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 Personality Disorder
is everybody’s
Knowledge and business
Understanding
Framework
Implementation
Recognising
Complexity
What’s driving this?

National PD programme set

up to establish evidence on: Within the
Public protection legislative
framework of
Health and social outcomes – human rights,
ongoing research programme mental health &
criminal justice
Social inclusion
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 Less educational

early intervention disruption
with children, Less educational failure
young people and Fewer children taken
families into care
More young people on
the path to success
Recognising Complexity
Potential cost benefits

appropriate use of
Primary care
Reduced Prescribing

Community PD Reduced harm from drug

services and alcohol abuse
Reduced risk of
(Tiers 1 to 3) offending
Reduction in A&E use

Improved Family life,

education and
employment
Improved staff retention
Recognising Complexity
Potential cost benefits

Less escalation to more

secure/intensive
Severe and services
complex PD Reduced risk to self or
others
(Tier 4)
Managing the challenge
to services
Recognising Complexity
Potential cost benefits

Less escalation to
prison, segregation,
Severe PD, high secure or forensic
risk of harm to placements
others Strengthened
community
(Tier 5) 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?
nick.benefield@dh.gsi.gov.uk
rexhaigh@nhs.net
clare.stafford@dh.gsi.gov.uk

www.personalitydisorder.org.uk