Transcript The National Personality Disorder Development Programme

The National Personality
Disorder Development
Programme
Personality: People and Pathology
2005 - 6
Two Government publications
National 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
Location of the new pilot services
• 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”
The Thames Valley 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
Government money: training
• 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
Four “network courses” in SE
Thames
Valley:
Oxford
base
Kent:
Maidstone
base
Hampshire
and Isle of
Wight:
Southampton
base
Surrey & Sussex:
Brighton base
Ten Essential Shared Capabilities
• =update of CPF + mapping for WD
• shift in culture in services
towards Choice, personcenteredness 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
From different
locations
•MH
•Other health
services
•Other statutory
servicess
•Voluntaries
• Berkshire – with
its 6 localities
• Oxfordshire
• Buckinghamshire
…for sharing best
practice
… 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
mental
health
services
Primary
care
A&E
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
mental
health
services
Qualification
A&E
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Further
training
PD
agents
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’
PD Treatment Facilities (few and far between)
XBX
pool
PD Treatment Facilities
XBX
pool
mental
health
services
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
Qualification
A&E
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Further
training
PD
agents
PD Treatment Facilities
Service
advocacy
XBX
pool
mental
health
services
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
Qualification
A&E
Awareness
cascade
probation
prison
s
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Seminars,
conferences, short courses,
workshops, etc
Further
training
PD
agents
Development of
new services
PD Treatment Facilities
Dynamic
teams
Primary
care
Qualification
A&E
Awareness
cascade
police
1 year PD
network
course
Voluntary
organisations
Social
services
housing
Further
training
PD
agents
Policy
makers
Seminars,
conferences, short courses,
workshops, etc
Input into course
philosophy, structure and
content
probation
prison
s
commissoners
Service
advocacy
XBX
pool
mental
health
services
MH managers
Development of
new services
PD Treatment Facilities
police
Seminars,
conferences, short courses,
workshops, etc
Qualification
A&E
1 year PD
network
course
Awareness
cascade
Further
training
housing
police
probation
PD
agents
Primary
care
Voluntary
organisations
Voluntary
organisations
mental
health
services
A&E
probation
prison
s
Policy
makers
Dynamic
teams
Input into course
philosophy, structure and
content
Primary
care
commissoners
Service
advocacy
XBX
pool
mental
health
services
MH managers
prison
s
Social
services
Social
services
housing
Interested recruits
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
Blue boxes = TVi county services
Yellow boxes = TVi servonly;
bright= employees)
Grey boxes = Non-TVi services
T4
WTC
Vol
Volunteer
Ad
Advertisment
MT
Meet the Team
Int
Interview
Other
(member of a
county service
next steps group)
Vol
SA
(pre 2005 ex-member of
Winterbourne TC with
planned leaving at least
6 months previously)
Int
(having received
MT Vol recognised therapy
TR
outside TVi)
SA
SA
STARS
membership
move-on group)
(Support, Training and
Recovery System)
Vol
TR Therapist Reference
PR Professional Reference
SA
Signed Agreement
C
Contract
CQ
Clinical Qualification
NOTES:
“Contract” includes all
normal NHS requirements
such as CRB check,
occupational health and
job description
AR
C
Int
MT
(Associate
Researcher)
TR
(Team Researcher)
Vol
(eX- Service User)
Ad
MT
PR
Ad
PR
Int
XSU
Int
C
Other
qualifications
for research
work etc
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
Other freelance training work etc
Career Pathways (2)
Vol
Volunteer
Ad
Advertisment
MT
Meet the Team
Int
Interview
TR Therapist Reference
PR Professional Reference
SA
Signed Agreement
C
Contract
CQ
XBX
(eXpert By
eXperience)
Clinical Qualification
Int
C
NOTES:
“Contract” includes
all normal NHS
requirements such
as CRB check,
occupational health
and job description
Blue boxes = TVi county services
Yellow boxes = TVi servonly;
bright= employees)
Grey boxes = Non-TVi services
NOTES:
XBXs (or anyone beyond) can cofacilitate 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.
DW
(Development
Worker)
Other training
for voluntary
sector work
etc
Ad
Vol
MT Int PR
ATT
C
(Assistant Team
Therapist)
Ad
CQ
MT
Int
PR
CQ
C
TT
(Team Therapist)
Higher
therapist
posts etc
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)