Priory Middleton St George pioneers specialist mental health treatment programme

A new specialist service at the Priory Hospital Middleton St George in County Durham is set to become the benchmark for the treatment of female patients with Borderline Personality Disorder (BPD).

The Sandalwood Programme is led by a Consultant Clinical Psychologist (Dr Heather Roberts) and all aspects of care are psychologically driven within the context of a full multi-disciplinary team discussion. The success of the programme is a credit to the entire Sandalwood MDT. Medication is used judiciously with an emphasis on developing psychological coping skills. Patients also have access to a full range of therapeutic interventions including psychology, occupational therapy, art and health and fitness.

The Priory Hospital Middleton St George has already built up a solid reputation for managing extremely complex patients who were difficult to place elsewhere due to high levels of self-harm.

The opportunities for self-harm were initially reduced by controlling the external environment and utilising medication for symptom relief. However, the drive to self-harm often remained and it was recognised that a psychologically driven culture was needed to successfully treat people with BPD.

The Sandalwood Programme utilises Dialectical Behaviour Therapy (DBT) and Schema Therapy as core interventions, both of which are recognised by the National Institute for Health and Clinical Excellence (NICE) as an effective treatment for BPD. Cognitive Behavioural Therapy (CBT) is also used.

All Sandalwood staff have completed two core training workshops which provide an overview of diagnosis, trauma, Schema Therapy, DBT and the challenges inherent in working with BPD.

The Programme will offer a pathway which allows progression through the service as patients recover. Hazelwood Unit offers a higher level of relational security and is suitable for people who are actively self-harming or unstable. Rosewood Unit, which will open in the next month, will be a step-down unit and offer a lower level of relational security. It will be suitable for patients who are more stable, engaged in recovery and not actively self-harming.

Since its inception in November 2010 the Sandalwood Programme has achieved:

• A substantial reduction in the use of psychotropic medication

• A significant reduction in the levels of observation required

• A reduction of 44% in the number of restraints required

• A considerable reduction in somatising

• An increase in the amount and scope of Section 17 leave

• A number of people well enough and waiting to be transferred to the step-down unit

BPD is present in just under 1% of the population* and presents with high levels of emotional distress, repeated crises, high levels of self-harm, suicidal intent and impulsive aggression. Patients with a severe form of this disorder are frequent users of mental health services. They are often admitted to inpatient units under the Mental Health Act because of high risk factors.

Prof Bruce Moore, Medical Director at the Priory Hospital Middleton St George said: “Many services find it difficult to offer treatment for BPD as the recommended treatments are specialist, resource intensive and often require a long-term commitment from all stakeholders.

“People with BPD often have multiple admissions to general mental health services without the opportunity to access the specialist services they require. This can lead to an on-going dependency on NHS services over many years and is not cost-effective in the long-term.

“The Sandalwood Programme offers a staged approach to assessment and intervention and provides stakeholders with the opportunity to invest resources in a planned programme of treatment which is transparent and committed to delivering the contracted services.

“It works towards recovery and enabling people to have a good quality of life outside hospital care, which in the longer term will reduce the demand on NHS funding resources.

“The positive outcomes we are achieving are beyond our expectations and we are very excited about the future of the programme. We are confident that the Sandalwood Programme at Priory Middleton St George will be seen as the gold standard for BPD treatment in the future.”

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