Training and Education
Suicide Alertness and Intervention Skills
Any service working with any user group would benefit from training staff and volunteers in Suicide Alertness and Intervention skills and there are a number of different courses available to suit any model of service from those who simply provide signposting or occasional contact to services who provide more intensive support.
Training is usually free and details of how to access it are available on the Choose Life website at www.chooselife.net
As well as the training, many Local Authority Areas have a Choose Life Co-ordinator who can work directly with services to help them develop organisational alertness to the risk's of suicide and support them to become 'suicide safer' for their clients, staff and volunteers. Details of how to contact the Choose Life Co-ordinator in specific areas are also on the website.
Cliff Watt
Locality Manager and Choose Life Co-Ordinator Aberdeen City
Maria Duggan spoke in one of our first conferences on the findings of the English capabilities framework which was an assessment of training needs in England and their findings that a considerable up skilling of workers was required to work effectively with people with personality disorder.
DBT, Mentalisation based treatment, STEPPS and CBT have all been presented at SPDN conferences as approaches for delivering care to patients with personality disorder. (see treatment and treatablity section for description of theoretical models). Future developments
The Mental Health Delivery Plan, published by the Scottish Government in December 2006 (Link), made a commitment to increasing the availability of psychological therapies to a broader group of service users. This group will include those with personality disorder and will help to alleviate the perceived exclusivity of psychoses as the only "severe and enduring" mental illness
This commitment will have considerable implications for workforce training requirements and NHS Education Scotland appointed Geraldine Bienkowski, Clinical psycholigist as ........... to help facilitate the process.
A document called the matrix ..... was produced outlining the means by which NHS health boards can hope
Mentalisation based treatment (MBT) was presented by Professor Anthony Bateman. Professor Bateman is a highly acclaimed psychotherapist and researcher who has devised evidence based manualised treatment using attachment theory as the underpinning knowledge base. The great advantage of this approach compared to traditional psychodynamic psychotherapy approaches is that it has manageable training requirements. There is a body of clinicians interested in pursuing this training in Scotland and evaluating it across Scotland.
Dialectical Behaviour Therapy (DBT) has been presented from a number of perspectives. This manualised therapy which has its basis in CBT, mindfulness and Buddhism was first described by Dr Linehan in USA as an effective intervention for women who self harmed. It has since diversified and is being used to treat people with a diagnosis of borderline personality disorder. Professor Reid pointed out that the evidence base was not as robust as for CBT or Psychodynamic psychotherapy. Dr Michael Gotz, Consultant Psychiatrist has been trained along with his clinical team in DBT and presented their experience. The patients appreciated the time invested in the therapeutic approach which is considerable but he wasn't sure that this was a reflection of the specific intervention. He found the model very "American" and difficult to translate to his patient population, the training was demanding and the time investment in therapy per patient considerable. The final results of the project are yet to be gathered and we would hope to hear from him again at that point.
Cognitive Behaviour Therapy (CBT) has been researched by Professor Kate Davidson in Scotland as part of a British multi centre trial with considerable numbers of patients participating and positive outcome. One of the points Professor Davidson stresses is the need for therapists to be trained and supervised to keep to the therapeutic model.
Future developments
A more thorough assessment of training needs for working with PD can be gained from the work in England as described above. It is hoped we might utilise this through NES and not need to repeat the exercise in Scotland.
The Mental Health Delivery Plan, which was launched in December 2006, makes a commitment to increasing the availability of psychological therapies available to a broader group of service users. This group will include those with personality disorder and will help to alleviate the perceived exclusivity of psychoses as the only "severe and enduring" mental illness.
The need for training in working with PD is well documented. This does not just refer to specialist interventions but to generic health workers who need to have a model in which to understand the complex and sometimes provocative nature of interactions that can occur.
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