Personality Disorder - Everybody’s Business

Personality Disorder Everybody’s Business July 2009

The impact of PD People with personality disorder may suffer lives of rejection, anguish and alienation. The effects on individuals, families and society can be pervasive, chaotic and expensive - and cross many organisations, services and systems.

The context ….  Policy guidance in 1999 & 2003 has led to considerable progress 

but locally services are still patchy

 2009 brings together key guidance  

to support change and leadership at regional and local levels

A ‘tipping point’ for personality disorder…

Focus for the day NICE Guidelines Bradley Review Knowledge and Understanding Framework Recognising Complexity

Personality Disorder is everybody’s business Implementation

What’s driving this? National PD programme set up to establish evidence on: Public protection Health and social outcomes – ongoing research programme

Social inclusion

Within the legislative framework of human rights, mental health & criminal justice

Why is PD important? 5 – 13% general population 20 – 50% substance misuse attenders 50 – 78% of prisoners 47 – 77% of people who commit suicide 50% of children with conduct disorder and many care leavers

Recognising Complexity

Commissioning guidance for PD services

Aims to support commissioners to work collaboratively to address need and improve outcomes for people with PD

Recognising Complexity Benefits of effective commissioning

 Can lead to improved quality of life for individuals and families  Get people back to work and education  Reduce pressure on staff and public sector organisations

Recognising Complexity Public service targets

 PSA 12  emotional health and well-being of children and young people

 PSA 14  increase number of children and young people on path to success

 PSA 16  increase proportion of socially excluded adults in settled accommodation, employment, education and training

Recognising Complexity Public service targets

 PSA 18  promote better health and well-being for all

 PSA 23  make communities safer

 PSA 25  reduce harm caused by alcohol and drugs

Recognising Complexity Commissioning for complexity

 Recognising overlapping client groups with:    

learning disability substance misuse offending behaviour think PD

 Encouraging effective pathways  think cooperation, co-production

 As part of other required duties and needs assessments  think PD

 Equalities matter  think PD

Recognising Complexity Effective commissioning

 Service user and carer involvement  Commissioning for outcomes  Quality and skills of staff

Recognising Complexity World class commissioning

   

Leadership Collaboration Involve patients/communities Engage with clinicians

Recognising Complexity Potential cost benefits

Reduction in conduct disorder

Prevention and early intervention with children, young people and families

Less educational

disruption

Less educational failure Fewer children taken

into care

More young people on

the path to success

Recognising Complexity Potential cost benefits

appropriate use of Primary care Reduced Prescribing

Community PD services (Tiers 1 to 3)

Reduced harm from drug

and alcohol abuse

Reduced risk of

offending

Reduction in A&E use Improved Family life,

education and employment

Improved staff retention

Recognising Complexity Potential cost benefits

Severe and complex PD (Tier 4)

Less escalation to more secure/intensive services Reduced risk to self or

others

Managing the challenge

to services

Recognising Complexity Potential cost benefits

Severe PD, high risk of harm to others (Tier 5)

Less escalation to prison, segregation, secure or forensic placements Strengthened

community management

More rational use of

high cost placements

How is this useful to you?  It will support you in     

Whole systems thinking Collaboration across sectors Involvement of service users Leadership Better outcomes for people

Policy in the future Bradley

 Evaluation of treatment options for prisoners  Evaluation of Dangerous and Severe Personality Disorder programme  Interdepartmental strategy

Policy in the future New horizons

A new vision and strategy for mental health and well-being, putting mental health in context of the family, society, employment and the environment. Due out for consultation in July at www.dh.gov.uk

Questions? [email protected] [email protected] [email protected] www.personalitydisorder.org.uk