Shine 2011 Health Foundation Grant
Reducing admissions to acute psychiatric care: The development and evaluation of an adapted Dialectical Behaviour Therapy training for Crisis Teams
Dorset Healthcare University Foundation Trusts (DHUFT's) Crisis Team (CT) is responsible for the assessment of all clients presenting to DHUFT in critical or emergency situations. Local data indicate many of these individuals meet diagnostic criteria for Emotionally Unstable Personality Disorder (EUPD). The team often make contact with them directly through emergency services and frequently admit them to hospital. The high admission rate comes about because staff believe themselves ill-equipped to deal with the problems associated with EUPD: admission is seen as ‘a safe option’ to manage risk. Contrary to this view, however, resource-intensive inpatient admissions have been shown to be ineffective or iatrogenic with EUPD clients (Paris, 2002; Hoch et al., 2006).
Dialectical Behavioural Therapy (DBT; NICE, 2009) is currently the most effective outpatient treatment for EUPD clients. Full DBT training is expensive because it equips staff to deliver full care programmes rather than brief interventions. Fortunately, however, local data (Clarke, Taylor & Remington, in prep.) suggest that staff also benefit from shorter, 2-day DBT training programmes.
We propose to develop and evaluate a 2-day DBT training programme tailored to the needs of CT staff. This programme will establish risk assessment skills and teach specific DBT techniques to provide more effective intervention and reduce hospital admissions. An open trial methodology will assess its impact on both staff and clients. On completion, the package developed can further evaluated and/or disseminated nationally to mental health services.
References
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Hoch, J.S., O’Reilly, R.L., & Carscadden, J. (2006). Best Practices: Relationship management with borderline personality disorder, Psychiatric Services, 57, 179 – 181.
Clarke, S., Taylor, G., & Remington, B. (In prep). A Randomized Control Comparison of Experiential Acceptance Commitment Training and Dialectical Behaviour Therapy Skills Training with Mental Health Care Staff. For Behavior Modification.
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Taylor, G. (2010). Understanding and ameliorating stigma towards clients with a personality disorder: An Acceptance and Commitment Therapy-based Approach. Thesis, (PhD). University of Southampton.
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Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). The Maslach Burnout Inventory (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.
Project timeable
Download Shine 2011 Project Timetable (pdf - 152kb). This document shows the project schedule, as well as outcome measures for both clients and staff.
