Personality disorders: Residential units backed in consultation

Respondents to a major consultation on the future of services for adults in southern England with severe personality disorders have strongly backed the retention or expansion of residential services.

The news follows the closure last May – albeit on a temporary basis – of the Henderson Hospital in Sutton, south London of one of the two residential units serving the client group across the South.

A draft report on the consultation found majorities of respondents supported providing two or four residential units across the four regions concerned: London, South East Coast, South East Central and East of England.

The 62 primary care trusts, which launched the consultation in April, believe the current model of care – with services concentrated in London in two residential units with no community outreach teams – is financially unsustainable, at £10m a year, and fails to meet need.

Regional outreach teams proposed

They have proposed creating specialist regional outreach teams to provide care closer to home, and offered four options for additional residential services – no, one, two or four units.

While indicating no preference, the consultation paper said having one unit, alongside community services, at a cost of £6m to £7m a year, “might provide the right number of spaces to be stable in the long-term”.

However, 57% of respondents backed having four residential units, an option that would cost £12m a year, while 56% supported two units, at a cost of £8m a year. Respondents were allowed to state more than one preference. Just 28% supported one unit and 16% no units.

Henderson closure

The issue has proved controversial since a campaign led by staff and former users failed to stop the closure of the Henderson, due to falling resident numbers.

Like the other service – the Cassell Hospital in Richmond – the Henderson was a “therapeutic community”, in which residents help run the centre and take part in group therapy sessions.

Consultation respondents raised concerns that having one unit would provide insufficient capacity to meet needs and mean service users would be too far from their local communities.

Universal agreement on reform

The consultation found near universal agreement on the need for changes in the way such “tier four” services are organised and on the proposal to create outreach teams in each region, though there were concerns that region-wide teams would be stretched.

A committee of NHS representatives has been set up to consider the way forward in November. The draft consultation report said the committee would consider feedback from respondents alongside “other evidence such as the reasons for change, assessment of needs, financial projections and suggestions from primary care trusts”.

RCP: No simple solution

The Royal College of Psychiatrists’ Faculty of Psychotherapy said in its response to the consultation: “There is no simple solution to these problems which patients and society faces.  There is a need to develop a range of options and to be aware of how bureaucracy can undermine progress.”

There were 373 responses to the consultation, 49% from health professionals and managers and 29% from service users and families. Not all respondents answered all questions.

Consultation options:

• No residential units, community outreach teams in each region, investment in day services, and acute inpatient beds on standby for people in crisis. Cost: £6m a year.
• One large unit, with 20-30 places, plus community outreach teams in each region. Cost: £6m-£7m a year.
• Two units, with 15-20 places in each, plus regional outreach teams. Cost: £8m a year.
• Four units, with 10-15 beds in each, plus outreach teams. Cost: £12m a year.

Currently, there are two units, with 44 beds in total, no community outreach teams, and beds purchased from the private sector when necessary, at a cost of £10m a year.

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