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Personality disorder service treating untreatable

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Nurses at the new Thames Valley Personality Disorder Service are giving hope to patients who have been told they are untreatable.

Nurses at the new Thames Valley Personality Disorder Service are giving hope to patients who have been told they are untreatable.

THERE is a specific group of people in the UK who are often told they cannot be cured. They are given the impression that their condition is too complicated and there is little hope of a full recovery. Yet these people do not have a terminal illness - they have been diagnosed with a personality disorder.

At least five per cent of people in the UK will be diagnosed with a personality disorder at some time in their lives. The Thames Valley Personality Disorder initiative aims to provide a new type of service for people with the condition. Team leader Naomi Evans and team therapist Dupe Adu-White work in a multidisciplinary branch called the Oxfordshire Complex Needs Service. They provide patients with intensive long-term treatment and work with a team of social workers and therapists, many of whom have a background in mental health.

'Personality disorder is usually the result of a traumatic event,' explains Ms Evans. 'It's very complex, because they may have blocked the experience out, but it can manifest itself in their behaviour. We try to get to the bottom of what's causing it'.

The service started as a pilot scheme two years ago. 'We wanted to show what the service would be like, and to prove that there was a real need for it,' recalls Ms Evans. 'We seconded staff from other resources and got funding from the Department of Health after putting forward a proposal, so now we're able to develop the pilot into a full service,' she explains. 'It's still in the transition phase as we still have a lot of development work to do, but that makes it even more exciting.'

The programme operates in four tiers. The first aims to engage the patients, many of whom have self-referred, and staff advise patients in an informal setting.

'Many patients can feel anxious about seeking treatment, so they are invited to bring their carers or a friend in the early stages,' says Ms Evans. They are then advised on what further treatment may be appropriate. 'The amount of time a patient stays at tier one varies considerably. It can be anything from a couple of months to a year. It all depends on their needs.'

Patients then move on to tiers two or three, which provide more intensive treatment, ranging from two to four days a week and lasting up to 18 months. At this level, treatment is often via group work, although one-to-one sessions are also available.

'They often take part in activities like psychodrama or creative art, but it varies. We let the group have a lot of input into their treatment,' explains Ms Evans.

Tier four provides support after patients finish their treatment to prevent relapse.

As team leader, Ms Evans admits she has her hands full. 'My role is a bit like being the captain of a ship. It involves line management of the whole team, delegating responsibilities, liaising with partner agencies and making sure everything runs smoothly.'

She also gets involved with patients. 'That's what I like best about my role, I like developing the staff, but there's also a clinical aspect, so I've got the best of both worlds.'

As the team therapist, Ms Adu-White also enjoys the challenges of working with a new service. 'I like having input into the development and the fact that my views are taken on board makes me feel appreciated.'

Ms Adu-White gets involved in engaging patients at tier one and assessing new referrals, while also helping to run small groups in tiers two and three. Her background is in forensic nursing. 'I worked in a medium secure unit for three years before applying for this role,' she explains. 'In that line of work I came across a lot of people with personality disorders and found I got good results.'

One of the challenges they face is finding the right environment to hold the sessions in. 'Many patients have had very negative experiences in hospitals - they have been told they are untreatable or that there's nothing wrong with them,' she points out.

'They often associate hospitals with fear and anxiety, so the environment we treat people in is crucial.'

Despite these difficulties, the people they help make it worthwhile. Ms Evans recalls one patient whose life was transformed by the service. 'We treated a lady who was really difficult at first, very angry and uncooperative,' she remembers.

'She needed a lot of support from the community teams and was always calling the emergency services because she had a crisis every day. Now, after being in the programme for a year, she's in full-time employment, has no contact with the emergency services and her life is back on track.'

People who have recovered from a disorder are often asked to come back and help run the groups. 'We call them "experts by experience" because they know what the patients are going through,' says Ms Evans.

'They can be a great source of support and they lead the groups in tier four - we've even made one of them assistant team therapist.'

Other counties are following Oxfordshire's lead and similar services will start in Berkshire and Buckinghamshire in the next year.

'It's very exciting being part of something that's constantly evolving,' enthuses Ms Evans. 'I'm expecting there to be a huge learning curve as we develop the service.

'We also want to carry on training other staff and agencies so they can help out and reach even more people'.

Ms Adu-White is equally as hopeful, 'There's lots going on,' she says. 'When we all work together I really feel like we're giving patients a new sense of hope.'

Treating patients with a personality disorder

 Be honest and open. If something a patient does upsets you then say so, but in a non-confrontational way.

 Establish a rapport with the patient and be non-judgemental.

 Establish links with other services that have contact with personality disorders, such as the local prison or A&E department. This will enable you to share information.

 Treat the condition in stages. Personality disorders can be very complex, but it is better to treat each problem in turn rather than trying to cure the overall disorder.

 Encourage patients to self-refer whenever possible - that way you know that they are making an active choice to seek treatment.

 New patients may initially be nervous about having treatment in a group environment. Do your best to make them feel at ease and encourage them to interact. It may be worth allowing them to bring their carers for the first few sessions.

 Encourage patients to form support groups after their treatment has finished. This helps them to maintain social interaction and makes it less likely that they will experience a relapse.

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