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Specialist mental health treatment programme for BPD

By Liz Lockhart

A new specialist service at the Priory Hospital, Middleton St George in County Durham has achieved significant success with the treatment of female patients with Borderline Personality Disorder (BPS).

Dr Heather Roberts, a consultant clinical psychologist, leads the Sandalwood Programme and all aspects of care are psychologically driven within the context of a full multi-disciplinary team discussion. Medication is used judiciously with an emphasis on developing psychological coping skills. Patients also have access to a full range of therapeutic interventions including psychology, occupational therapy, art and health and fitness.

The Priory Hospital, Middleton St George has built up a solid reputation for managing extremely complex patients who were difficult to place elsewhere due to high levels of self-harm.

The opportunities for self-harm were initially reduced by controlling the external environment and utilising medication for symptom relief. However, the determination to self-harm often remained and it was recognised that a psychologically driven culture was needed to successfully treat patients with BPD.

This programme uses DBT (Dialectical Behaviour Therapy) and Schema Therapy as core interventions. Both of these are recognised by the National Institute for Health and Clinical Excellence (NICE) as effective treatments for Borderline Personality Disorder. CBT (Cognitive Behavioural Therapy) is also used.

All of the staff at Sandalwood have completed two core training workshops which provide an overview of diagnosis, trauma, Schema Therapy, DBT and the challenges inherent when working with BPD.

The programme offers a pathway which allows progression through the service as patients recover. The Hazelwood nit offers a higher level of relational security and is suitable for people who are actively self-arming or unstable. The Rosewood Unit, which will open next month, will be a step-down unit and offer a lower level of relational security. It will be suitable for patients who are more stable, engaged in recovery and not actively self-harming.

Since its inception in November 2010 the Sandalwood programme has achieved:

  • A substantial reduction in the use of psychotropic medication
  • A significant reduction in the levels of observation required
  • A reduction of 44% in the number of restraints required
  • A considerable reduction in somatising
  • An increase in the amount and scope of Section 17 leave
  • A number of people well enough and waiting to be transferred to the step-down unit.

‘Many services find it difficult to offer treatment for BPD as the recommended treatments are specialist, resource intensive and often require a long-term commitment from all stakeholders’ said Prof. Bruce Moore, Medical Director at the Priory Hospital, Middleton St George.

‘People with BPD often have multiple admissions to general mental health services without the opportunity to access the specialist services they require. This can lead to an on-going dependency on NHS services over many years and is not cost-effective in the long-term’ he added.

‘The Sandalwood Programme offers a staged approach to assessment and intervention and provides stakeholders with the opportunity to invest resources in a planned programme of treatment wich is transparent and committed to delivering the contracted services. ‘

It works towards recover and enabling people to have a good quality of life outside hospital care, which in the longer term will reduce the demand on NHS funding resources.’

‘The positive outcomes we are achieving are beyond our expectations and we are very excited about the future of the programme. We are confident that the Sandalwood programme at Priory Middleton St George will be seen as the gold standard for BPD treatment in the future.’ Prof. Moore concluded.


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