Why we need to offer wiser care for personality disorder...
Transcript of Why we need to offer wiser care for personality disorder...
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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
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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%
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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.
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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?
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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
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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
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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.
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What Works
Personality Disorder Recovery
DBT
MBT
CAT
Structured Care
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Predictive Recovery by Axis II Pathology
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What is helpful? • Attachment • Secure attachment facilitates recovery • But how?
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Recovery • Reliability • Consistency • Coherency • Mirroring emotions internal states
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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
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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
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What do we do in 5bp CHOICE
Cluster A Cluster B Cluster C
DBT
MBT
SCM
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Myths to working with Personality Disorder
• Being drawn into the ‘Fantasy Elsewhere’
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Medication • Over prescribing
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Myths to working with Personality Disorder
• Hospitalisation – Doing more is NOT always helpful?
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Proposal
Alternative To Admission
CRISIS CRISIS BEDRecovery
TeamHome
TreatmentHome
Treatment
In patientadmission
Banked bed days self referral
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Training Opportunities Skill based training
(SCM)
Nationally Recognised KUF Programme
3 day Training course
1 Day CJ focussed Workshop PDiM
E Learning