DBT pilot Forth Valley: Trials and errors

1. DBT pilot Forth Valley:Trials and errors

3. The beginning: something must be done • Existing patients with BPD: time consuming, distressing • No coherent approach • BPD patients drift towards certain therapist • Some therapists ‘don’t mind BPD’

4. Numbers: in-patients 17th May 2005

5. Numbers: outpatients

6. Numbers: out-patients • Forth Valley population 200.000 19-65 • 1%: 2000 no way!! • Outpatient clinic: 10% • 10 GA consultants: 20 BPD each, 10 ‘on the go’ • About 100 patients ‘on the go’ • Cornton Vale Prison (female)

7. The plan • Use the staff who see BPD patients anyway • Increase staffs’ skill • Funding: Choose Life Initiative • Collect data: lots • Don’t tell management • Don’t think beyond the pilot

8. Would you like to receive training in DBT? • 85 nurses shout: yes!! • Selection by persistence

9. Selecting therapists 1. Are you/ currently dealing with BPD patients? 2. How much time do you spent on such patients? 3. Can you/ your team afford to spend more time on such patients? Would you like to? 4. Do you have time for the training? 5. Will you have time for once weekly supervision? 6. Do you have a room to run group sessions in? • Have you discussed your application with the local consultant psychiatrists/ service managers? • How did they respond?

10. Training days • 6 therapists • Chester 1st training week October 2005 • Start treatment beginning Jan 2006 • Once weekly group therapy (two groups) • Once weekly team meeting • Chester 2nd training week June 2006

11. Data collection Pre- programme: • Staff and patient questionnaires • Patient demographic information (incl. number of suicide and self harm attempts, medication use, admissions to hospital) • Psychometric tests (GAS; HADS; DAST; SADD) During: • Weekly patient session evaluations • 8 weekly staff questionnaires/ evaluations • Weekly therapist time logs • Psychometric tests and demographic data to be collected after 6 months. Post programme: • Staff and patient questionnaires • Demographic data • Psychometric tests Follow-up: • Demographic data • Psychometric tests.

12. Number games • 16 patients (15 f, 1m) • 3 patients have dropped out so far

13. Pre and during programme data

14. Patient feedback • “There are other people the same as me” • “they are teaching me to manage my problem” • “It’s overwhelming”

15. Summary of Results • low drop – out rate • Less often suicide attempts • Less alcohol, less time on psychiatric ward • Depression and global functioning the same • Most patients appreciative of intervention

16. Therapists’ time per week

17. DBT: The problems • It ain’t english • time consuming: 3.5 hours therapist’s time per week per patient • Hidden and open criticism from some colleagues • Rocking the boat • What happens when therapy stops

18. The delights • Patients • Good adherence • They appreciate our efforts • Remarkable improvement in a minority • Therapists • Sense of purpose and direction • Cohesion

19. A sense of purpose and direction? • Treatment for PD rather than avoiding patients • vehicle for a service development – even if it isn’t DBT!

20. The active ingredients • Validating environment • A structure • Being removed: ‘the specialists’ • Skills based: teaching patients to manage themselves

21. How to do it better next time • Involve management early • Think of the time beyond the pilot • Try two different models simultaneously • Don’t underestimate the time