The PDS service is countywide and operates from 2 locations: The Brenchley Unit, Maidstone and - The Ash Eton Unit, Folkestone. The Day Therapeutic Community is suitable for people who have a borderline or other severe personality disorder, who are unlikely to be able to benefit from weekly psychotherapy and who will be able to attend regularly for three days a week, with potential patients needing to have a degree of insight into their problems and be motivated to change themselves and their lives. The day service is an intensive form of treatment that encourages openness in an environment that is safe, supportive and challenging. Therapeutic community principles involve active participation of patients in all aspects of their treatment
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
The Personality Disorder Service (PDS) provides specialist treatment to service users with a diagnosed personality disorder that is severe and/or complex. The service also works with people with a history of multiple service use. Users of the service are likely to have experienced trauma, with difficulties in establishing and maintaining relationships. They will often have a history of self-harming and suicidal behaviour. The Service model is underpinned by the Therapeutic Community core values – attachment, containment, respect, communication, interdependence, relationships, participation, process, balance and responsibility. Over the years the specialist service has developed strategies to meet the increasing demand for its services.
The PDS service is countywide and operates from 2 locations: The Brenchley Unit, Maidstone and – The Ash Eton Unit, Folkestone. The Day Therapeutic Community is suitable for people who have a borderline or other severe personality disorder, who are unlikely to be able to benefit from weekly psychotherapy and who will be able to attend regularly for three days a week, with potential patients needing to have a degree of insight into their problems and be motivated to change themselves and their lives. The day service is an intensive form of treatment that encourages openness in an environment that is safe, supportive and challenging. Therapeutic community principles involve active participation of patients in all aspects of their treatment including:
What makes your service stand out from others? Please provide an example of this.
The service has also been working on developing its relationship with the KMPT Voluntary Services department, with the aim of including past and present service users in their daily activities. Four volunteers with lived experience of Personality Disorder have now been employed by the service to help the Psychotherapists facilitate the therapeutic community sessions. Not only does their first-hand experience benefit current service users but this employment is also a positive influence on their own ongoing recovery. They also act as role models to current service users, providing advice and support.
How do you ensure an effective, safe, compassionate and sustainable workforce?
The service has also been working on developing its relationship with the KMPT Voluntary Services department, with the aim of including past and present service users in their daily activities. Four volunteers with lived experience of Personality Disorder have now been employed by the service to help the Psychotherapists facilitate the therapeutic community sessions. Not only does their first-hand experience benefit current service users but this employment is also a positive influence on their own ongoing recovery. They also act as role models to current service users, providing advice and support.
Who is in your team?
1 WTE band 8a Manager Brenchley: 1.6 WTE Band 7 Occupational Therapist 5 WTE Band 8b Psychotherapists 0.8 WTE Band 8 Psychotherapist 0.2 Band 6 Clinical Research and Audit Co-ordinator 1 Band 4 administration 1 Band 3 administration Ash Eton: 0.8 WTE Band 7 Occupational Therapist 1 WTE Band 8b Psychotherapist 2.8 WTE Band 7 Psychotherapist 1 Band 3 adminstrator
How do you work with the wider system?
The Personality Disorder Service also works closely with specialist support services within Kent. These include Community Mental Health Teams (CMHTs) ensuring people are linked into the appropriate health care services to gain assessment and support with enduring mental health needs. They also work with Crisis Resolution and Home Treatment Teams (CRHTs) and Single Points of Access (SPoA) to provide immediate support for emergency mental health crises, ensuring people get the right help at the right time by the right team.
The Personality Disorder Service, in partnership with colleagues in the field and with the involvement of Experts by Experience, has developed a training programme for professionals working with this client group: ‘Understanding and Working with Personality Disorder’. The training programme and workshops have been offered for a number of years. The Experts by Experience group is comprised of those who have experienced care from a mental health service previously, so have first hand experience. This training programme and workshops aim to facilitate a better understanding of personality development and disorder and the relational difficulties inherent in working with personality disordered clients.
Participants are encouraged to explore their own experiences with colleagues and service users from other agencies in the field and to promote improved service responses to this client group back at the work place. The Personality Disorder Service also signposts their service users to support groups as required. The MEGAN (the Medway Engagement Group And Network) is a Peer Support Group for people with Personality Disorders. It provides opportunities for mental health service users, past and present, to share their views and experiences of mental health issues and services and participate in local service planning and development.
Do you use co-production approaches?
Service users are fully consulted when it comes to making changes to the service. Their views have been sought throughout recent PDS implementation groups. The members were also spoken to at length by the assessors during the Community of Communities (CofC) review. Members are also asked to complete the Friends and Family Test (FFT) and PREM (Patient Reported Experience Measure). The service has also been working on developing its relationship with the KMPT Voluntary Services department, with the aim of including past and present service users in their daily activities. Four volunteers with lived experience of Personality Disorder have now been employed by the service to help the
Psychotherapists facilitate the therapeutic community sessions. Not only does their first hand experience benefit current service users but this employment is also a positive influence on their own ongoing recovery. They also act as role models to current service users, providing advice and support. Current service users have been invited to sit as members of the panel during the review of the Personality Disorder model. This ensures their views and ideas are fully taken into account throughout the whole process. The service users (Community Members) run their own weekly business meeting, where they set their own agenda of items for discussion and chair the meeting. This acts as a forum whereby they highlight issues and ideas for service improvement. The actions from this meeting then feed into the agenda for the staff business meeting, meaning all areas highlighted are fully discussed and addressed.
Do you share your work with others?.
Good Practice is shared internally through Team Meetings, KMPT Quality Newsletters, ‘Peak of the Week’ newsletters and also through communication emails throughout KMPT. Daily community meetings also take place with the staff and group members for good practice to be discussed and shared. The Personality Disorder Service have continued to shared their experience through presentations at a number of professional conferences over the years (national and international), have organised events, a training programme and workshops and also published a journal article about the Personality Disorder service. Updates are also provided monthly at the KMPT Specialist Services Clinical Governance meetings, during team presentations and via presentations by the Psychotherapists at the Consortium of Therapeutic Communities.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The following accounts were compiled as part of an analysis of the Therapeutic Community members’ experiences of the PD Service. This is one of the stages of the Clinical Outcome Project and focuses on the exploration of the processes by which change occurs in therapy practice. ‘I think every element in this programme was helpful. From having small groups, to art therapy to the day a week large group and studio time, these are all fundamental elements to the programme which help and encourage members to interact with each other in a therapeutic and social way.’ ‘I think the flat authority structure and the encouragement of socializing between members outside the unit mean that I did not feel that I was an alien in the world.’ ‘Regular structure.’ ‘Regular reviews to update progress.’ ‘There are people with same condition that understand.’ ‘Meeting people who had the same experience as you.’ ‘Small group and amazingly art therapy where you had more time and space.’ ‘The therapists who really cared and challenged.’
From members (service users): ‘Finding other people who understood where I’m coming from.’ ‘I am more real with people, and surprisingly, people understand that and respond in a genuine way. I express my emotions more freely when I need to.’ ‘I have a lot more confidence, self-worth and feel that I am someone.’ ‘I feel that attending the service has enable me to let go of my identity as a service user and to make changes in my life such as being in full-time employment, continuing my education, moving into my own place, driving again and being in a healthier relationship.’ ‘I will never forget it. The great courage I’ve seen cannot fail to inspire me for the rest of my life.’
Has your service been evaluated (by peer or academic review)?
The Service has been part of the Community of Communities (CofC) a Quality Network of Therapeutic Communities (TCs) since the network was established in 2002. The CofC is based at the Centre for Quality Improvement within the Royal College of Psychiatrists. The aim is to enable services to demonstrate and improve the quality of their work, through an annual standards-based review process. The methods and values underpinning the project mirror the central philosophy of TCs. Staff, client members and ex-client members of participating communities are fully involved at each stage of the process.
How will you ensure that your service continues to deliver good mental health care?
The Specialist Personality Disorder Service (PDS) is implementing a new care pathway strategy; the project will monitor the implementation of this strategy to assess clinical effectiveness and performance and to understand in what ways the care pathway works for people who are users of the PDS. Ongoing reflective practice and development of systematic knowledge about the organisation of treatment delivery, the role and impact of therapeutic interventions based on practice-based evidence continues as a key priority as the PDS implements the new PD Care Pathway. The Clinical Effectiveness and Performance project will include 4 key areas: (a) Performance and Activity; (b) Clinical Outcome; (c) Service user involvement and experience and (d) Working closer with carers and families. Another area will also explore the PDS’s ongoing collaboration with professionals across KMPT services. The new care pathways strategy is being implemented in both PDS locations in West and East Kent.
What aspects of your service would you share with people who want to learn from you?
The recruiting of the four volunteers with lived experience of Personality Disorder has also been a change to the delivery of the model, however has been deemed an important step in adding value to the interventions provided by the service. In terms of the relocation of the Brenchley Unit, it has been very important to be as open and honest as possible with the service users at all times throughout the process. Many of the service users had developed an attachment to the physical surroundings of their previous environment. The Psychotherapists had already provided strategies for the service users not to find themselves in as many highly distressing situations throughout their time in the Therapeutic Community, and therefore the aim of the service was to keep as much continuity in place as possible in terms of emotional support, while the physical environment was changing.
Personality Disorders can have a profound and pervasive effect upon the individual’s capacity to think, behave and feel. While a change in physical environment could therefore be problematic even to those without a diagnosis of Personality Disorder, to those with this diagnosis any changes to the environment can be particularly distressing. The service were therefore focused on meeting the emotional needs of the service users while their physical environment was being adapted. They concentrated particularly in involving the service users fully in all decisions, and making themselves available to provide support and advice when it was required. Some service users who may previously have continued to receive care co-ordination from the CMHT whilst also receiving specialist personality disorder therapy, may not necessarily receive this. The Personality Disorder Service therefore now work even harder at involving the CMHT and crisis teams when required, recognising that the increasing pressures on them may mean means less routine involvement.
How many people do you see?
Approximately 200 referrals received over the past 12 months. Each Therapeutic Community has a maximum of 24 places. In addition to this, West Kent offers outreach groups that feed into the therapeutic community, of which 104 people attend, and a leavers group consisting of 28 people. In East Kent, they offer a smaller introductory group of between 9 and 12 people and a leavers group consisting of 10 to 15 people.
How do people access the service?
Referrals are made either by GP or through secondary care mental health care services, i.e. Community Mental Health Teams. Referrals are screened via a weekly referral meeting.
How long do people wait to start receiving care?
Average wait from referral to treatment is approximately a year.
How do you ensure you provide timely access?
Referrals are screened via a weekly MDT meeting. This specialist personality disorder service offers a treatment programme to complex service users who are in receipt of secondary mental health service care and are on a care programme approach (CPA) pathway.
What is your service doing to identify mental health inequalities that exist in your local area?
The clinical research and audit co-ordinator within the service is undertaking a system for the routine collection of relevant data for monitoring and enhancing service quality using research-based tools to support clinical decisions and service effectiveness. The Clinical Outcome Project has been designed to investigate a broad range of clinical outcomes in routine practice in the Personality Disorder Service with a view to support the establishment of a practice-based evidence culture within the Service providing additional information and insight into the depth and scope of therapeutic practice. A Needs Assessment was also undertaken by Public Health England for Kent and Medway to establish the needs of people with Personality Disorder in Kent.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
The therapeutic community welcomes all adults 18+ into treatment if they meet the eligibility criteria.
What is your service doing to address and advance equality?
All services adhere to legislation in place in relation to equality and diversity.
How do you identify the needs of a person using the service ?
Screening is undertaken via a thorough discussion with the Multi-Disciplinary Team (MDT). The tool used is the Specialist Personality Disorder Service Referral Screening Tool, which has proved useful to decide which clients may be suitable to the service.
How do you meet the needs of people using the service and how could you improve on this?
The Core Standards of the service: CS1 There is a clear Therapeutic Community model of practice that is consistently applied across the service CS2 Community Members are aware of the expectations of Community Membership CS3 Community Members are encouraged to form a relationship with the Community and with each other as a significant part of Community life CS4 Community Members work together to review, set and maintain Community rules and boundaries CS5 There is a structured timetable of activities that reflects the needs of Community Members CS6 All behaviour and emotional expression is open to discussion within the Community CS7 Community Members take part in the day to day running of the community CS8 Everything that happens in the Community is treated as a learning opportunity CS9 Community Members share responsibility for the emotional and physical safety of each other CS10 Community Members are active in the personal development of each other (extract from Community of Communities Service Standards for Therapeutic Communities) The Brenchley Unit has been a member of Community of Communities for 16 years. In this context the Core Standards and Core values together identify common core beliefs, values and structures that are held by Therapeutic Communities.
What support do you offer families and carers?
Consultation events have been held with the family and Carers of people who have used, or currently use the KMPT specialist personality disorder service and other mental health services in Kent and Medway. The Brenchley Unit meeting with carers and families provided a space for sharing their experiences of what was helpful, what was unhelpful and for suggestions for future developments. In June 2017, the East Kent Personality Disorder Service at Ash Eton, Folkestone, held a Family and Friends evening. This event provided a vital opportunity for friends and family members of the Therapeutic Community Members (as well as the service users) to obtain further understanding of what the service delivers and the objectives of the programme, as well as provide support and advice on how the Community Members can be best supported. Feedback was collected following the June event, with family and friends providing valuable insight into how effective they found the evening.
Highlights included: • 80% found the presentations either ‘very good’ or ‘excellent’. • 100% felt supported enough to speak openly about their own experiences. • 100% felt their concerns were addressed. • 80% felt their experience of the event overall was either ‘very good’ or ‘excellent’. A number of participants also chosen to put forward their view on what they learned as a result of the event, and also their view of the service overall: ‘’ It is a very warm and friendly service. My daughter has greatly improved’’. ‘’ I now know that other families are experiencing very similar emotions / challenges’’. ‘’ There is tremendous empathy between the people in the group and they really seem to benefit from this support as well as from the key aims of the whole programme’’. ‘’It was helpful to have a place to talk’’. ‘’This was just an excellent evening. Everyone in the community was so friendly and welcoming and as a parent, it was really good to have the open discussion. Thank you!’’
Further information
Making a difference – the experience of members engagement with the community programme What follows are the experiences of members. This demonstrates in a nutshell how and why the Personality Disorder Service Therapeutic Community programme works for people who use it. Extract (from a member (service user)): What aspects of your engagement with the community programme made a difference for you? ‘Well, the social aspect was a big difference for me as I was, at the time, avoiding contact with the people and had stopped engaging with society full stop.
The routine over 3 days was also very helpful as I was not working and had almost no organised routine at all. I think, though, that the group therapy made the biggest difference to me and it was something I wanted to avoid at first and then, after a while, I embraced wholeheartedly.’ How do you think the therapy has helped? ‘It has helped to look at myself and my behaviour and actively encouraged me to seek change my habits and thought processes. Therapy helped me to understand that I am not different, that it is not just me who feels and acts out and I know that it is normal to have bad days and it will pass. I also feel that my outlook of “Oh, nothing will ever change” has gone now as therapy helped me to understand that I can change things. Anytime.’ Is there anything else you would like to add? ‘Yes, the service is one of the most important places I have ever attended. I find it difficult to express my feelings about the place without resorting to hyperbole but I think the work done here is incredible and it has changed my life completely. The service has made me more open and less angry and it deserves to be funded for every county in the country. It’s been life changing.’
Comments – from members (service users) in the Leavers group: “The community allowed me to access new resources in reworking how I handle life situations. I often return to things that have been said to me re “they are feelings, they will pass”. It also allowed me to look at how I viewed authority and boundaries.” “The community has changed my life. Although I still have no hobbies I have a sense of self I did not have at the beginning.
The critical voice in my head is mostly silent and now is mostly except when I fall back into depression. In being around others I found myself.” “It helped to communicate more with people; I found I was able to get out of bed with the purpose of this community. Belonging here has felt important. The different aspects of therapy throughout the week were very beneficial, giving different opportunities to talk and manage emotions to communicate with people and be supported by the community.” “This therapy has been the most helpful and most complete help I have had from mental health services in all my years.”
Mental Health Nurse (MHN) Student reflections: ‘’The service is a rich and challenging learning environment for students on placement. Spending time here is a great opportunity to learn about individuals with complex needs. It is a space to become familiar with different therapies utilized, such as MBT, Art Therapy and Psychodrama and to participate in group sessions and activities. Students learn how the multidisciplinary team (with their diverse core disciplines and skill sets) and linked services work together to support community members. There is the opportunity to trace the long and challenging pathway members take from outreach, through the community and on to leavers groups. Perhaps one of the most astounding aspects of this community is the focus on the community members to support one another, to learn how to navigate relationships with each other in this open space. It is invaluable to observe and learn how therapists facilitate these processes and crucially, create and maintain the safe spaces for the work to happen. I have been struck by the determination of members to learn new skills and change their lived experience – the community is such a huge commitment. There is also a strong focus on debriefing, feeding back and reflecting after therapy sessions, these sessions are a great learning experience and support for students’’.
https://www.kmpt.nhs.uk/services/personality-disorder-service-ash-eton-community/7211 and also: https://www.kmpt.nhs.uk/services/personality-disorder-service-the-brenchley-unit/7155
Hours the service operates *
Monday to Friday, 9am to 5pm
Population details
Brief description of population
All clients in Kent and Medway, aged 18 +
Size of population and localities covered:
1.8 million across Kent and Medway
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
Local Clinical Commissioning Groups (CCGs)
Provided by (e.g. name of NHS trust) or your organisation: *
Kent and Medway NHS and Social Care Partnership Trust
