Personality
Disorder Service
Chadwick Lodge, Hope House
PROVIDING QUALITY INSPIRING INNOVATION DELIVERING VALUE
Set within access to a thriving community, Chadwick Lodge offers a comprehensive specialist personality disorder service supporting women to complete a personalised treatment programme and health plan. The goal is to progress the person back to a life outside the hospital environment or to other care environments as part of the care pathway.
At the right time, access to the local community is a vital step for promoting service users’ long term independence. With access to various activities, shops and community colleges we can ensure that external activities on the programme can be fully tailored to the person’s interests.
The new locked Personality Disorder Service at Hope House within Chadwick Lodge, provides a three stage, 12 month recovery-focused programme with Dialectical Behaviour Therapy (DBT) at its therapeutic centre. The skills taught within the DBT programme promote greater self awareness, and will also teach the individual to build resilience while managing overwhelming situations more effectively.
“I am confident that I will never be in hospital again and I can live a normal life
1”
1All service user quotes are their own
Personality Disorder Service, Hope House
Through the DBT programme, the multidisciplinary team will support service users to:
• manage life outside of hospital safely
• engage in voluntary or paid work
• enjoy healthy relationships
• explore their own interests
• move forward to a future they have planned and worked hard for
The programme provides the service user with the opportunity to learn and practice key skills in stage one, and through stages two and three, use these to take ‘positive risks’ for their future:
we believe that exposing individuals to new situations during these last few months is imperative to ensuring a successful discharge. Every service user has a minimum of three service user led Care Programme Approach (CPA) meetings during their treatment programme, at three months, nine months and pre discharge. Milestones will be set at the initial CPA to monitor the service user’s progress over the 12 months.
The final stage of the DBT programme will focus on relapse prevention and the building of life skills in preparation for the community. It is envisaged that during the final stage of the
programme, the service user will be considering registering at college and/or looking for voluntary work, based on work completed in the treatment programme and health plans and interests developed during their time on the unit.
“I have now gone almost six months without any form of self-harm, I feel much more positive about my life”
The dialectical behaviour therapy programme
Service users may have a history of one or more of the following:
• primary diagnosis of Borderline Personality Disorder (BPD) or emotionally unstable personality disorder
• presenting symptoms that match the criteria for BPD but without a formal diagnosis
• numerous contacts or admissions with mental health services
• co-morbidity with other disorders, such as eating disorders, mood disorder, post-traumatic stress disorder and/or substance misuse
• a history of trauma and/or abuse
• a high incidence of risk to self, such as self-harm and/or suicide intent
• step-down from a low secure BPD treatment programme
• step-up from an acute service or transition from an adolescent unit
Outcomes: our service users’ success
We regularly monitor our service users’ physical and mental healthcare needs to ensure that they receive the very best, nationally-recognised treatment throughout every stage of their care.
The graph below evidences a reduction in the total of deliberate self-harm (DSH) episodes for five service users over a period of ten months from admission at one of the Priory Group’s hospitals in Roehampton where the same therapeutic treatment model is employed.
22 Outcomes are based on a study at one of the Priory Group’s hospitals at Roehampton 2012/13 following the same 12-month recovery-focused programme with Dialectical Behaviour Therapy (DBT) at its therapeutic centre.
N u m b e r o f e p is o d e s o f se lf -h a rm
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10
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DSH Episodes
0 2 4 6 8 10 12 14 16 18 20 22 24
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Service user profile
Rachel* is approaching the end o f a year in the DBT programme a nd is preparing to discharge after more than a decade in hosp ital. Rachel is a 27 year old femal e with a diagnosis of borderline personality disorder (B PD), eating disorder and complex post traumatic stress disorder (PTSD). She has no know n family history of mental health problems but a breakdown in family relationships from a you ng age meant she endured emot ional, sexual and physical abuse. She has never been emplo yed and been in hospital on a Se ction 3 since December 2001 when she was 15. She was referre d to social services in 1996 for dif ficulties in school and was detained under the Mental Healt h Act at the age of 15. She regula rly self-harmed and took multiple overdoses in summer 20 01 and was subsequently admitt ed to child and adolescent mental health services (CAMHS) and then at 18 transferred to in-p atient adult services. At the age of 24 her behaviour escalate d, becoming disturbed and high r isk which led to two transfers to manage her risk. She was adm itted to one of the Priory Group’s hospitals at Roehampton, in July 2012 aged 26.
Rachel had refused therapy thro ughout her 12 years in hospital b ut accepted therapy within the Priory. She feared rejection a nd believed she didn’t deserve to get better. However she attended all sessions and compl eted individual DBT therapy, a D BT skills group, DBT skill coaching group and psychoeduc ation groups. She engaged in m indfulness therapy every day and extended mindfulness once a week. The therapeutic work ai med to create a life worth living for Rachel by managing he r symptoms, building structure, d eveloping skills and to respond to situations through ch oice.
As she prepares for discharge, Ra chel is beginning to make links with the community and ha s established goals for her reintegration. She has developed emotion regulation skills and increased her awareness of uniq ue warning signs. Supportive housing has also been arranged for her.
‘I have found the skills that I h ave learnt within the programme very helpful and th ink they will help me to have a much happier life outside of hospital. I am very grateful for these skills.’ Rachel
*Name has been changed to protect identity
