Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

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Personality disorder is also linked in the public mind with criminality and dangerousness; in fact, the majority of people with difficulties associated with personality disorder are not violent or criminal. REFLECTING ON EXPERIENCES OF STIGMA AND DISCRIMINATION: Many of us understand what it is like to be stigmatised from our own experience in society. Are you... - Black or from a minority ethnic group? - Lesbian, gay or bisexual? - Transgendered? - Female? - Disabled? - Religious? - Ever been unemployed/needed benefits? “I was treated less sympathetically because of personality disorder. They believe it’s not mental illness but something you’ve brought on yourself.” “I think the diagnosis is saying ‘trouble maker’. You’re ignored. People can be hostile. You’re not taken seriously. People don’t believe there’s anything wrong with you if you’ve got personality disorder.” It takes considerable emotional resilience to deal with people making judgements and assumptions about you. For someone who already feels vulnerable and like an outsider who does not ‘fit’, as many people with personality disorder do, then it can be very difficult to face stigma. “I became a ‘services leper’. I was told by the psychiatrist I had been blacklisted. After the diagnosis was made I felt excluded. There was a general unwillingness to help and I was refused treatment.” Personality disorder has been called ‘a very sticky label’. When it comes to personality, people often assume that we cannot change,‘the leopard can’t change its spots’. Actually, we know that people can change very considerably, sometimes through professional help, but also through forming helpful relationships, having good experiences, and through the passage of time. But, once someone has that label, it can be difficult to persuade others that they have changed. 24
BACKGROUND The notion of treatability For many years, people given the diagnosis of personality disorder were regarded as ‘untreatable’ and were either excluded from services or severely marginalized within them. On the edges of services, psychotherapists and psychologists had been providing treatment to people who had problems associated with the diagnosis for many years. By the 1990s, evidence was beginning to emerge from a number of research trials that some of these psychological treatments were effective. But generic mental health services continued to regard the problems associated with personality disorder as untreatable. This seems to be because the notion of treatability was largely defined medically within the 1983 Mental Health Act. It meant treatable by medication. No one thinks the psychological and emotional difficulties of personality disorder can be cured by medication (though some aspects, like symptoms of depression or anxiety, can be helped by medication). So people with personality disorder were dealt a double blow: they were stigmatized by a diagnosis that many experienced as attacking of personal identity, and without access to any form of help or treatment. Over the last 10 years, this has changed to a degree. A combination of government policy and some investment in innovative specialist personality disorder services has increased the range of provision and gone some way towards improving accessibility (see Appendix 2 for links to policy documents that were important in bringing about change, such as ‘Personality Disorder: No longer a diagnosis of exclusion’). However, provision and accessibility remain extremely patchy. Where a person lives still determines whether they can get treatment and support from statutory services. Why give a diagnosis of personality disorder? While many people believe the diagnosis is not useful or valid, others feel a sense of relief on receiving it. The label can be stigmatizing but the diagnosis also helps some people to make sense of their experience and enables them to put a name to things they grapple with but are difficult to explain. Being given a diagnosis also enables people to become more informed about different treatment options, what other people have found helpful and about the issues themselves. It can also help people feel less alone, and more part of a community of likeminded others. It enables people to seek out peer support and connect with others who have a shared experience, which can be extremely powerful. Where there is local specialist service provision, a diagnosis is also the key to unlocking this. 25
Page 1 and 2: Working effectively to support peop
Page 3 and 4: Contents Foreword .................
Page 5 and 6: Executive summary It’s not person
Page 7 and 8: INTRODUCTION THE PURPOSE OF THIS GU
Page 9 and 10: WORKING TOGETHER Professionals have
Page 11 and 12: BACKGROUND Each person’s personal
Page 13 and 14: BACKGROUND • People with personal
Page 15 and 16: BACKGROUND taken overdoses is stock
Page 17 and 18: BACKGROUND How do we describe and u
Page 19 and 20: BACKGROUND 1) Openness (seeking out
Page 21 and 22: BACKGROUND “Music has got me thro
Page 23 and 24: LEARNING POINTS FROM CHAPTER 1 —
Page 25: BACKGROUND There is no underlying
Page 29 and 30: BACKGROUND For many years, because
Page 31 and 32: Learning points from Chapter 2 —
Page 33 and 34: BACKGROUND Most professionals agree
Page 35 and 36: BACKGROUND soothing, responsive car
Page 37 and 38: BACKGROUND THE THEORY OF MENTALIZAT
Page 41 and 42: PRACTICAL GUIDANCE RECEIVING GOOD C
Page 43 and 44: PRACTICAL GUIDANCE What might get i
Page 45 and 46: PRACTICAL GUIDANCE THERE ARE MANY R
Page 47 and 48: PRACTICAL GUIDANCE HELPFUL THINGS T
Page 51 and 52: PRACTICAL GUIDANCE Here are some ex
Page 53 and 54: PRACTICAL GUIDANCE Some teams will
Page 55 and 56: PRACTICAL GUIDANCE Specific psychol
Page 57 and 58: PRACTICAL GUIDANCE borderline and a
Page 61 and 62: PRACTICAL GUIDANCE There are many d
Page 63 and 64: PRACTICAL GUIDANCE It is extremely
Page 65 and 66: PRACTICAL GUIDANCE 6) ISSUES OF POW
Page 69 and 70: PRACTICAL GUIDANCE We all know that
Page 71 and 72: PRACTICAL GUIDANCE Common defences
Page 73 and 74: PRACTICAL GUIDANCE It is possible t
Page 75 and 76: PRACTICAL GUIDANCE ORGANISATIONAL V
Page 77 and 78:
Learning points from Chapter 7 —
Page 79 and 80:
therapist and client is a collabora
Page 81 and 82:
Appendix 2: References and resource
Page 83 and 84:
SELF HARM: National Self Harm netwo
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