October 2016 - Andy Williams, consultant medical psychotherapist, Chair of medical psychotherapy faculty in Scotland

Personality Disorder - Raising awareness, raising expectations and raising hope

I am beginning to realise just what the College in Scotland means to me, as I look forward to a range of events and projects in various stages of planning with some excitement. I have served on committees in the College at different times as a trainee and a consultant, and recently as chair of the Medical Psychotherapy Faculty in Scotland. I have helped organise many interesting psychotherapy conferences, secure in the knowledge that the organisational and planning skills of the College staff are behind me to keep things on track. I could easily lapse into thinking that this kind of internal professional focus is the main purpose of belonging to the and trundling along to meetings. I am aware, however, that I have been increasingly impressed over recent years by the ambition of the executive committee to engage in a more public and political way with subjects to do with mental health in Scotland. I am not sure my own performance during media training singled me out as destined for the limelight – but the aim of putting ourselves into a more vocal position on subjects that perhaps do not get the attention they should on behalf of our patients seems to me to be absolutely right.

A lot has been made recently about the issue of parity of esteem for mental health (“No Health without Mental Health”). My own area of interest throughout my career has been working with people with a diagnosis of personality disorder, who could be said to be one of the least well provided for groups of patients within mental health. This puts them at the bottom of the list twice over; the least deserving patients in the least deserving end of healthcare! It can often feel that way as a clinician too, when trying to advocate for better care and treatment services, but feeling at the bottom of everyone’s priority list. It has felt at times over the past 10 years in my clinical job like a losing battle to engage managers and colleagues to take a sustained interest in this group of patients, even though our knowledge and understanding about these conditions has continued to grow, alongside some therapeutic optimism and pockets of expertise in some of these therapies.

There have been some rays of light in the gloom in Scotland, like the Scottish PD Network, which has brought together clinicians, service users and carers to share experiences and expertise in a lively conference format, and the progress in some health boards with developing and implementing better care pathways for people with personality disorder. Now, it feels as though a bit of momentum is gathering, as the College in Scotland has chosen personality disorder as a theme to pursue following the last strategy day. Rather suddenly at the end of last year, I found myself agreeing to chair a Short-life Working Group on personality disorders for the College. I had fears that this might involve me sitting in a room with Karen, waiting for anyone who might turn up. I have been extremely pleasantly surprised by the level of enthusiasm so far, with many people from across the College faculties coming forwards with interest and ideas, wanting to identify themselves with this work, and bringing a wide range of experience and knowledge. We have met several times since the start of the year, with representatives from service users, nursing, social work, police, psychology, AHPs all contributing.

We have started on a number of strands of work, including a survey of the current status of specialist and general services for people with PD in Scotland (this is being led by 2 higher trainees, and is based on a similar survey in England by kind permission of its authors), and a survey of training models for staff. I have a bit of a passion for engaging people’s interest and enthusiasm through training about personality disorder, and will be interested to gather views about what are thought to be the core components that are important. My guess is that improving understanding of the development of personality difficulties, and consequently improving staff’s capacity for empathy might be key.

We have been offered the next forum of the Scottish PD Network on Wed 19th October to present some of the progress so far, and to gather in a wider stakeholder group’s opinions. The day will be a combination of talks and opportunities to feed in to the process, and I would encourage anyone with an interest to come along.

We plan to work on a document next year for the College, to describe the current status of care for people with personality disorder in Scotland, and a good practice guide. My hope is that this piece of work raises the profile of this group of patients and encourages discussion and engagement within the profession, as well as in the public domain.

I am in awe of the campaign “Healthy Start; Healthy Scotland”, and hope that we can in some way emulate the success of this. We would all support the work that should be targeted on preventing mental health problems by early intervention, but we must not neglect those for whom difficulties persist into adolescence and adulthood.

Andy Williams, Consultant Medical Psychotherapist, Chair of Medical Psychotherapy Faculty in Scotland