Transcript Slide 1
Personality Disorder Services Mapping Exercise Dr Sacha Evans1, Dr Rosemary Sedgwick2, Dr Oliver Dale1, Dr Faisil Sethi2, Dr Clive Stanton3, Dr Chiara Samele4, Dr Norman Urquía4, Mr Steve Goldsack5, Dr. Lucinda Shoolbred1 and Mrs. Monica Doran1 National Personality Disorders Services Review Group (PDSRG) INTRODUCTION Personality disorder has a weighted prevalence of 4.4% (Coid et al, 2006) and there is a great deal of evidence that this group experiences very poor outcomes on a range of measures. Up to 9% of people with personality disorder commit suicide (Stone, 1993) and they are more likely to suffer stroke and ischaemic heart disease (Moran et al, 2007). They have a significantly reduced life expectancy (Fok et al, 2012). Given the tendency for chaotic use of services, this group carry a significant health challenge. Yet we also know that there are a range of cost effective interventions endorsed by NICE and, if given the right help, the prognosis is favourable. However personality disorder remains a controversial diagnosis and there is a perception that there is patchy service availability. THE COMMUNITY PILOT PROJECTS CONCLUSIONS 11 community pilot personality disorder programmes were commissioned and evaluated by the National Personality Disorder Development Programme. They were different in organisation and content and have provided some of the key principles for service provision in personality disorder. • No single service structure intervention has proven superior. KEY RECOMMENDATIONS FROM POLICY DOCUMENTS A number of overarching themes have emerged since the publication of Personality Disorder: no longer a diagnosis of exclusion. •The importance of service user involvement, •The continuing stigmatisation of people with personality disorders, •The role of specialist services with appropriately trained staff, •The value of psychological therapies. WHAT DOES THE LITERATURE SAY? The main findings from the literature review regarding services for people with personality disorders are: •The prognosis for borderline personality disorder is favourable. •There are a number of effective treatments for borderline and antisocial personality disorders. •Teams and their work need to be well structured. •Psychological and social interventions work. SERVICE STRUCTURES Different service structures have been researched including managed clinical networks, service user networks, community teams and specialist services. METHODS We searched for terms such as ‘personality disorder’ AND ‘service’ OR ‘management’ in Medline for literature published between 2003 and 2014. Additionally, we used crossreferences to broaden our understanding. • The availability of effective services across the UK is not clear. • Where services are available, there is a tendency for care to be delivered piecemeal. • There is a perception of service inequality. • There is concern that those with personality disorders continue to be excluded from services. • There is a growing evidence base for the management of antisocial and borderline personality disorders; less is known about how to manage other personality disorders. THE PDSRG AIMS The aim of this review was to ascertain the progress in service development since the publication of Personality Disorder: no longer a diagnosis of exclusion (NIMH(E), 2003). • No model has proved superior, • Cost effective services can be developed, • These require investment in both economic and human terms, • They require effective teamwork and strong leadership, • Therapeutic alliance and networking is key. The National Personality Disorder Service Review Group (PDSRG) is a multidisciplinary team which, in collaboration with the General Adult Faculty of the Royal College of Psychiatrists and West London Mental Health Trust, aims to map the service provision for personality disorder in England and Wales. NEXT STEPS The PDSRG, will be undertaking a Mapping Exercise to elucidate the services currently available in England & Wales. We will be contacting personality disorder Service Leads and Managers over the next 2-3 months to request they complete a survey detailing the services their trust provide. Please contact Dr Oliver Dale ([email protected]) for more information. REFERENCES Coid, J. et al., 2006. Prevalence and correlates of personality disorder in Great Britain. The British journal of psychiatry : the journal of mental science, 188(5), pp.423–31. Fok, M et al., 2012. Life expectancy at birth and all-cause mortality among people with personality disorder. Journal of Psychosomatic Research, 73(2), pp 104-107 Moran, P et al., 2007. Personality Disorder and Cardiovascular Disease: Results from a National Household Survey, 68, pp. 69-74 Stone, M.H., 1993. Long-term outcome in personality disorders. The British Journal of Psychiatry, 162(3), pp.299–313. Wilson, L. & Haigh, R., 2011. INNOVATION IN ACTION : Review of the effectiveness of Centrally Commissioned Community Personality Disorder Services 1 nor West London Mental Health Trust, 2South London and Maudsley NHS Foundation Trust, 3Prince of Wales Hospital, Sydney 4Medway Engagement Group & Network, 5Informed Thinking