21/09/2016 Keir Harding Cheshire & Wirral Partnership Trust - PDF document

21/09/2016 Keir Harding Cheshire & Wirral Partnership Trust @keirwales  Not the best service  Not the best staff  (I will ask you some questions as we go along. Type quick or I will feel awkward!)  Have a think….  What might you expect to see?  What might be the core features? 1

21/09/2016  10 Members  2/3 staff at a time  All decisions made by voting  Members run the group – Chair, secretary, link, housekeeper, health&safety  Thursdays 10-3  All time spent together  R&R – Extra time to reflect on actions that worry people. Need to convince people you are thinking about it.  Assessment – Extra time to think about what is stopping you getting here. Need to convince people you’re addressing it.  Participation – People feel you’re not using the group ‘properly’. 4 weeks to address it.  Links Meet  10.00 – 10.45 Business  11.15-12.30 Talk time  Links Meet  1.15 – 2.15 Group 3  2.30-3.00 After group  Links Meet 2

21/09/2016  Members are experts at living with their difficulties.  We act based on discussion and consensus.  We act as equals.  Everything can be talked about.  We balance caring for individuals and each other. • Group therapy • Value for money • Peers help you • Empowered • Other perspectives • We change things to • Safe suit our needs • Encouragement • Choice • Doing things • Equal with staff differently • We are the experts • Connection • Responsible (Remember this one!!!) • Not ‘something that’s • Understanding done to us’. • Use our experiences • Less alone Lees, Manning, & Rawlings, 2004 Mitchell, Wilson, & MacKenzie, 2007 2002 Smith, Gates, & Foxcroft, 2006 Nice Guidelines BPD 3

21/09/2016  The qualitative findings indicate underlying changes in thinking that may account for some of the measurable changes in members' mental health and functioning  Services enable individuals to address two main problem areas: relating to others and self-harm.  The study suggests that once-weekly TCs provide an effective therapeutic approach to the problems associated with personality disorder.  Hodge et al 2010  Significant improvements in both the mental health and social functioning of service users. Changes in patterns of self-harm and service use were suggestive of possible underlying improvements. We also found evidence of the possible offset of costs within 16 months of an individual leaving one of the services.  Conclusions: This study suggests one-day therapeutic communities may be both clinically- and cost-effective for people with personality disorder  Barr et al 2010  What is a TC?  Where is the magic?  Who joins?  Ethics?  Evidence? 4

21/09/2016  Gask 2013  General principles of management include consistency, reliability, encouraging autonomy, and the sensitive management of change  A sense of belongingness is correlated with improved self-esteem and overall well- being. The capacity for responsible agency is central to behavioural change.  TCs are typically used in fields where positive outcome requires both personal growth and behavioural change.  We suggest that TCs are uniquely placed to demand such growth and change of their members • Supported • Understood • Understanding • Connection • Friendship • Connected • Connection • Connected? • Accepted • Connected • Hard to accept care • Need to share • Liked for yourself • Get out what you • Cant help everyone put in all the time • Support 5

21/09/2016  Graded Activity  Focus on what people want and need to do  Putting thoughts into words  Using words to get what you want/need  Keep client active in problem solving  What will you DO to survive/get life more like you want?  Think again…  What would be the biggest challenges to setting up a service like this in an area that has never experienced this way of working?  A specialist personality disorder service  A clinician who had worked in a day TC   A strong association with a formal, structured therapy.  No money 6

21/09/2016  Conference with ex TC service users  Highlighting that “doing things to people” didn’t work for all.  Recruiting allies  Lower expectations  Recruit staff  Venue  A good enough service is better than a gold standard one that doesn't exist  Visit places that are doing it. 7

21/09/2016  Convince people to give you their time for no immediate reward  Evangelise  Secondment opportunities  Working differently  “If you build it they will come”  Great facilities Vs Costing nothing  Lunch  Phone  WE WILL TALK ABOUT IT!!!!  What will you do if....  Learning that rationale decisions can be made  Events are things to learn from rather than to be avoided 8

21/09/2016  Rules that hammer home personal responsibility  Structure designed with service users. A failure?  Steering group – Reflect the reality that we are hosted by the NHS.  Expectations  Are we being tricked  Old shoes are really comfortable  Thinking hats on…  What might a good enough member of staff do in a service like this?  Role? Way of being? 9

21/09/2016 • Listen • Don’t do things for • No judgement you • Question/Prompt • Allow people to sit • Model something with difficulty • How to talk and • Slow things down? listen • Step back? • Explore things • Increase • Question the usual responsibility ways of doing things  Have you told...Vs ...is ****ing useless  Direction Vs Learning what happens  Being good Vs being neglectful  Genuine  Equal  Silent  Reflective 10

21/09/2016  Hearing a voice “kill your mum”  Kill self to protect mum  3 days without sleep  Told no one else  “Do something!!!”  Resisted being handed the phone  Kept talking about it  Noticed the fury  “Make someone see her!”  The group have set up a whatsapp account  Initially very supportive  Eventually fraught & terrifying  Steering group  Rules for the use of the app? 11

21/09/2016  Emphasised the ‘outside contact rule’  Noticed that relationships could also be difficult  No attempt to control  Is being on whatsapp compulsory?  Anything can be talked about...  Any thoughts?  Views?  Questions?  Comments? Keep the conversation Keir.Harding@cwp.nhs.uk @KEIRWALES going! 12