choice, person-centeredness and mental health promotion is a key imperative

• were significant gaps in pre and post qualification training of all professional staff in their ability to deliver the MHNSF and the NHSP

• Being rendered helpless rather than helped by service use

• embedded in induction and continuing professional /practitioner development

Essential Shared Capabilities

1. Working in Partnership. 2. Respecting Diversity. 3. Practising Ethically.4. Challenging Inequality. 5. Promoting Recovery. 6. Identifying People’s Needs and Strengths.7. Providing Service User Centred Care. 8. Making a Difference. 9. Promoting Safety and Positive Risk

Taking.10.Personal Development and Learning.

What this course IS

• Across different agencies• Suitable for all levels of experience• To build a network of

interested practitioners• To become aware of how other

people in other settings deal with what we call “PD”

• Weaving strands together from different agencies

• Visionary, holistic, provocative• To change attitudes and

practice

What this course IS

• Hearing a wide spread of theory relating to PD

• Suitable for all levels of experience

• To build a network of interested practitioners

• To cascade awareness “wide and thin”

• Hopefully be accreditable for recognised qualifications in the future

• To change attitudes and practice

What this course IS NOT

• A training in therapy • “Do it, tick the box, move

on” • Just a series of lectures• Us spoon feeding you• An afternoon off

Developing a network of “PD Agents”

From different agencies

•MH•Other health services•Other statutory servicess•Voluntaries

…for sharing best practice

From different locations

• Berkshire – with its 6 localities

• Oxfordshire• Buckinghamshir

e

… for support and help with snags

The tasks of “PD Agents”

AWARENESS TRAINING

• Different staff groups

• Geographical spread

• Agent’s agency• Various

formats• With service

user input• Feedback

SERVICE ADVOCACY

NETWORKS

• In localities• Involving all

interested parties

• Putting case where needed

• Support from TV & NIMHE

1 year PD network course

prisons

Primary care

probation

police

mental health services

A&E

Voluntary organisations

housing

Social services

PD agents


prisons

probation

police

A&E


housing

Social services

Further training

Qualification


Feedback from year 1 Thames Valley

• ‘A very human approach – I left feeling more sympathetic to clients.’

• ‘It felt less like “us versus them”’• ‘A very useful, even inspiring, opening up of our

thinking about ‘madness’ treatment, personal freedom and responsibility’.

• ‘I learned a lot about working with PD in the work discussion groups’

• ‘A useful alternative to traditional care provision’• ‘Inspiring’• ‘Insight into others contact with clients helped in

reducing feelings of isolation’

XBX pool

PD Treatment Facilities (few and far between)

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services

PD Treatment Facilities

Dynamic teams

Input into course philosophy, structure

and content

Further training

Qualification

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams

Awareness cascade


and content

Service advocacy

Further training

Qualification

Seminars, conferences, short courses,

workshops, etc

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams

Awareness cascade


and content

Service advocacy

Further training

Qualification

commissoners

MH managers

Policymakers

Development of new

services


workshops, etc

PD agents

XBX pool


prisons

Primary care

probation

police


A&E


housing

Social services


Dynamic teams

Awareness cascade


and content

Service advocacy

Further training

Qualification

Primary care


A&E

prisons

probation

police


housing

Social services

commissoners

MH managers

Policymakers

Interested recruits

Development of new

services


workshops, etc

From care pathways to career pathways

• So this develops a network of PD Agents

• Who are professionals already employed in relevant services

• So it’s all very well for them…

• …but what about the XBXs?

Career Pathways

Ad

Signed Agreement

Volunteer

Advertisment

MT

Int

Meet the TeamInterview

TR

PR

Therapist ReferenceProfessional Reference

SA

C Contract

Clinical QualificationCQ

VolSTARS

membership

(Support, Training and Recovery

System)

XSU(eX- Service User)AR

(Associate Researcher)

WTC (pre 2005 ex-member

of Winterbourne TC with

planned leaving at least

6 months previously)

move-on group)

Other (having received

recognised therapy outside TVi)

SA

SASA

TRInt

MT

CInt

Vol

Vol

MT

Vol

Vol

NOTES:XSUs (or anyone beyond) can do training, service advocacy or other consultation alone or with either PD Agents or PD team staff. They can do supervision with PD Agents or PD team staff

Blue boxes = TVi county servicesYellow boxes = TVi servonly; bright= employees)Grey boxes = Non-TVi services

NOTES:“Contract” includes all normal NHS requirements such as CRB check, occupational health and job description

Other freelance training work etc

T4 (member of a county service

next steps group)

CInt

MT

PR

Ad

PR

Ad

Int

TR (Team Researcher)

Other qualifications for research work etc

Career Pathways (2)

Ad

Signed Agreement

Volunteer

Advertisment

MT

Int

Meet the TeamInterview

TR

PR

Therapist ReferenceProfessional Reference

SA

C Contract

Clinical QualificationCQ

Vol

XBX(eXpert By eXperience)

DW (Development

Worker)

ATT (Assistant Team

Therapist)

TT (Team Therapist)

PR

PR C

Ad

CQ

CQ

AdMT Int

MTInt

C

Higher therapist posts etc

Other training for voluntary sector work etc

Int

C

Vol

NOTES:XBXs (or anyone beyond) can co-facilitate Tier 1 and Tier 4 groups, and carers groups, with PD Agents or PD team staff. Participation in TVi Training, supervision six monthly individual reviews is required.

Blue boxes = TVi county services

Yellow boxes = TVi servonly; bright= employees)

Grey boxes = Non-TVi services

NOTES:“Contract” includes all normal NHS requirements such as CRB check, occupational health and job description

Summary

3 special features of training model:

• Ex-service (XBX) user development (dynamic teams & career pathways)

• Awareness cascade (all areas and agencies)• Advocacy networks (grass roots: XBXs and

clinicians)

the national personality disorder development programme

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