Thursday, 11 January 2018

Consensus statement ...nearly

After a monumental struggle to herd the cats, Sue Sibbald, Alex Stirzacker and Norman Lamb managed to get eight felines into the bag:
  • Mind
  • Centre for Mental Health
  • Royal College of Nursing
  • British Association of Social Workers
  • Royal College of General Practitioners
  • British Psychological Society 
  • Anna Freud Centre
  • Barnet, Enfield and Haringay Mental Health Trust

One more joined the party, the next day, perhaps after being shamed into doing so - the Royal College of Psychiatrists.

Here are the links to the statement itself and the BBC webpage on it.

The gang of three - plus the Man from Mind - at the parliamentary launch of the Personality Disorder Consensus Statement

Here's the briefing from GBL, some of which is in the Consensus Statement itself, and some of which found its way into the BBC News piece:

Some key facts and figures on ‘personality disorder’
·         Though PD is most visible in forensic settings (ie linked to public safety and dangerousness), the size of the problem in general mental health settings is hardly ever recognised. It affects, at some level of severity:
o    Between a third and two thirds of all psychiatric inpatients
o    92% of homeless people
o    60-80% of prisoners
o    Up to a quarter of GP consultations in inner city London
·         Suicide rate for Borderline PD (= “Emotionally Unstable PD”) = 10%;
o    this means people diagnosed with it are 400 x likelier than the national average;
o    Epidemiology figures indicate that at least half of all suicides ‘have some PD involvement’
o    On average, people with PD live 17 years less than the general population (including other reasons as well as suicide)
·         It costs a fortune, one estimate gives
o    £34bn (yes, not million!) for general management costs across all health services
o    £14½m for inpatient stays
o    Yet only 55 beds are commissioned by NHSE for severe cases

That’s the bad news, here’s something a bit more positive:
·         17% of areas had dedicated community PD (ie non-forensic) services in 2003, now (2016-7) it is 79%
·         Since the launch of the national training programme, over 100,000 frontline staff have received awareness and attitude training

Some opinions on ‘personality disorder’
·         Although most public interest is in forensic PD, that is relatively well-resourced
·         The lack of understanding of PD in general mental health services is a public health scandal
o    That lack of understanding is at least as significant as the lack of NHS resources (especially beds)
o    Many private hospital providers make their profits by providing bed-based services which rely on this lack of understanding
·         The vast majority of people with these problems do not get help from NHS – they suffer loneliness, isolation, social exclusion and desperation without knowing that help is possible. Many kill themselves without anybody else ever knowing. Many others manage to cope with help from voluntary organisations, churches and other religious groups, and random kind people.
o    The NHS is very wary of taking people with these complex problems onto its lists – partly because they are so short of resources – but also because these conditions are often seen as ‘untreatable’ and potentially a waste of what resources they do have.
o    Also, suicides are increasingly seen as unacceptable in mental health services (eg ‘zero tolerance’ programmes), and people with these conditions are at high risk. So, without deliberate direct intent, it is ‘convenient’ to find them untreatable, so that the suicides of those unregistered people with ‘PD’ are not counted as mental health failures by the NHS.
·         Cross-departmental work is needed to address this at policy level: the National Personality Disorder Development Programme did this (across DH, MoJ, DCLG and DfE) but was stopped in 2011.
·         The only national coordination is now through the IAPT programme, which is does not have sufficient scope to be fit for the task.

Please contact me if you would like more information, or would like to be put in contact with other experts.
Dr Rex Haigh, NHS Consultant Psychiatrist in Medical Psychotherapy; Clinical Advisor to National PD Development Programme, 2002-2011.

These opinions are not necessarily those of organisations for whom I work.

Overall, a lot of work and conflict contained in many struggly months - and a worthwhile day at the end of it. Maybe it's a new start for doing something meaningful about the ghastly industrialisation and corporate fascism of public service mental health. But it's a shame...
  • That RCPsych wasn't enthusiastically in there from the beginning
  • The BBC piece used a rather frightening forensic case to open it
  • More journalists were not at the launch - to write more about it in broadsheets etc
  • The statement itself is not more slickly produced (not something I usually complain about!)
  • Paul Farmer from Mind couldn't be there
  • NHS England were only there in disguise - when Simon Stevens should have been
  • It doesn't link up with anything else going on in the field (eg BIGSPD, specialist commissioning, innovative services, relational practice and enabling environments, great progress in the homelessness and justice sectors).
  • Nothing is on the horizon for joined-up leadership of the field - and the kerfuffle with the RCPsych being left out didn't help. But thereby lie dragons.
  • It was the greyest, darkest, drizzliest January day in lining memory. London at its most iconic.

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