Shared learning database
Type and Title of Submission
An integrated pathway for the treatment of personality disorder in health services.Description:
The submission presents three documents which outline a care pathway developed to assist primary and secondary mental health care services offer NICE compliant treatment for patients with borderline and personality disorder.Category:
ClinicalDoes the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
CG78 - Borderline personality disorder: treatment and managementCategory(s) that most closely reflects the nature of the submission:
Description of submission
The aim of our implementation initiative was to provide clear structured NICE guidance compliant advice on the accurate and appropriate management of patients with personality disorder who presented to health care services. We wanted to be sure that patients with this diagnosis received treatment that was compassionate, respectful, informed and consistent. We also wanted to be sure that patients with different degrees of severity were treated at the right level of intensity within health care settings.Objectives
1 To improve the care of patients with borderline personality disorder in our local health care system. 2 To ensure that staff were educated about the appropriate interventions and strategies for dealing with this condition. 3 To improve the equity and consistency of treatments offered to patients with this condition and to ensure that they were evidence based and compliant with NICE guidanceContext
The complex cases service was a specialist unit set up some years ago to offer treatment to patients with personality disorder. Our aim had been to provide a service well embedded in secondary care. As a result we had extensive contacts with secondary care services but we knew from our work with user groups and staff groups that there were great variations in the management that our patients received in different areas of the health care system. For this reason we began to educate general practitioners and local staff about personality disorder and it soon became clear that straightforward structured guidance and some help with basic psychological interventions would be important tools in furthering our educational aims. We took advantage of a more extensive restructuring of clinical pathways within our trust and the publication of NICE guidance to both locate our work with personality disorders within the overall context of our local services and to ensure that advice and treatment was compliant with NICE guidelines. Furthermore we were concerned with the introduction of the IAPT initiative locally that patients with personality disorder at the mild to moderate end of the spectrum might receive sub optimal treatment within the IAPT program unless there were specific interventions structured for that program and targeted at it. We worked with local user groups, IAPT workers, local GP's and secondary mental health care groups to understand their views and develop guidance that was practical, could be implemented for the most part within existing resources and embodied best practice as set out in the NICE guidelines.Methods
Objective 1 To improve the care of patients with borderline personality disorder in our local health care system. Result. The design and initial piloting of a structured brief psychoeducational intervention focusing on self care and risk reduction for patients with Borderline Personality disorder (See attached document) The dissemination of clinical guidelines that paraphrase and apply current NICE guidance but which also provide practical advice for the management of common clinical dilemmas in the management of patients with personality disorder (see attached document). 2 To ensure that staff were educated about the appropriate interventions and strategies for dealing with this condition. The production of a leaflet offering information and guidance to local General Practitioners on best practice, NICE guidance and local care pathways in relation to personality disorder. Consultation, liaison and support to local General Practitioners in teaching sessions and in regard to individual patients. 3 To improve the equity and consistency of treatments offered to patients with this condition and to ensure that they were evidence based and compliant with NICE guidance. The training and support of key staff (Personality Disorder Links) in secondary mental health care teams such as community mental health teams, inpatient wards etc. using the guideline document. The training and support of staff on the IAPT program in the development and delivery of the brief psychoeducational intervention.Results and evaluation
The brief intervention for personality disordered patients will be evaluated first as a pilot and then more formally if funding is available in a randomised controlled trial. The Guidelines will be monitored through our system of PD links who will liaise with individual clinical teams. We are in the process of designing a program of continuing support and professional development for PD links.Key learning points
THINGS THAT ARE SUCCESSFUL. - Developing guidelines that take account of staff's actual experience of managing patients in local settings. - Advice that builds on current systems and does not require too much system change. - Advice that doesn't involve spending any extra money. - Using the experiences of patients in health care services to target areas of poor or less than ideal treatment or respect. - Supporting advice with extensive programs of education and liason. THINGS TO AVOID - Advice that is too vague. - The hope that anything can be implemented very quickly. - Services that remove patients from their local setting and treat them somewhere far away from home or in a special way so that when they return nothing local can match what they have received.
View the supporting material
|Name:||Dr Chess Denman|
|Job Title:||Consultant Psychiatrist|
|Organisation:||Cambridge and Peterborough Mental Health Partnerships Trust.|
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This page was last updated: 21 August 2009