National Personality Disorder
Development Programme

 

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Clinical ideas for a comprehensive 
personality disorder service
for the Thames Valley

 

 Rex Haigh &  Steve Pearce

 August 2002

 

               

1.    Current relationship between psychotherapy services and personality disorder work.

2.    Introducing SPD and DSPD.

3.    Introduction of a day unit to a psychotherapy service (such as Winterbourne in Reading or others elsewhere: Red House in Manchester,             Brenchley in Maidstone, Halliwick in Harringay), or availability of a free-standing residential unit (eg Henderson, Main, Webb etc).

4.    Introduction of outreach facility to other mental health settings, and other agencies.

5.    Covering the rest of the DSPD population with assertive engagement (for example, part of the work at Halliwick, and some new assertive outreach teams who have PD as part of their remit).


 

PD service models: relation to psychotherapy services

 

 

1.    Current relationship between psychotherapy services and personality disorder work:

 

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2.    Introducing SPD and DSPD:

 

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3.    Introduction of a day unit to a psychotherapy service (such as Winterbourne in Reading or others elsewhere: Red House in Manchester, Brenchley in Maidstone, Halliwick in Harringay), or availability of a free-standing residential unit (eg Henderson, Main, Webb etc)

  

 

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4.    Introduction of outreach facility to other mental health settings, and other agencies

(such as Fair Mile “Inreach” work, or the “outreach” teams of Henderson Hospital in London, Main & Bridger House in Birmingham, Webb House in Crewe and Francis Dixon Lodge in Leicester)

 

 

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5.    Covering the rest of the DSPD population with assertive engagement (for example, part of the work at Halliwick, and some new assertive outreach teams who have PD as part of their remit):

 

 

 

 

Text Box: These people whom the service attempts to engage may not be willing recipients of therapy, and the active assessment may involve some effort to find and talk to people in numerous settings, which are very different to outpatient therapy services, as part of assertive engagement.
 
 

 

 

 


 

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A hub and spokes PD service for the Thames Valley

 

First ideas for a clinical service model

 

1. The four tiers of delivery

 

Text Box: NOTES
      Tier 1 is similar to assertive outreach in AMI services. 
      It needs to be organised with numerous agencies at locality level. 
      Individual and joint consultations
      Includes a weekly non-exploratory group
 
 
      Tiers 2 and 3 require larger geographical coverage for formation of appropriate groups
      They also provide many opportunities for staff training
      Tier 2 can be district, regional or supra-regional (eg HOST).
 
 
      Tier 3 (daily programme) needs to be locally accessible
      Either mixture of individual and group therapies, or only groups

 
 
 
      Tier 4 primarily group, but with specific consultations for particular individuals according to each person’s needs. 
      Could also be designed to include therapy with families and carers
 

 


 

 

 

 

 


 

 

2.    Care Pathways

 

3.    Thames Valley-wide relationships

 

 

 

 

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Preliminary notes on staffing and organisation

 

1. Thames Valley “Axis 2 Institute”

 

 

TV “Axis 2 Institute” establishment

WTEs

 

Approx. costs

Clinical director

0.5

£40k

Clinical academic

0.5

£40k

Manager - training

0.5

£25k

Manager - administration

0.5

£25k

Research worker

1.5

£40k

A & C 4

1.0

£20k

Total

4.5

£190k

 

 

Procedures

*      Clinicians in each service spend one day seconded to another service to establish and maintain consistency of approach across services

*      The institute (“TVA2I”) is commissioned by mental health trusts/primary care trusts/care trusts/TVHA? to administer SPD services

*      Regular local training and supervision is supplemented by TVA2I training, either centrally located/rotating location or some via videoconferencing, distance learning etc.

*      TVA2I maintains an overview of local needs and developments partly by close liaison with Local strategic fora (LSFs). LSFs are guided by TVA2I in local implementation of regional policy initiatives.

*      TVA2I research workers spend 2 sessions per week in each of 4 clinical services (?+Broadmoor) carrying out and co-ordinating research and audit

 

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2. Thames Valley “Axis 2 Services”

Text Box: Tier
Duration 
 
Patients (max)
 
Staffing (clinicians)
Approx cost 
(including admin, consultancy, supervision, training, oncosts etc)
1
Up to 12 months
Up to 10 in primarily individual contact plus engagement group of up to 15
None, if included in tiers 2 and 3
Nil
2
18 months
12-18 per project: set up with 4 projects = 48 patients
4 WTEs for 4 projects 
£250K for 4 projects
(eg £64K bid for abusing parents project inc admin, supervision & consultancy)
3
18 months
24
5 WTEs
£320K
4
6 months (overlapping with tier 2 or 3 for longer)
10-25 at any time, depending on flow
Included in tiers 2 & 3
Nil
 

 

 

 

 

 

 

 

 

 

 

 *      Oxfordshire and Berkshire require funding for tiers 2 & 3

*      Berkshire requires new funding for tier 2 only

*      Different counties may have funding phased in over different years.

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