Women’s Borderline Personality Disorder Services

Silverstone is a specialist comprehensive Dialectical Behaviour Therapy (DBT) unit, specifically for the treatment of women over the age of 18 with a diagnosis of Borderline Personality Disorder (BPD) who often have a coexisting diagnosis of Complex Post Traumatic Stress Disorder (CPTSD).

Women admitted to Silverstone present with complex mental health needs, risky behaviours that can be challenging to appropriately support in community settings, and significantly impaired functioning.

Treatment and care

Dialectical Behaviour Therapy (DBT) is an evidence-based therapy developed by Dr Marsha Linehan in the 1980s. It was originally designed to treat individuals with Borderline Personality Disorder but has since been adapted for a range of mental health conditions. DBT combines elements of cognitive behavioural therapy (CBT) with concepts of mindfulness and acceptance. It operates on the dialectical principle, which means balancing opposing ideas or concepts. In DBT, this often involves finding a balance between acceptance and change.

Our treatment programme on Silverstone includes all five functions of a comprehensive DBT programme:

  • Enhancing capabilities
  • Enhancing motivation
  • Ensuring generalisation
  • Structuring the environment
  • DBT consultation. 

Our DBT provision includes a combination of group, 1:1 therapy and out of session skills coaching for patients (Stage 1 DBT). Patients are divided into two DBT group cohorts depending on progress, a Skills Acquisition Group and a Skills Generalisation Group.

Women who present with ongoing trauma symptoms are offered evidence based trauma interventions following an assessment for suitability once behavioural control has been established (Stage 2 DBT).

Multi-disciplinary clinical team trained in DBT

Silverstone is staffed by a well established multi disciplinary clinical team including expertly trained DBT therapists from a range of professional backgrounds. All DBT therapists are trained by the only licensed provider of DBT training in the UK (British Isles DBT Training). The DBT team has a minimum of two therapists accredited by the Society for DBT UK at any time and also boasts two accredited DBT Adherence Supervisors who support therapist and programme development with a focus on enhancing fidelity to the model. All ward based staff are required to attend training on ‘Behavioural Principles’, specialist skills training including trauma informed care principles and motivational interviewing. Our nursing team receive weekly group ‘consult’ sessions to ensure ongoing monitoring and review of practice.

We recognise the significance of a structured environment in supporting the recovery of women admitted to an inpatient unit for treatment, and as such offer a daily timetable to support with goal setting and building a positive routine. Patients in our care are supported to develop skills in:

  • Support with activities of daily living
  • Self-care
  • Self-catering
  • Self-medication
  • Pursuing educational / vocational activities
  • Promoting independence.

Our patients are very often a long way from home and at times also have limits placed on their access to particular environments. Our experienced Social Work team are available throughout the week to facilitate patients in being able to maintain outward connections. This includes supporting arrangements for contact with family and significant others and ensuring carers involvement in all aspects of care and treatment. Other responsibilities include:

  • Carers/ family work
  • Statutory work
  • Finances /budgeting
  • Housing
  • Diversity needs
  • Discharge planning / External stakeholder liaison.

Admission criteria

  • Adult women who meet the diagnostic criteria for Emotionally Unstable Personality Disorder – borderline type (ICD F60.31) and Complex PTSD(ICD 6B41).
  • The patient will present with management difficulties that require admission for inpatient treatment, either on an informal basis or under detention of the Mental Health Act 1983 (as amended by the Mental Health Act 2007). The problems and behaviours will require significantly enhanced relational, procedural, security and/or physical security for their safe management. 
  • The patient will be of at least low average intelligence. 
  • The patient will require at least one year's treatment in the DBT programme.  There will be a reasonable expectation that the patient will Commit to the treatment according to DBT principles and remain in the programme for one year. 
  • The patient will be agreeable to committing to a full inpatient DBT model of care and will be given information regarding the Support Level Framework utilised on Silverstone ward with consideration for consent and capacity at the time of assessment.  
  • If the patient does not commit to the DBT programme before the first CPA/Section 117 Discharge Planning Meeting (held after three months), or subsequently breaches her Commitment and leaves the DBT programme, we would request that an alternate placement is sought. This measure is required to ensure that the therapeutic milieu of the unit is not disrupted by patients who are not participating in the DBT treatment programme. 

Vocational, educational, creative and therapeutic interventions tailored to individual needs

The St Andrew’s site provides an unrivalled range of facilities. Delivered by an extensive multi disciplinary clinical team, patients are able to access a multitude of vocational, educational, creative and therapeutic interventions tailored to their specific mental and physical health needs. These include beauty therapies, dentistry, a physical healthcare/ on site GP, dietetics, physiotherapy, sports and exercise therapies, horticulture, art and crafts and animal care/therapy dog service. Vocational and educational opportunities extend off site, and within the hospital grounds we offer patients the chance to develop work and life skills, in a fully supportive environment. We have an on-site education department and our vocational centre, Workbridge, which includes a garden centre, coffee shop, IT and design suite, woodwork and ceramics workshops or community vocational placements.

 

Service Aims and Objectives

Silverstone Ward aims to provide:

  • A specialist long term solution for women with severe emotional and behavioural difficulties and a primary diagnosis of borderline personality disorder. With an emphasis on seeking to reduce readmission rates and length of stay for this patient group.
  • Treatment targeting parasuicidal behaviours, emotional vulnerability, and historical trauma with a view to supporting patients to identify and progress towards a ‘Life Worth Living’ in the community.
  • Rehabilitation and recovery, through skill acquisition and generalisation to promote independent living (both psychological and occupational).

 

Isham House - our DBT Hub

Located within Isham House on our Northampton site, Silverstone forms part of our specialist DBT programme. Isham House brings together all DBT wards and expert multi disciplinary clinical teams 'under one roof'. It is perfectly located to meet the needs of women with a diagnosis of Borderline Personality Disorder across the Midlands. In areas where there is a lack of suitable provision, Northampton is perfectly placed to support local and national needs. Length of admission to Silverstone is approximately 18 months and patients are supported with discharge planning from the point of admission. We are able to offer Community/Out-reach programmes to support with patient discharge. This includes online DBT input where DBT resources are not available nearer home.

Who can refer

The service is an Integrated Care Board (ICB) and Healthcare Foundation Trust funded service. We are also able to accept referrals from health boards outside England.

Exclusion criteria

  • The presence of cognitive, literacy, speech, language or hearing deficit sufficient to significantly impair capacity to learn within the DBT programme.
  • The presence of any other additional primary diagnosis sufficient to significantly impair capacity to engage with the DBT programme e.g. substance misuse disorder, eating disorder, DID, Autism, Psychosis.
  • An assessment of the extent of any physical violence and aggression is a consideration when determining the appropriateness of placement on the ward.
  • If the patient does not commit to the DBT programme before the first CPA/Section 117 Discharge Planning Meeting (held after three months), or subsequently breaches her Commitment and leaves the DBT programme, we would request that an alternate placement is sought. This measure is required to ensure that the therapeutic milieu of the unit is not disrupted by patients who are not participating in the DBT treatment programme.

DBT Therapy Team

  • Dr Victoria Taylor – Consultant Clinical Psychologist and DBT Programme Lead, Accredited DBT Therapist, Accredited DBT Adherence Supervisor
  • Grace Loxley – Trainee Clinical Associate in Psychology and DBT Therapist
  • Lucy Snape – Occupational Therapist and DBT Therapist
  • Samantha Bland – DBT Therapist
  • Dr Emily Fox, Director of Psychological Therapies, Accredited DBT Therapist, Accredited DBT Adherence Supervisor, British Isles DBT Trainer and Chair of the Society or DBT UK
  • Dr Stacie Mahoney – Forensic Psychologist and Accredited DBT Therapist
  • Emily McGrath – Assistant Psychologist

The multi disciplinary team

  • Iain Holland – Hay – Ward Manager
  • Toni Bromley – Deputy Ward Manager
  • Dr Stacie Mahoney – Forensic Psychologist and Accredited DBT Therapist
  • Emily McGrath – Assistant Psychologist
  • Hayley O’Malley – Occupational Therapist
  • Rebecca Stanton – Riche – Technical Instructor
  • Elizabeth Moss – Principal Social Worker
  • Emma Barrett – Social Care Assistant
  • Dr Kumar Shanmugam – Locum Responsible Clinician

The Centre for Developmental and Complex Trauma (CDCT)

Our Northampton site is also home to The Centre for Developmental and Complex Trauma (CDCT) which focuses on improving the lives of marginalised populations, who have been subject to repeated trauma exposure. The centre was established to provide a forum to network, coordinate and engage in activities to improve outcomes for people who live with the impact of trauma. The work of the CDCT seeks to:

  • Improve the lives and outcomes for people who have experienced repeated trauma
  • Bridge the gap between academic knowledge and clinical practice
  • Increase awareness of the trauma experiences and care needs for the most marginalised sections of society.

The Silverstone multi disciplinary clinical team work closely in collaboration with the CDCT team on clinical service evaluation and research projects. These projects have to date supported the team to better understand the prevalence of comorbid CPTSD within the current patient group, identify areas of functioning most significantly impacted by trauma symptomatology and implement service improvement projects based on these findings.

"The Centre for Developmental and Complex Trauma has partnered with the DBT service at St Andrew’s Healthcare since 2020, to support the services’ ongoing programme of development to ensure the provision of data driven assessment and treatment activities. Focusing on establishing and meeting the trauma needs of their population The DBT team are committed to working with key stakeholders and practitioner researchers to ensure their service evolves to meet the holistic needs of service users.  Their dedication to developing and delivering high quality care that meets the trauma and personality needs, based on the latest evidence, integrated with an understanding of the needs of their service users, is key to the improving outcomes for a marginalised and stigmatised population." Dr Deborah Morris, Director, Centre for Developmental and Complex Trauma