Personality disorder training combats stigma

Social workers are being trained to understand personality disorder by someone who knows the subject best but whose history can prove a shock to some of them, writes Louise Tickle

A lot of people with personality disorder have traumatic histories. So when a professional care-giver doesn’t listen, or misrepresents what you’ve said when they write up your notes, it can have awful consequences,” says Kath Lovell, a service user with personality disorder who is now national project development manager for the charity Emergence (incorporating Borderline UK and Personality Plus).

“You just feel really sick inside. Even now, when I go as a patient to my community mental health team, they’ll say and do things that are outrageous, and I can leave feeling hysterical. I’m lucky, because I’m at a stage where I can articulate to them at the next session why they’ve upset me, but my wider concern is for users who cannot articulate in that way, and whose response is to go on to self-harm or become aggressive.”

To help tackle adverse and stigmatising reactions from professionals, Lovell has helped to develop the new Knowledge and Understanding Framework (KUF) training programme on personality disorder. The first step – the awareness level framework – is being delivered to more than 300 frontline non-medical staff, including social workers, police staff, youth workers, probation officers and prison officers.

Different modules

There are two further levels – a BSc for those working in acute inpatient situations, and an MSc for those in management positions or higher clinical roles. Modules from the degree courses can be incorporated into other degree disciplines – an opportunity for social work students to gain deeper understanding of the condition.

There’s no doubt that the words “personality disorder” imply there is something wrong with the essence of an individual.

“The term itself is unhelpful – it’s seen as untreatable, and it’s often used to describe someone as difficult,” says Dr Neil Gordon, senior fellow at the Nottingham-based Institute of Mental Health, who led on the development of the KUF.

The main aim of the basic training, he says, “is to increase the awareness of personality disorder presentations, and the understanding of why people might be behaving in certain ways”. Following on, the idea is to enable professionals to alter their response.

Defined as “variations or exaggerations of normal personality attributes”, research suggests about 10% of people would meet the diagnostic criteria for personality disorder. In adult prisons, between half and 78% of inmates are estimated to have the condition.

“You’d often find that, through their life, there’s been a long history of failing to maintain useful relationships with others,” says Chris Hardy, a social worker from the Tyne and Wear Mental Health Trust who is training as a trainer on the basic course.

“It can be people who repeatedly make the same kinds of mistake, and don’t seem to be able to learn from it,” he says. “Almost invariably, you’ll find there’s an abusive background of some kind, though not necessarily violent or sexual abuse.”

Challenging stigma

The training challenges the stigma many professionals still attach to people with personality disorder. Ignorant and unsympathetic attitudes remain prevalent, typically because frontline staff rarely get the chance during their professional training to learn anything about the roots of the condition, and feel ill-equipped to deal with it.

“I’ve come across social workers and other mental health professionals with deeply disparaging views of personality disorder,” Lovell says. After a suicide attempt, she adds, “they’d say I was attention seeking”.

The kind of upset and damage this leads to is Hardy’s motivation for wanting to promote a more positive view among his colleagues. “There’s been a lot of therapeutic pessimism,” he says. “I’ve worked with some people for years and seen little progress, so there’s some sense that there’s little point. And there’s still a sense from the medical profession that it’s not a mental illness, that it can’t be dealt with by medication.”

Lovell notes that, given the reactions she has observed while delivering the training, there’s still a long way to go.

“They get very surprised when they see the likes of me in the room,” she says.

“It’s the ultimate anti-stigma measure, that I can be delivering training with a reputable professional. It shows them that ‘recovery’ is possible. That means it’s worth them investing in people with personality disorder. To some people, that is a shock.”

Training tips

● Consider the possibility that a user may have an undiagnosed personality disorder when they exhibit challenging behaviour which might easily be put down to aggression, obstructiveness or maniuplation.

● When you encounter emotional and challenging behaviour from someone with a personality disorder, contain the event in a supportive way, making the user feel safer and trust that their well-being is your priority.

● Allow time to reflect on your attitudes and reactions. Discuss the challenges service users with personality disorders present for you.

For information on the awareness training level e-mail lorna.viikner@nottshc.nhs.uk

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