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The National Personality Disorder Development
Programme
Personality People & Pathology
1 June 2005, Friends Meeting House, OxfordRex Haigh & Steve Pearce
The National Personality Disorder Development
ProgrammeAims:
• To develop new approaches to treatment and care of people diagnosable with PD
• Strengthen the capabilities of the workforce through education and training
• Reduce social exclusion
Two Government publicationsNational Institute for Mental Health for England (NIMHE)
• Deliberate variety of approaches
• All involve many stakeholders
• Working together to provide new type of service
• Service users help in planning
• Care pathways approach• Very strong control over
finances & governance• Emphasis on evaluation,
outcome & dissemination• Results in 2005-7
Government money: services
The National Personality Disorder Development
Programme
Rex HaighConsultant Psychiatrist in Psychotherapy, Berkshire Healthcare NHS Trust
Personality Disorder Development Consultant, NIMHE South East Personality Disorder Service User Consultation Lead, Department of Health
Two Government publicationsNational Institute for Mental Health for England (NIMHE)
New Government Money
• Started as “crumbs from the DSPD table”• Personality disorder: the “DSPD” units
– £128m (£100m capital + £28m revenue)– For a few hundred people– eg £0.5m per patient per year at Broadmoor
• Personality disorder: community programme– £18m– For ~5% of the population (3,000,000 people)– Equals £6.60 each case per year
(or 33p per head of population)
• Intention to coordinate across 4 “silos”
Four “silos”
• New pilot projects– 2 years funding thence PCT
• National specialist commissioning– Henderson, Main House and Webb House
• DSPD units– 4 in prisons, 6 in forensic and 4 womens
units
• Training initiatives– Divided amongst 8 NIMHE regions
What “No Longer a Diagnosis of Exclusion” is funding:
the 11 new community pilot services
• Deliberate variety of approaches
• All involve many stakeholders• Working together to provide
new type of service• Service users help in planning • Care pathways approach• Very strong control over
finances & governance• Emphasis on evaluation,
outcome & dissemination• Results in 2005-7
What “No Longer a Diagnosis of Exclusion” means
www.publications.doh.gov.uk/mentalhealth/personalitydisorder.pdf
• 2004-2007 • 11 new pilot projects• Learning from diversity
– 4 “big ones”– 2 managed networks– 2 predominantly SU-led– 1 early intervention– Different therapeutic
models, some mention none
The 11 pilots
• A quick tour, giving:– Who submitted bid– Who manages it
(=owns it?)– Clinical model– Distinguishing
features
Leeds• Submitted by Tom Mullen,
Leeds Mentally Disordered Offender Development Coordinator, Leeds MHTT
• Provider: Leeds MHTT• Managed clinical and service
network• Core team working across
agencies• Providing
– Assessment– Clinical Services– Care coordination
• Largest urban project
Nottinghamshire
• Submitted by Helen Scott, Executive Director, Nottinghamshire Healthcare NHS Trust (MHT)
• Provider: Nottinghamshire Healthcare NHS Trust (MHT), and local advocacy groups
• Coordinated network with new clinical services
• 3 levels of provision– L1= advice and information– L2= “stop and think” CBT– L3= therapeutic community
• With satellite services across the county
• Integrated team• Wide range of stakeholders• Large population (>1m) and budget
Coventry• Submitted by Coventry PCT• Provider: Coventry PCT• New clinical services
– “community psychotherapy team”– group-based programmes for simple,
complex, & severe PD
• Integrated with new NSF-aligned psychiatric services
• New building• Most favourable funding to
population ratio
Thames Valley
• Submitted by Drs Rex Haigh & Steve Pearce, consultant psychiatrists in psychotherapy
• Providers: 3 MHTs - Berks, Bucks & Oxon
• Hub and spokes – 3 hubs– Approx 10 spokes
• New 4 tier clinical services– Assertive assessment (XBX)– Local treatment provision– 3 day TCs– Recovery tier (XBX-led)
• Multiple agencies involved• Integrated with training• Largest area & population (>2m)
Camden & Islington• Submitted by Stephen Pilling,
Consultant Clinical Psychologist, Camden and Islington Mental Health and Social Care Trust
• Providers: Charitable Trust (“Umbrella Ltd”), two PCTs and the MH/SC Trust
• Provision of two services:– Primary care: early recognition and
brief treatment, DBT-based– Voluntary sector: helping people to
reengage in work and be active citizens
• Small project• Small population• Inner city
NE London• Submitted by Dr Janet
Feigenbaum, Consultant Clinical Psychologist
• Provider: NE London MHT• Dual Diagnosis Assessment
and response Team: “DDART”
• Dual diagnosis – PD & substance misuse
• Provision of– Assessment– Interventions
• DBT based• group & individual • with outreach
– Case management
SW London
• Submitted by Dr Steve Millar, Consultant Psychiatrist in Psychotherapy
• Provider: SW London & St Georges MHT
• Service User Network (SUN)
• To set up 4 local networks to– Support SUs– Improve access to services
• Large urban population• Small staff numbers
Colchester
• The Haven Project Ltd
• Voluntary sector• Drop-in day services• Features of
therapeutic community
• Also short term crisis beds
Cambridge & Peterborough• Submitted by Annette Newton
(Area Director and MH Policy Lead, MHT), Prof Geoff Shepherd (Director of Partnerships and Service Development, MHT) and Dr Chess Denman (Consultant Psychotherapist)
• Provider: Cambridge & Peterborough Mental Health Partnership Trust
• No theoretical approach specified in bid
• Services provided in two “hubs”– Assessment– Interventions– Case management
• Development workers = spokes, to work across agencies and promote recovery model
North Cumbria
• Submitted by Dr Mike Rigby, Consultant Psychiatrist in Psychotherapy
• Provider: North Cumbria MHT
• “Itinerant therapeutic community”– Intensive day service
model– Aspatria RC & Carlisle
• Closely integrated with training programme
• Large rural area• Low population
Plymouth
• Submitted by Phil Confue, Director MH & LD, Plymouth PCT
• Provider: Plymouth PCT
• Early intervention model• Young people (<25)
engaged through youth enquiry service
• Social inclusion focus: “to prevent career as psychiatric patient”
• Delivered in partnership with voluntary agencies
• Includes DBT treatment
Evaluation of the 11 pilots• Local
– as described in individual bids– cooperation emerging
• National– Imperial College London
• Mike Crawford, Dorothy Griffiths, Tim Weaver, Deborah Rutter, Peter Tyrer
– Mental Health Foundation • Iain Ryrie, Jan Wallcraft
– University College London • Anthony Bateman, Gerhart
Knerer, Peter Fonagy– Institute of Psychiatry
• Paul Moran– University of Liverpool
• Jonathan Hill
Multi-method evaluation– A macro-level organisational
evaluation of the context, form, function and impact of pilot services
– A micro-level cohort study examining changes in health, social outcomes and direct costs of care among a cohort of people using these services
– A micro-level qualitative study of service quality from the perspective of service users
– A Delphi exercise to examine the level of consensus among academics, service users and providers about lessons that can be learnt for future service development
What do they cost?
• Smallest – SUN - £254,000• Largest – Thames valley - £1,006,335
– Full year effect– Including capital expenditure and management
costs– Excluding local contributions
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
1
Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Cost to NIMHE per project
How many new staff?
• In original bid (possibly amended since)
• Minimum: Carlisle = 6• Maximum: Thames Valley = 30.5
27.0
23.522.6
30.1
8.47.4 6.5
11.5
8.5
6.0
12.2
0
10
20
30
1
Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Number of staff per project
Population covered
• Less than half a million – Waltham Forest
DDART– Coventry– North Cumbria– Essex Haven– Camden and
Islington– Plymouth
• Over a million– Thames Valley
(Berkshire, Buckinghamshire and Oxfordshire)
– Nottinghamshire
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
1
projects
Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb &PetN Cumbria
Plym
Population served by each project
Calculation: money spent per “case”
Assuming 5% of total population “have” PD:
• MAXIMUM – Coventry - £56• MINIMUM – SW London SUN - £6.52• MEAN - £17.75• REST OF ENGLAND in PCT baselines - £4.01
Spend per case for each project
0
10
20
30
40
50
60
1
Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Calculation: “cases” per new staff member
• MAXIMUM – SW London SUN – 7662– (14 minutes each per year = 19 sec weekly)
• MINIMUM – Coventry – 701– (2hr 37mins each pa = 3 mins 25 sec weekly)
• MEAN - 2311
“Caseload” per project
0
1000
2000
3000
4000
5000
6000
7000
8000 Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Calculation: cost of each new staff member
• MAXIMUM – North Cumbria – £70,883• MINIMUM – Leeds – £31,852• MEAN - £41,038
– Note: does not include contribution of volunteers, service users or ex-service users if unpaid.
Cost per new staff for each project
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000Leeds
Notts
Coventry
TV
Cam & Is
DDART
SUN
Haven
Camb & Pet
N Cumbria
Plym
Summary of “new money”
• For 11 new pilot projects from NIMHE: – £6.8m for 7.5m population = £17.75 per case
• Into PCT baselines 2004-5– £8m (England only) = £3.20p per case
• Into PCT baselines 2005-6– £10m (England only) = £4.01 per case
• For training programme 2004-5 & 2005-6– £2m = £250K per NIMHE region
More “new money”?
• To bring England up to average level of pilot projects would cost
• £868m
• This represents increasing current funding by 52x• Or current funding is 1.93% of what is needed
• Awaiting announcement from spending round (March 05?)
• But most will need to come from service remodelling
Forensic Service Developments
DSPD services 2 new 70 bed units at Broadmoor and Rampton
operational from 2005/6 Two new prison pilot sites at Frankland and
Whitemoor are operational from 2004 Planned womens DSPD prison pilot at Lower
Newton 6 pilot forensic services for people with PD who
present a risk to others Women's high support community services
(residential core and cluster services for women leaving high secure care)
Forensic Service Developments
Pilot services provided by:
– South London and Maudsley– Nottingham Healthcare Trust (Rampton)– East London Mental Health Trust– West London Mental Health Trust (Broadmoor)– Oxleas Trust– Newcastle, North Tyneside and Northumberland
Trust– Merseycare Mental Health Trust
Forensic Service Developments
Pilots include:
• Dedicated PD units within high secure services
• Dedicated PD units within medium secure services
• Associated hostels in three pilots • Community Team in six
Personality Disorder Capability Framework – Breaking the Cycle of
Rejection
• Comprehensive approach to improving capabilities of the workforce across many agencies responding to people diagnosable with PD
• Total of £2m for 2004/5 allocated to 8 NIMHE Regional Development Centres for new initiatives to implement the framework.
Personality Disorder Capability Framework – Breaking the Cycle of
RejectionTraining initiatives reflect
partnership between WDDs, HEIs, NIMHE RDCs.
National bodies (NHS University, Royal Colleges etc.), committed to joint work to establish training initiatives consistent with Capability Framework
Learning networks will ensure dissemination of learning from pilot services.
Training and education programme will be independently evaluated
Personality Disorder Capability Framework – Breaking the Cycle of
Rejection
Current training and education initiatives include:
• mapping/scoping exercises and training needs analyses
• stakeholder consultation• “PD awareness cascade” courses• PD basic training modules to be
incorporated in pre and post reg training
• multi-agency modular training approaches
• exploring training needs of commissioners.
Local multi-agency training is also included in many of the service development pilots
TRRT – training, research and recovery
team • 4th team of TVi• TRAINING – to deliver this
course and other events using XBXs and Agents
• RESEARCH – to undertake national data collection and local evaluation of TVi
• RECOVERY – to make service user, ex-service user and expert by experience partnerships essential
• AND – external relations etc etc…
TRRT: who, where, when?
• 3.3 wtes:– Sue Robinson Team Administrator 1.0wte– Clare Stafford Project Manager 0.5wte– Fiona Blyth Training Coordinator 0.5wte– [vacant] Team Researcher 0.5wte– Sheena Money Expert by Experience 0.3wte– Yolande Hadden Expert by Experience
0.3wte– Rex Haigh Programme Director 0.2wte
• Managed by OMHT through CS
• Located on Warneford site• Phase 1 – setup – y1• Phase 2 – provide – y2• Phase 3 – the future – y3+?
TRRT and training
• To coordinate all training offered
• To “capacity-build” SU, XSU & XBX involvement (STARS) for training and clinical function
• To provide (very limited!) funding for training activities – alongside NIMHE funding
• To provide (more substantial) funding for XBX input
• To get it onto secure financial footing
PD agents
XBX pool
1 year PD network course
prisons
Primary care
probation
police
mental health services
A&E
Voluntary organisations
housing
Social services
PD Treatment Facilities
Dynamic teams
Awareness cascade
Input into course philosophy, structure
and content
Service advocacy
Further training
Qualification
Primary care
mental health services
A&E
prisons
probation
police
Voluntary organisations
housing
Social services
commissoners
MH managers
Policymakers
Interested recruits
Development of new
services
Seminars, conferences, short courses,
workshops, etc
SE Training Plan – aka “network course” – aka “awareness cascade”
TRRT and research• Two serious attempts at
recruitment July 04 and Feb 05
• Coordination with – National team– Nottingham– Coventry
• Minimum dataset agreed across TV = National + SCID2 + CORE +
• Awaiting ethical clearance• Other local research (eg
qualitative and user-led) will need to await appointment of researcher
TRRT and recovery
• To make service user partnership (+XSU +XBX) essential– Writing bid together– Planning clinical policies together– Two paradoxes emerging
• To administer fairly– Systems, administration,
payment
• Employment and life beyond– Examples– Other agencies
STARSsupport, training and recovery
system• XSUs and XBXs• Monthly meeting• Last Friday afternoon• Lunch - check-in –
feedback – planning & allocation – open group – educational slot – check-out
• Usual attendance about 20, with 25 on our books
• In a central Reading nightclub owned by lottery winner, friend of an ex-service user!
• Requests for involvement taken through Sue
• Agreed at TRRT• Includes Training, Clinical
and Service Advocacy• Training and advocacy
activities in TV – we pay XBX fees and expenses (if outside, we charge)
• Agents would be welcome – especially if they come and tell us what they are up to, or with requests for involvement
TRRT: other coordination
• Initially – recruitment– eg polymorphous and non-
disciplinary job profiles• Team building• In-house training structures• Coordination between
teams• Annual Development
Conference – 6 July Kindersley Centre
• Organisational links – PCTs, MHTs, national team, learning network, ATC, CofC, NIMHE, BUK, RCPsych, multitude of others
Morning session: TVi clinical pilot
Professionals’ session: 10am – 12noon[Service user session running in parallel]
Oxford• Presentation of case vignettes by Naomi Evans, Team leader – any questions.• Discussion of the current service and focus on commissioning arrangements
from 2006/7Berkshire• Presentation of case vignettes and research findings by Davey Rawlinson,
Senior Psychotherapist. Any questions• Discussion of current service, funding and commissioning arrangements
currently and from 2006/7.Buckinghamshire• Presentation of case vignettes by Marion Panchkowry and Alex Esterhuyzen,
programme leads.• Discussion of the current service and focus on commissioning arrangements
from 2006/7TRRT• Presentation of TRRT development and activity by Rex Haigh, Programme
Director and Fiona Blyth, Training Coordinator• Discussion of likely commissioning arrangements from 2006/7
Personality Disorder Capability Framework – Breaking the Cycle of
Rejection
• Comprehensive approach to improving capabilities of the workforce across many agencies responding to people diagnosable with PD
• Total of £2m for 2004/5 allocated to 8 NIMHE Regional Development Centres for new initiatives to implement the framework.
Personality Disorder Capability Framework – Breaking the Cycle of
Rejection
Training initiatives reflect partnership between WDDs, HEIs, NIMHE RDCs.
National bodies (NHS University, Royal Colleges etc.), committed to joint work to establish training initiatives consistent with Capability Framework
Learning networks will ensure dissemination of learning from pilot services.
Training and education programme will be independently evaluated by NU (Peter Lewis is our link)
Personality Disorder Capability Framework – Breaking the Cycle of
Rejection
Current training and education initiatives include:
• mapping/scoping exercises and training needs analyses
• stakeholder consultation• “PD awareness cascade” courses• PD basic training modules to be
incorporated in pre and post reg training
• multi-agency modular training approaches
• exploring training needs of commissioners.
Local multi-agency training is also included in many of the service development pilots
Training in the South-East
Developing a network of “PD Agents”
AWARENESS TRAINING
• Different staff groups
• Geographical spread
• Agent’s agency• Various
formats• With service
user input• Feedback
SERVICE ADVOCACY
NETWORKS
• In localities• Involving all
interested parties
• Putting case where needed
• Support from TV & NIMHE
Four “network courses” in SE
Thames Valley: Oxford base
Hampshire and Isle of
Wight: Southampto
n base
Kent: Maidstone
base
Surrey & Sussex: Brighton base
Courses spec: 1 - philosophy
• Based on “Breaking the Cycle of Rejection” Capabilities Framework
• Encourages patient/client autonomy and development of individual responsibility
• Well-reflecting the views of users and carers • Non-threatening• Empowering learners to use what they
already know• Finding common language • Focus on attitude change and stigma
reduction
Courses spec: 2 - structure
• Starts September 2004, finish by June 2005• Between 20 and 40 course participants• Variety of teaching methods• Planned and run by multidisciplinary team,
including contributions from all significant services in SHA area
• Service user or ex service user input to planning and delivery
• Inclusive and accessible (e.g. no disciplines excluded through use of jargon)
• Multi-professional• Multi-agency• Multi-sector
Cont…
• Mechanism for cascade of awareness training through course participants
• Continuing support for course graduates wanting to undertake further PD work
• Participation in SE-wide and national evaluation• Use of IT and NIMHE KC for dissemination of
course material and widening reach of PD training• Commitment to continuation and further
development beyond year 1• Collaboration with other SE courses in annual
development conference
Courses spec 3 - content• Minimum of seminars + work discussion + reflective
component• Evidence-based, where it exists• Case formulation from different approaches• Explains PD phenomenology an continuum• Includes Aetiology• Interventions and evidence• Sociological and deviance perspectives• Eclectic with regard to therapeutic or theoretical models• Management principles: engagement, attachment and
consistency• Stigma and education • Attend to team and organisational dynamics• Models of supervision• Skills: what to do and what not to do• Service design discussions
Courses spec 4 - admin• Pamphlet to
include course aims, intended audience, dates and outline of content
• With SEDC logo• Produced by end of
June• Circulated widely
within all MH trusts in SHA
• Circulated to other agencies within SHA area (eg primary care, voluntary sector, social services etc)
• Course outlines using pro-formas below to be received by SEDC by June 11
• Approval for funding by end of June• Supporting costs will be paid in
three parts: £10,000 in July for setting up
• Further £10,000 in December 2004 when evidence of course delivery, including course brochures, number of participants with their professional backgrounds, work settings and employing organisations is received
• Final £10,000 in Summer 2005 when number completing the course, participants’ feedback and analysis, and plans for future development are received
1 year PD network course
prisons
Primary care
probation
police
mental health services
A&E
Voluntary organisations
housing
Social services
PD agents
1 year PD network course
prisons
probation
police
A&E
Voluntary organisations
housing
Social services
Further training
Qualification
mental health services
XBX pool
PD Treatment Facilities (few and far between)
PD agents
XBX pool
1 year PD network course
prisons
Primary care
probation
police
mental health services
A&E
Voluntary organisations
housing
Social services
PD Treatment Facilities
Dynamic teams
Input into course philosophy, structure
and content
Further training
Qualification
PD agents
XBX pool
1 year PD network course
prisons
Primary care
probation
police
mental health services
A&E
Voluntary organisations
housing
Social services
PD Treatment Facilities
Dynamic teams
Awareness cascade
Input into course philosophy, structure
and content
Service advocacy
Further training
Qualification
Seminars, conferences, short courses,
workshops, etc
PD agents
XBX pool
1 year PD network course
prisons
Primary care
probation
police
mental health services
A&E
Voluntary organisations
housing
Social services
PD Treatment Facilities
Dynamic teams
Awareness cascade
Input into course philosophy, structure
and content
Service advocacy
Further training
Qualification
commissoners
MH managers
Policymakers
Development of new
services
Seminars, conferences, short courses,
workshops, etc
PD agents
XBX pool
1 year PD network course
prisons
Primary care
probation
police
mental health services
A&E
Voluntary organisations
housing
Social services
PD Treatment Facilities
Dynamic teams
Awareness cascade
Input into course philosophy, structure
and content
Service advocacy
Further training
Qualification
Primary care
mental health services
A&E
prisons
probation
police
Voluntary organisations
housing
Social services
commissoners
MH managers
Policymakers
Interested recruits
Development of new
services
Seminars, conferences, short courses,
workshops, etc
SE Training Plan – aka “network course” – aka “awareness cascade”
• 3 County clinical services
• Plus “Umbrella” function including training
• …called TRRT • In close
partnership with STARS
TRRT – training, research and recovery
team • 4th team of TVi• RH, SM, YH, CS, SR and ---
just--- FB. “TR” yet to be appointed.
• TRAINING – to deliver this course and other events using XBXs and Agents
• RESEARCH – to undertake national data collection and local evaluation of TVi
• RECOVERY – to make service user, ex-service user and expert by experience input essential
ROLE IN TRAINING• To coordinate all training
offered• To “capacity-build” SU, XSU
& XBX involvement (STARS) for training function
• To provide (very limited!) funding for training activities
• To provide (more substantial) funding for XBX input
• To get it onto secure financial footing
STARSsupport, training and recovery
system• XSUs and XBXs• Monthly meeting• Last Friday afternoon• Lunch - check-in –
feedback – planning & allocation – open group – educational slot – check-out
• Usual attendance about 20, with 25 on our books
• In a central Reading nightclub!
• Requests for involvement taken through Sue
• Agreed at TRRT• Includes Training, Clinical
and Service Advocacy• Training and advocacy
activities in TV – we pay XBX fees and expenses (if outside, we charge)
• Agents would be welcome – especially if they come and tell us what they are up to, or with requests for involvement
Aims of today
• To bring different parts of the training and service initiative together
• To understand what we are all doing• To know where to get help and
collaboration• To start planning what else we want
to do• To get at least 3 useful new email
addresses or phone numbers in our address books …!
Thames Valley
• 3 hubs – Reading, Oxford and Bucks
• Various satellites• Numerous partners• 4 tier model• Working without
county boundaries• TV-wide functions:
recruitment, induction, training, staff support, evaluation, XBX input, awareness training, service advocacy
Thames Valley Initiative service model: outline of tier 1
• Tier 1 is similar to assertive outreach in AMI services: not “office-bound”.
• It needs to be organised with numerous agencies at locality level.
• Individual and joint consultations
• Includes weekly non-exploratory group, drop-ins, various formats
AKA…• Assertive Engagement• Facilitated
Engagement• Active Assessment• Engagement &
assessment• What is the best name
for it?...
Thames Valley Initiative service model: choice & consent in tier 1
• To develop close liaison with all relevant other agencies, for example through “PD Agents” network
• assessment and engagement will be a two-way and continuing process with certain stages and decision points
• this will be related to sharing responsibility with other clinicians, then taking full responsibility in later part of the programme
• we will not take direct referrals in the traditional “passing on of responsibility” way
• the final common pathway to all coming into the services will be individuals’ choice (ie self-referral)
• that will be as informed as facilitated as possible
• with particular emphasis on employing ex-service users in full collaboration, as XBXs
Thames Valley Initiative service model: activities and aims for tier 1
• Telephone advice to members of staff dealing with a potential PDPs.
• Consultation and support regarding individual clients.
• Support to clients who self-refer
• Liaison with all relevant agencies.
• Staff education, by telephone or by TVi staff attending others’ staff meetings.
• Drop-in sessions for potential PDPs.
• Access groups, for PDPs to understand the service and to support them in engaging in further therapeutic work.
• Providing care tailored to each individual that takes account of disabilities, gender, sexual orientation etc.
• Ensuring that everyone can access the service by employing staff from a range of ethnic and cultural backgrounds
• Helping PDPs disengage with other services they may be receiving, as appropriate
Various combinations of different days for different referral groups, iin different locations
Numerous activities in different settings with different agencies, statutory & voluntary.
Tier 1: Assertive engagement and active assessment
Definitive therapeutic activities at different times in the week, for different populations, in different locations
Could include weekend
programmes for those in full time
work or education
Tier 2: Outreach, inreach and “access to therapy”
Whole-time daily programme at service core, with different activities, therapies and groups.Admin centre, also training base.
Tier 3: Day programme: therapeutic community
Half day per week (or less), possibly with overlap into last weeks/months of tier 2 or tier 3 programme. In liaison with other agencies (eg college, employment). Normally thence back to GP care only.
Tier 4: Leaving process – support & recovery
Various combinations of different days for different referral groups, iin different locations
Different activities at different times in the week, for different populations, in different locations
Could include weekend
programmes for those in full time
work or education
Whole-time daily programme as service base, with different activities, therapies and groups.Considerable user-involvement. Also training base.
Numerous activities in different settings, one common weekly “drop-in” engagement group for informal meeting and information sharing
Tier 1: Assertive engagement and active assessment
Tier 2: Outreach, inreach and “access to therapy”
Tier 3: Day programme: definitive treatment
Half day per week (or less), with overlap into last weeks/months of tier 2 or tier 3 programme. In liaison with other agencies (eg college, employment). Normally back to GP care only.
Tier 4: Leaving process – graded disengagement
Referral to more suitable services: occasionally to out-of-area residential units (eg Henderson or Cassel Hospitals) or to outpatient psychology or psychotherapy, when suitable.
Unplanned discharge
Unplanned discharge
Liaison psychiatry
Planned discharge
Young offender services
Planned discharge
For those able, willing, and likely to be helped by going on to a more intensive treatment programme
For those able to take sufficient degree of responsibility for themselves
For those with specific issues, geographical or time limitations, or not best served by daily programme
MIND, RF , etc
CAMHS eg parents
with PD
A&E HV
PCMAPPPs
Prisons SHs
GP
SSDs
Drugs & Alcohol
units
Housing
Homeless services
Univ & College health &
counsellingNHS DirectSelf-
referral
Samaritans
Adult mental health: CMHTs, IP, crisis services, assertive
outreach
ProbationCourt divert
schemes
Forensic
stepdown
Occupational health
PD service model:coordination between local services
Parenting Assessment
Project
Berkshire Local
Strategy Forum
Oxfordshire Local
Strategy Forum Bucking-
hamshire Local
Strategy Forum
Thames Valley Strategy Forum
& ‘Axis 2 Institute’-Training functions only (grey arrows)
-Strategy fora to coordinate services AND training functions
(blue arrows)-Includes administration of service
user input (throughout)-located in one trust or as part of SEDC / TVSHA
-strategic links with other region-wide agencies
-liaison with other regions
Broadmoor Hospital: Psychotherapy & DSPD units
Bucks Axis 2 Service
Berks Axis 2 Service
Oxon Axis 2 Service
Grendon PrisonMilton Keynes PCT / Local
Authority
Local MH services
Local MH services
Local MH servicesREAP
Elmore
Social Services
MINDAssessment Wing F
Therapy Wings A, B, C, D, G
CONNE-CTION
CONNE-CTION
NC(?)
Thames Valley Initiative service model: XBX involvement
• 2 employees are XBXs• Also use pool of ~20 with
sessional rates• Tasks: training, planning
and clinical– Training: almost autonomous,
across agencies (details later)– Planning: local, regional,
national– Clinical: mostly tier 1 and tier 4
– user-friendly introduction to services and supportive network and “getting a life”
“We would all have completed a recognised treatment in order that we have moved on enough to achieve sufficient objectivity to be able to look beyond our own therapeutic needs. The support and social element of the group would be available to people immediately after treatment, but involvement in training, planning and other paid work would not occur until six months after the end of treatment, in order to support people to move on from therapeutic attachments.”
Onwards and Upwards: Berkshire Group
• Climate change• Central resources for
education• Local radio• Need to get something
concrete• Awareness of what we
are doing – promotion & awareness
• Getting involved in TVU nurse training
• Work with CMHTs – events / day conference
• Will work with next lot of agents
• Using what else is within the agents’ group
• NOW!• XBX activity will need
more funding, non-NHS possibilities
Onwards and Upwards: Buckinghamshire Group
• Using agents to influence managers
• Coming on course is more than just the one year itself
• Invite managers into the course to see work being done in project groups
• With TRRT help• XBXs – how
involvement has benefitted
• Central resource of training materials – off-the-pegs
• PD agents y1 & y2 will meet quarterly
• Need to get out to GPs to support and educate (mixed picture)
Onwards and Upwards: Oxfordshire Group
• Sarah’s shopping list• No we can’t do any
more – but we did• How do we keep on
meeting?• Need to connect up
with this year’s PD agents
• Pick up ones who have dropped off the radar
• Rolling out training we have already planned
• Getting help to do that from others
• GPs, other key areas to involve
• Rethink & Mind• Detailed planning
involving TRRT & STARS
• Conference – fuzzy time line – still intended
• PCT roadshows• Reln agents-clin team
• Still need to think about HOW to do it.
The National Personality Disorder Development
Programme
Training plans for the South-EastSue Earley (TVi), Kevin Emrys (TVi), Rex Haigh (SEDC),
Sheena Money (TVi), Sue Robinson (TVi)
14 February 2005Wellshurst Golf Club, East Sussex
Ten Essential Shared Capabilities
• =update of CPF + mapping for WD
• shift in culture in services towards Choice, person-centeredness and mental health promotion is a key imperative
• were significant gaps in pre and post qualification training of all professional staff in their ability to deliver the MHNSF and the NHSP
• Being rendered helpless rather than helped by service use
• embedded in induction and continuing professional /practitioner development
Essential Shared Capabilities 1 & 2
• Working in Partnership. Developing and maintaining constructive working relationships with service users, carers, families, colleagues, lay people and wider community networks. Working positively with any tensions created by conflicts of interest or aspiration that may arise between the partners in care.
• Respecting Diversity. Working in partnership with service users, carers, families and colleagues to provide care and interventions that not only make a positive difference but also do so in ways that respect and value diversity including age, race, culture, disability, gender, spirituality and sexuality.
Essential Shared Capabilities 3 & 4
• Practising Ethically. Recognising the rights and aspirations of service users and their families, acknowledging power differentials and minimising them whenever possible. Providing treatment and care that is accountable to service users and carers within the boundaries prescribed by national (professional), legal and local codes of ethical practice.
• Challenging Inequality. Addressing the causes and consequences of stigma, discrimination, social inequality and exclusion on service users, carers and mental health services. Creating, developing or maintaining valued social roles for people in the communities they come from.
Essential Shared Capabilities 5 & 6
• Promoting Recovery. Working in partnership to provide care and treatment that enables service users and carers to tackle mental health problems with hope and optimism and to work towards a valued lifestyle within and beyond the limits of any mental health problem.
• Identifying People’s Needs and Strengths. Working in partnership to gather information to agree health and social care needs in the context of the preferred lifestyle and aspirations of service users their families, carers and friends.
Essential Shared Capabilities 7 & 8
• Providing Service User Centred Care. Negotiating achievable and meaningful goals; primarily from the perspective of service users and their families. Influencing and seeking the means to achieve these goals and clarifying the responsibilities of the people who will provide any help that is needed, including systematically evaluating outcomes and achievements.
• Making a Difference. Facilitating access to and delivering the best quality, evidence-based, values-based health and social care interventions to meet the needs and aspirations of service users and their families and carers.
Essential Shared Capabilities 9 & 10
• Promoting Safety and Positive Risk Taking. Empowering the person to decide the level of risk they are prepared to take with their health and safety. This includes working with the tension between promoting safety and positive risk taking, including assessing and dealing with possible risks for service users, carers, family members, and the wider public.
• Personal Development and Learning. Keeping up-to-date with changes in practice and participating in life-long learning, personal and professional development for one’s self and colleagues through supervision, appraisal and reflective practice.
More info on 10 ESC
• www.nimhe.org.uk/downloads/78582-DoH-10 Essentials.pdf
• Or Google “Ten Essential Shared Capabilities”