Dr John D McGinley: Psychology Director The State Hospitals Board For Scotland BPS Representative...

Dr John D McGinley: Psychology DirectorThe State Hospitals Board For Scotland

BPS Representative Forensic Network BoardProfessional Governance Panel of BPS

www.bps.com

UNDERSTANDING PERSONALITYDISORDER

Behind the label of personality disorder there is a personality -Behind which is a person

Diagnosis is characterised by confusion and lack of agreement. Where understanding is required, fear has emerged. Heather Castillo 2003

MH (Care and Treatment) (S) Act 2003MH (Care and Treatment) (S) Act 2003

1. Mental disordermental illnesspersonality disorderlearning disability

2. Medical treatmentprevent worseningalleviate symptomsavailable

3. Significant risk to person or safety of othersCompulsion necessary

5. Impairment of ability to make decisions about treatment (civil application only)

Personality Disorder AssessmentPersonality Disorder Assessment

Clarify diagnosis and comorbidityClarify diagnosis and comorbidity Identify treatment needs and care planningIdentify treatment needs and care planning Formulation of person’s profile Formulation of person’s profile Functional links with extremes of behaviour: Functional links with extremes of behaviour: dangerousness and criminalitydangerousness and criminality Justification for pathways – criminal Justification for pathways – criminal justice and mental health disposalsjustice and mental health disposals Professional governance: ethical: audited: Professional governance: ethical: audited: accredited: training: supervision: research accredited: training: supervision: research

Wellbeing, Recovery and RehabilitationWellbeing, Recovery and Rehabilitation

Mental healthMental health

Physical healthPhysical health

Intellectual developmentIntellectual development

Emotional and Spiritual developmentEmotional and Spiritual development

Citizenship: Rights, responsibilities and risksCitizenship: Rights, responsibilities and risks

Person Care &Treatment in Forensic SettingsPerson Care &Treatment in Forensic Settings

FORENSIC MENTAL HEALTH SERVICESFORENSIC MENTAL HEALTH SERVICESMANAGED CARE NETWORKMANAGED CARE NETWORK

Care Standard 2Care Standard 2

Organisations will have in place an Organisations will have in place an infrastructure that delivers a range of infrastructure that delivers a range of generic and specialist treatments, and generic and specialist treatments, and interventions that supports persons’ interventions that supports persons’ recovery, meets appropriate and social recovery, meets appropriate and social care needs of persons and fulfils the care needs of persons and fulfils the multidisciplinary treatment plans.multidisciplinary treatment plans.

Understanding Personality DisorderUnderstanding Personality Disorder

People with personality disorders are treated as part of core services in mental health and forensic

settings

British Psychological SocietyBritish Psychological SocietyRecommendation 1.Recommendation 1.


British Psychological SocietyBritish Psychological SocietyRecommendation 2.Recommendation 2.

Service developments require the skills

of clinical and forensic psychologistsas clinical leaders


British Psychological SocietyBritish Psychological SocietyRecommendation 3Recommendation 3

Staff in health and social care, education, criminal justice and voluntary sector

require some level of training rangingfrom basic awareness to specialist

training.



Structured assessments are essential toTreatment based on client’s needs



People with personality disorders need a multi - disciplinary and multi - agency service



People with personality disorders are treated as part of core services in mental health and forensic settings



Personality disorder is a problem that affects individuals across the lifecycle: to identify problems early, good communication between agencies is essential.



Clinical supervision is essential to maintain the emotional health of staff.



Urgent need for good quality research to inform service development.



The views of service users should informservice developments.

““no longer a diagnosis of exclusion”no longer a diagnosis of exclusion”

Person distressed by a personality Person distressed by a personality disorder, whether disorder, whether primary or co-morbid primary or co-morbid conditioncondition, deserves consideration under , deserves consideration under mental health legislation for care and mental health legislation for care and treatmenttreatment

When assessing the impact of a mental disorder, When assessing the impact of a mental disorder, in all circumstances, all persons being assessed in all circumstances, all persons being assessed should be screened for personality disordershould be screened for personality disorder

Maladaptive and inflexible thinking: Schema Focused TherapyMaladaptive and inflexible thinking: Schema Focused Therapy

Poor integration of concept of self or others: Psychodynamic TherapyPoor integration of concept of self or others: Psychodynamic Therapy

Attachment and emotional developments: Psychodynamic TherapyAttachment and emotional developments: Psychodynamic Therapy

Reformulation in collaboration: Cognitive Analytic TherapyReformulation in collaboration: Cognitive Analytic Therapy

Skills training: Cognitive Beh. TherapySkills training: Cognitive Beh. Therapy

Therapeutic alliance and validation: Dialectical Beh. TherapyTherapeutic alliance and validation: Dialectical Beh. Therapy

Motivational engagement: Cognitive Beh. TherapyMotivational engagement: Cognitive Beh. Therapy

Meeting person’s needs:Psychotherapeutic

eclecticism

Higher attrition ratesHigher attrition rates Poorer outcomePoorer outcome

More clever psychopath!More clever psychopath!SService “abusers” rather than “users”ervice “abusers” rather than “users”

UntreatableUntreatableAlienation: disliked patientsAlienation: disliked patients

Split the team!Split the team!

Challenge assumptionsChallenge assumptions

Hope and developmentsHope and developments

Service users stories of hopeService users stories of hope

New century re-birth of hope and raising expectationsNew century re-birth of hope and raising expectations

Hearing voices networksHearing voices networks

See meSee me

Proud of our experienceProud of our experience

Improving alliance with service usersImproving alliance with service users

Improved assessment proceduresImproved assessment procedures

Developing effective treatment paradigmsDeveloping effective treatment paradigms

Collaborative relationships – practitioner (the expert by Collaborative relationships – practitioner (the expert by training)training) and service user (the expert by experience)and service user (the expert by experience)

Person FocusPerson Focus

Needs led – idiopathicNeeds led – idiopathic

Holistic - context (family) Holistic - context (family)

Readiness - capacity – motivationReadiness - capacity – motivation

Contract – engagementContract – engagement

Complexity – formulationComplexity – formulation

Feedback – understandingFeedback – understanding

Wellbeing recovery - Wellbeing recovery - maintenancemaintenance

Care pathways via National NetworksCare pathways via National Networks

Maintenance of treatment outcomes: national forensic Maintenance of treatment outcomes: national forensic networknetwork Integrate care pathways: national forensic networkIntegrate care pathways: national forensic network

Standardised treatments through levels of security: Standardised treatments through levels of security: national national forensic networkforensic network

Standardise training and competencies: national forensic Standardise training and competencies: national forensic schoolschool

Accreditation of treatments: national forensic networkAccreditation of treatments: national forensic network

Personality Disorders: Clinical Governance GuidelinesPersonality Disorders: Clinical Governance GuidelinesRoyal College of Psychiatrists Council Report CR 71, February 1999

It is the responsibility of psychiatrists to offer treatment It is the responsibility of psychiatrists to offer treatment where ever possiblewhere ever possible

Improve teaching of psychiatry traineesImprove teaching of psychiatry trainees

Prioritise limited capacity of psychiatric servicesPrioritise limited capacity of psychiatric services

Develop preventive interventions in child and adolescent Develop preventive interventions in child and adolescent servicesservices

Develop clearer definition of treatment goalsDevelop clearer definition of treatment goals

Ensure multidisciplinary cooperationEnsure multidisciplinary cooperation

Dr John D McGinley: Psychology DirectorThe State Hospitals Board For Scotland

BPS Representative Forensic Network BoardProfessional Governance Panel of BPS

www.bps.com

UNDERSTANDING PERSONALITYDISORDER

Behind the label of personality disorder there is a personality -Behind which is a person

Diagnosis is characterised by confusion and lack of agreement. Where understanding is required, fear has emerged. Heather Castillo 2003

Dr John D McGinley: Psychology Director The State Hospitals Board For Scotland BPS Representative...

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