Daniel Lombard reports on the four options coming out of
a consultation by primary care trusts
A major consultation into the future of services for adults with
severe and complex personality disorders in the south of England
ends this month.
Sixty-two primary care trusts in the London, South East Coast,
South East Central and East of England regions have been seeking
views on service reform over the past three months.
The PCTs are proposing to provide more people with care closer
to home and the expansion of community outreach services. They are
also consulting on how much "live-in" care - if any - is needed
alongside these services.
Unsustainable model of care
They say the current model of care - in which services for all
four regions are concentrated in London in two residential units,
with additional beds purchased from the independent sector - is
unsustainable and fails to meet service users' needs.
Both are "therapeutic communities", in which residents help run
the centre and take part in group therapy sessions, but only one of
them - the Cassel Hospital in Richmond - remains open.
The other, the Henderson Hospital in Sutton, was
closed - at least temporarily - in May 2008 due to falling resident
numbers, though the move was vigorously opposed by staff and
specialist "tier four" services could be better used in other ways.
They have put forward four options (see panel, right) for reform,
ranging from having no residential units to four.
Specialist outreach teams
Each involves the creation of specialist community outreach
teams in each of the four regions to identify potential service
users, signpost people and families to appropriate treatment, offer
follow-up care, and train fellow professionals.
While indicating no preference, the consultation document says
having one unit, rather than the current two, "might provide the
right number of spaces to be stable in the long-term".
However, the issue is controversial, as evidenced by the fervent
campaign last year by staff and patients to keep the Henderson
open.
Support for the maintenance of residential services was on show
at a consultation event attended by 25 users, carers and
professionals in London this month.
Consultant psychiatrist in psychotherapy Diana Menzies, one of
two remaining staff at the Henderson, which is still providing an
outreach service, says residential care would provide the best form
of treatment in the long-term.
"If the no-bed option is chosen, commissioners will still need
places and will spot purchase from the independent sector, but they
won't be involved in the way that the service is run," she
says.
Live-in units
Anita Bracey, a campaigner and psychiatric nurse, says two
live-in units would provide the most stability for people with
personality disorders.
One carer says units should be spread out geographically, making
it easier for relatives to visit their loved ones.
However, others feel service users may benefit from moving away
from their home environment. "Sometimes it's useful for people to
move away from toxic situations," according to one former resident
of the Henderson Hospital.
Ann Malkin, clinical psychologist at Central and North West
London NHS Foundation Trust, says it is imperative that any future
model will receive proper financial support from PCTs.
Referral pathways
Social worker Martin Wrench, the other remaining Henderson team
member, says referral pathways needed to be more flexible.
"People who were homeless or in prison didn't have a prayer of
getting into the Henderson unless they had a GP or community health
team," he says.
The consultation closes on 27 July, with a decision expected in
November and any changes implemented from 2011.
Reform options suggested by a
group of 62 PCTs:
● No residential units and with greater
investment in day and outreach treatment, and acute inpatient beds
on standby for people in crisis. Cost: £6m a year.
● One large unit, with 20-30 places. Cost:
£6m-£7m a year.
● Two units, with 15-20 places in each.
Cost: £8m a year.
● Four units, with 10-15 beds in each.
Cost: £12m a year.
Full details on
consultation
Related articles
How therapeutic communities can help rebuild lives
Staff and users left in limbo at personality disorder unit
External information
NHS consultation into tier four personality disorder
services