Download Using this template - Scottish Personality Disorder

Borderline personality disorder
Implementing NICE guidance
2009
NICE clinical guideline 78
What this presentation covers
Background
Scope
Key priority areas for implementation
Costs
Discussion
Find out more
Characteristics
• Borderline personality disorder (BPD) can be seriously
disabling and often takes a huge toll on the individual.
• It is characterised by a pattern of instability of
interpersonal relationships, self-image and affects, and
by marked impulsivity.
• A common factor is history of traumatic events during
childhood and adolescence.
• People with BPD are among the most likely to
use mental health services.
Particular risks
• BPD is particularly high in the prison population.
• Suicide is a particular risk in BPD.
Scope of guidance
• Adults diagnosed with BPD; young people with
borderline symptoms and people with learning
disabilities and BPD.
• NHS services providing treatment.
• Interface with other services.
• Effective clinical management.
Key priorities for implementation
• Access to services.
• Autonomy and choice.
• Developing an optimistic and trusting relationship.
• Managing endings and transitions.
• Assessment.
• Care planning in community mental health teams.
• The role of psychological treatment.
• The role of drug treatment.
• The role of specialist personality disorder
services within trusts.
Access to services
• Equal access to health and social care services
regardless of diagnosis or a history of self-harm.
Autonomy and choice
Work in partnership with people with borderline personality
disorder to develop their autonomy and promote choice by:
• ensuring they remain actively involved in finding
solutions to their problems, including during crises
• encouraging them to consider the different treatment
options and life choices available to them, and the
consequences of the choices they make.
Developing an optimistic and
trusting relationship
• Explore treatment options in an atmosphere of hope
and optimism, explaining that recovery is possible and
attainable.
• Build a trusting relationship, work in an open, engaging
and non-judgemental manner, and be consistent and
reliable.
• Bear in mind when providing services that many people
will have experienced rejection, abuse and trauma, and
will have encountered stigma often associated with
self-harm and borderline personality disorder.
Managing endings and
supporting transitions
The ending of treatments or services, and transition
between services can evoke strong emotions and reactions.
• Anticipate, discuss, structure and phase changes
carefully beforehand.
• Build collaboration with other care providers into the care
plan during endings and transitions – include access to
services in times of crisis.
• Ensure and agree support during referral periods
to other services.
Assessment
Community mental health services
(community mental health teams,
related community-based services,
and tier 2/3 services in child and
adolescent mental health services –
CAMHS) should be responsible for the
routine assessment, treatment and
management of people with borderline
personality disorder.
Care planning
Comprehensive multidisciplinary care plans developed in
collaboration with the service user.
• Identify the responsibilities of health and social care
professionals.
• Manageable treatment aims and specific steps.
• Long-term treatment strategy underpinned by realistic
goals linked to short-term treatment aims.
• Crisis plan for when self-management strategies are
insufficient.
• Share care plan with GP and service user.
The role of psychological
treatment
Service characteristics
•
Explicit and integrated theoretical approach – shared
with service user.
•
Structured care in accordance with guideline.
•
Provision for therapist supervision.
•
Consider twice-weekly sessions according to need and
context.
•
Do not use psychotherapeutic interventions of less
than 3 months’ duration.
The role of drug treatment
Drug treatment should not be
used specifically for borderline
personality disorder or for the
individual symptoms or behaviour
associated with the disorder (for
example, repeated self-harm,
marked emotional instability, risktaking behaviour and transient
psychotic symptoms).
The role of specialist
personality disorder services
• Assessment and treatment services.
• Consultation and advice to primary and secondary care services,
and diagnostic services to assist general psychiatric services.
• Facilitate information sharing and collaboration, and ensure
communication between primary and secondary care.
• Provide or advise on social, psychological and drug treatment,
and on programmes on diagnosis and management.
• Oversee the transition of young people to adult services.
• Support, lead and participate in development of treatments.
• Oversee the implementation of this guideline.
• Monitor services for minority ethnic groups.
Costs
• Training healthcare professionals in recognition,
diagnosis and treatment.
• Establishing multidisciplinary teams.
• Cross-organisation communication.
• Consultation and treatment with a learning disabilities
specialist.
• An increase in the use of services because of greater
awareness/diagnoses.
• Provision of patient literature and video materials
for treatment options.
Discussion
• What services currently exist in this area?
• What provisions do we have for people from minority
ethnic groups or whose first language is not English?
• How effective is communication between services?
• How do we manage people with learning disabilities?
• How do we build openness and optimism?
• What are current local prescribing practices?
Find out more
Visit www.nice.org.uk/CG78 for:
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the guideline
the quick reference guide
‘Understanding NICE guidance’
costing report
audit support