10. Personality disorder - resource source (resolution)
North of Tyne Branch
That this meeting of RCN Congress asks Council to lobby for adequate funding and training for staff treating people with a diagnosed personality disorder.
On this page:
- Watch the debate
- Read the progress report
- Read the debate report
- Read the background information
10. Personality disorder - resource source (R)Progress reports
Council Committee: NPPC
Committee decision: New work
Council member/other member/stakeholder involvement: David Miller, Kevin Bell
Staff contact: ian.hulatt@rcn.org.uk
This issue had not previously been covered by the RCN Nursing Department or forum activity. There are existing established training resources available on caring for people labelled as having a personality disorder. The role of the RCN may be to help members access existing resources.
A task and finish group has been established for this work. The members are:
- Ian Hulatt, RCN Mental Health Adviser – staff lead
- William Corulla – sponsoring entity
- David Miller – Council member
- Kevin Bell – Council member.
Further members may be added as work progresses.
Members of the group met by teleconference on 1 September and decided on the future direction of travel. Since the teleconference meeting:
- William Corulla has had a preliminary meeting with his Director of Nursing Services to discuss a business case for a non secure service for PD clients. The business case was warmly received and William is awaiting further developments
- the PD Management Steering Group, which William Corulla is a member of, decided to bring three proposals together for the Directors and Senior Management Team of his trust. These are for a non-forensic in-patient service for women, a day hospital, and a multidimensional psycho-diagnostic centre. A decision is awaited on these proposals
- the decisions on trust business cases will be influential in determining how the RCN promotes the care of people with personality disorder, and will provide potential case examples of innovations in practice
- Ian Hulatt met with the RCN Emergency Care Association on the 20 September 2010 to discuss potential joint work on caring for people with challenging behaviour in emergency settings. This matter is now being considered by the committee as they plan their work for the year ahead
- the issue was discussed at the Forensic Nursing Forum development day on 15 of September.
- a fringe meeting is being held on Monday 11 April (12.45pm, room 13 Upper Galleria ACC) at Congress 2011 to raise awareness of the issue of personality disorder and direct members to appropriate resources.
Debate report
William Corulla from the North of Tyne branch urged delegates at Congress to support a resolution to ask Council to lobby for adequate funding and training for staff treating people with a diagnosed personality disorder. He highlighted the lack of staff training and facilities available and expressed concern that traditionally underfunded mental health services may be subject to further cuts during the current economic crisis.
David Baker from the Bradford and Airedale branch seconded the resolution, highlighting the varied pathways into health care used by this group. He urged Congress delegates to consider the range of training needed for staff to be able to effectively support and understand those with personality disorders.
John Black from Inner South East London branch said it was a myth to say that this group cannot be treated and asked delegates to consider the feelings of service users who will often feel unsafe and will expect to be abandoned. This was backed up by Paul Phillips who said that personality disorder is the ‘worst named condition the world has ever known.’
The resolution was supported by mental health nurse David Baker who described the current level of support as a ‘very very sorry state of affairs’. Cat Forsyth, who has worked as a learning disability nurse for over 30 years urged Congress delegates to consider a partnership approach which would involve service users and result in effective, person-centred care.
The resolution was passed with an overwhelming majority.
Vote
For: 390 (96.06%)
Against: 16 (3.94%)
Abstain: 14
Background
Personality disorders present in approximately one person in 20, and can cause significant distress to the sufferer and those around him or her. Such disorders are often associated with a variety of public health issues such as smoking and drinking habits, higher rates of suicide and accidental death, sexual and anti-social behaviours, and poor mental health.
A personality disorder during adolescence doubles the risk of anxiety, mood disorders, self harming behaviour and substance misuse disorders during early adulthood. Individuals with a personality disorder also have higher rates of social problems such as homelessness compared with the general population. Estimates suggest that personality disorders are prevalent in up to 70 per cent of the prison population.
Individuals labelled with a ‘dangerous and severe personality disorder’ are currently treated in high secure environments and the process is subject to evaluation. Pilot services, which cover England and Wales, currently provide 300 high secure places for men, 75 medium secure and community places with community teams, and a research and development programme.
Nursing staff most commonly encounter people with personality disorders in environments such as accident and emergency departments, where their presentation may include self-harm, and alcohol and substance misuse.
Modern policy and practice towards individuals with personality disorders is far more inclusive; the National Institute for Mental Health in England (NIMHE) publication Breaking the cycle of rejection: the personality disorder capabilities framework (2003) aims to help nurses (and others) interact with this group of patients, while in Northern Ireland a new strategy for people with personality disorders has recently been published (Department of Health, Social Services and Public Safety, 2008).
Levels of awareness of the specific needs of this client group have traditionally been extremely varied, yet many nurses in a wide range of settings are needed to care for them, highlighting the requirement for adequate funding and staff training.
References and further reading
Department of Health (2003) Personality disorder: no longer a diagnosis of exclusion - policy implementation guidance for the development of services for people with personality disorder, London: DH.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009546
Department of Health, Social Services and Public Safety (2008) Personality disorder: a diagnosis for inclusion: the Northern Ireland personality disorder strategy, Belfast: DHSSPS.
www.dhsspsni.gov.uk/showconsultations?txtid=33345
National Institute for Mental Health in England (2003) Breaking the cycle of rejection: the personality disorder capabilities framework, Leeds: NIMHE.
www.spn.org.uk/fileadmin/SPN_uploads/Documents/Papers/personalitydisorders.pdf