why we need to offer wiser care for personality disorder...
TRANSCRIPT
Why we need to offer wiser care for personality disorder?
structured community care to alternative to admissions
Dr Mark Sampson Consultant Clinical Psychologist Lead Clinician in personality
disorder 5bp
Personality Disorder in the offending population
• Public Health and Criminal Justice (Prevalence) Prisoners 16+ Population 16-64 Psychosis 8% 0.4% Dep/ Anx 45% 17.6% Drugs 45% 3.4% Alcohol 30% 5.9% Personality Disorder 66% 4.4%
Prevalence • High use of healthcare services was
confounded by comorbid mental disorder and substance misuse.
• Cluster B disorders were associated with early institutional care and criminality.
• British Journal of Psychiarty 2006 May;188:423-31. • Prevalence and correlates of personality disorder in Great Britain. • Coid J1, Yang M, Tyrer P, Roberts A, Ullrich S.
What is Personality Disorder? Personality Disorder is a medical label Although not a very good label evidence suggest if
used sensitively it is outcomes better for service user. It is when somebody has long standing
difficulties coping Persistent, pervasive and problematic
However: – It is different from a mental illness?
Personality Disorder What is a Personality Disorder?
– Personality Disorders in their current form first emerged in DSM III when they utilized a multi-axial diagnostic system- Multi-axial Assessment
– Axis I Clinical Disorders – Axis II Personality Disorders – Axis III General Medical Conditions – Axis IV Psychosocial and Environmental Problems – Axis V Global Assessment of Functioning
D.S.M. I.C.D. Cluster A paranoid schizoid schizotypal
Cluster B antisocial borderline narcissistic histrionic
Cluster C avoidant dependent obsessive compulsive
paranoid schizoid
dissocial emotionally unstable - impulsive - borderline histrionic
anxious dependent anankastic
What to work on? • Co-existing mental health problems not uncommon (i.e.
Depression, Eating Disorders, Anxiety, Poly drug use)
• Therapy/Treatment Options 1. Address the clinical disorder only e.g.
depression/anxiety, psychosis, eating disorder etc 2. Address the clinical disorder but modify the treatment to
account for personality disorder 3. Personality disorder seen as primary problem and
therapy/treatment aimed to address this.
What Works
Personality Disorder Recovery
DBT
MBT
CAT
Structured Care
Predictive Recovery by Axis II Pathology
What is helpful? • Attachment • Secure attachment facilitates recovery • But how?
Recovery • Reliability • Consistency • Coherency • Mirroring emotions internal states
Why is this difficult? • System
– Wrong model of care • Fixing rather than mirroring • Passing on rather than containing • Lack of a coherent model
• Practitioner • Lack of appropriate training e.g. managing internal states • Practitioner capacity for tolerating emotions
• Client communication of internal state of confusion
Clear Coherent Approach
Affect Regulation Clear theoretically driven
Protocols on risk management
Have a clear Identity
(theory –goals) Have a clear
coherent way of Interacting
What do we do in 5bp CHOICE
Cluster A Cluster B Cluster C
DBT
MBT
SCM
Myths to working with Personality Disorder
• Being drawn into the ‘Fantasy Elsewhere’
Medication • Over prescribing
Myths to working with Personality Disorder
• Hospitalisation – Doing more is NOT always helpful?
Proposal
Alternative To Admission
CRISIS CRISIS BEDRecovery
TeamHome
TreatmentHome
Treatment
In patientadmission
Banked bed days self referral
Training Opportunities Skill based training
(SCM)
Nationally Recognised KUF Programme
3 day Training course
1 Day CJ focussed Workshop PDiM
E Learning
