| |  | | | | Dialectical Behaviour Therapy | | | | | | | | |  Spring Hill House provides a specialist service for adult females with a diagnosis of Borderline Personality Disorder, who have been detained in hospital for a lengthy period as a function of serious suicidal, self-harming and aggressive behaviours. This programme is based on the principles and practices of Dialectical Behaviour Therapy (DBT) and is provided within a 20 bed female only facility.
Admission Criteria
 Female
Age: 19-45
Borderline Personality Disorder - uncomplicated by learning disability or frank mental illness
Intellect - Low Average or above
Subject to Treatment Section of the Mental Health Act 1983 (or equivalent)
Not subject to current criminal proceedings, remand or prison sentence
Presently in secure environment and/or subject to 24hr 1:1 or greater observation
Detained in hospital for more than one year and without current discharge plan
Commitment - the patient must be willing to commit to the Dialectical Behaviour Therapy Programme within Hereward Wake Ward at St Andrew's Hospital for a minimum period of one year
Funding - a funding agreement must be in place prior to the patient's Commitment (see assessment procedures below)
Treatment - patients are not accepted for long term care, but a treatment package, following which they must return to the referrer's care. A guarantee is required from the referrer that the patient will be taken back with alacrity in the event the patient is unable to meet her Commitment and withdraws from treatment
Referral Information Required
Patient's demographic information
Personal history
Details of present admission
Present Care Programme Approach (CPA) Care Plan
Present Risk Assessment/Management documentation
Details of Section, classification of disorder and date of detention
Details of previous admissions
A selection of past and recent reports (e.g. for Mental Health Review Tribunals)
Present medication
Present RMO and contact details
Catchment area RMO and details
CPA Key Worker and details
Proposed funding authority (including contact details)
Assessment
There will be a minimum of two Pre-Admission Assessment Visits (PAAV) from members of the Clinical Team. The process of Pre-Admission Assessment and waiting times for available beds preclude urgent or rapid admission. Admission will inevitably be delayed by months.
The final PAAV will take place only after all the information has been collated, funding has been agreed, a guarantee has been received from the referrer to take the patient back in the event the patient withdraws from treatment, and it is evident the patient will Commit to treatment.
At the time of the last PAAV the decision regarding admission will depend entirely upon the patient's Commitment to treatment. Commitment is a process rather than the signing of an agreement. It includes a full explanation of the diagnosis and why the diagnosis has been made; thorough orientation to the treatment and its contents; and some discussion of the problems patients have had in treatment previously. The patient commits to stay in therapy for a specified, usually lengthy period of time, to attending the scheduled therapy sessions and to working towards reducing suicidal and parasuicidal behaviour as a goal of therapy. She commits also to work on problems that arise which interfere with the progress of therapy.
Treatment Programme
Dialectical Behaviour Therapy
DBT is a manualised cognitive behavioural therapy for Borderline Personality Disorder. At its core it attempts to balance a relentless insistence on problem solving informed by behavioural principles and techniques, with an attitude of acceptance embodied in validation, empathy and a radical acceptance of how things are "in the moment".
For further information on DBT, visit www.behavioraltech.com
Treatment Targets
The list of Programme treatment targets is specific, including only those targets that need to be accomplished in hospital. The targets are the goals and objectives of the treatment as agreed at the time of Commitment and subsequently.
Life threatening behaviours (self and others)
Treatment destroying behaviours by either the patient or others
Behaviours prompting hospitalisation
Acquisition of skills, especially crisis survival skills
Planning of a stable discharge
DBT Continued...
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