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Mental Health - Pathways

We have developed strong clinical pathways for three key conditions:  

  •          Psychosis      
  •          Borderline personality disorder
  •          Affective disorders.
        

For each of these we have a pathway for both routine care and for crisis/acute care.

Click here to view the flowcharts for these clinical pathways.

road, green, trees, sun, long way to go.jpg

Psychosis

A psychosis pathway, named TRIumPH (Treatment and Recovery in PsycHosis) aims to ensure those with psychosis will receive the right support in the right place at the right time.

It is hoped the new pathway will replicate the successes seen in stroke and cardiac care, where the right approach has transformed sufferers health and quality of life.  It incorporates the newly announced national access and intervention targets for first episode in psychosis, NICE guidelines and will support their achievement. 

What are we hoping to achieve?

That people with suspected first episode in psychosis have early access (within 2 weeks and earlier if an urgent referral) to assessment and are offered NICE recommended interventions: medication, Cognitive Behaviour Therapy, family work, employment support, carers support and that their physical health needs are considered and supported.  This in turn will improve outcomes for services and users by:

  • Lessening the impact of the condition through early detection and support
  • Reduce the burden on expensive inpatient resources (by ensuring that people are treated early, effectively and remain in the community through assertive outreach support)
  • Decrease the time taken to recover (by reducing the duration of untreated psychosis)
  • Reduce the mortality gap through better management of physical health
  • Long term, it is hoped that the pathway will help to reduce relapse rates
  • The pathway also aims to reduce variation in service provision and ensure gold standard care is provided to everyone


About psychosis

If you have psychosis, you might have experiences that are not part of the reality experienced by people around you.  You might see or hear things that other people cannot see or hear (hallucinations), or you might hold unusual beliefs that other people do not (delusions).  Some people describe it as a "loss of contact with reality".

In many cases, if you experience psychosis you believe that hallucinations and delusions are real.  About 1 in every 100 people will experience a psychotic episode in their lifetime.

People who have psychotic experiences might be diagnosed with a variety of conditions, depending on the nature of the experiences, their duration, the presences of other symptoms (e.g. changes in mood) and possible causes.  Psychotic symptoms are associated with the following conditions:

  • Schizophrenia
  • Bipolar disorder
  • Schizoaffective disorder
  • Drug induced psychosis
  • Psychotic depression
  • Postnatal (puerperal) psychosis
  • Personality disorder
  • Organic psychosis
  • Delusional disorder
  • Reaction psychosis/brief psychotic episode


If you, your family or a carer, think you are experiencing symptoms of psychosis help is available through the Early Intervention in Psychosis Service.

 
Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a label that mental health professionals use. It describes the behaviour of certain people who have serious problems in living.  

People with this diagnosis often experience stronger emotions than the average person. They may often feel afraid or desperate and do impulsive things as a result.  They may have problems getting and keeping good relationships because of their feelings of anger or fear are so strong. 

People with BPD may think others are trying to take advantage of them or have their feelings easily hurt.  Also they may have a feeling of emptiness or sadness inside that makes them want to die or self-harm.  Painful emotions tend to cloud their judgement so that decision-making is impaired.

People with BPD also lack the skills to understand and cope with their emotional experiences. They tend to be confused by them or reject their emotions altogether. Because of this, people with BPD often feel that life is one crisis after another.  Mood swings and the behaviours that come from them may make it difficult to live a good life.

Borderline personality disorder is a complex diagnosis. This is because the symptoms look different from one person to another. To get a formal diagnosis, a person needs to show signs of at least five of these nine symptoms on a frequent basis:

  • Intense worries about abandonment and strong efforts to avoid it
  • Unpredictable, rocky relationships
  • Uncertainty about self-identity
  • Reckless, risky behaviours
  • Self-harming behaviours
  • Highly volatile emotions
  • Profound feelings of hollowness or emptiness
  • Easily provoked rage
  • Short-term flights from reality.

 

It is thought that symptoms develop in childhood. They are based on a combination of:

  • Inherited biology, which may leave the individual more vulnerable to emotional extremes.
  • Neurobiology (differences in some structures in the brain).
  • The environment – essentially a place where a child was unable to develop and thrive, e.g. due to neglect or abuse. (However, even ‘normal’ family environments are sometimes inadequate for biologically vulnerable individuals).


The developing child is ill-equipped to cope with painful emotions and thoughts. To try to solve life’s problems, they develop self-defeating behaviours.

Treatment

It’s important to keep in mind that Borderline Personality Disorder and the person is not the same thing.  BPD is something people have, not something they are. 

Generally life with BPD is more difficult. It’s harder to live life to its full. There is also a greater risk of death by suicide, sometimes accidentally.  

Medication alone is not enough to overcome the symptoms of BPD.  Whilst therapy is not essential in the recovery process, it has been found to help. For many people, psychological treatments work but they take time and effort.   

At Southern Health, our first line of psychological therapy is usually Dialectical Behaviour Therapy (DBT). Either in full or in an adapted form, usually termed Emotional Coping Skills (ECS). These both involve weekly skills groups alongside individual therapy. Other helpful interventions include developing a ‘My Crisis Plan’ and second stage therapies also include Cognitive Analytic Therapy.

So, how will therapy help? It will help a person to:

  • Live in the present. Not being overwhelmed by regrets of the past and worries about the future
  • Learn skills in how to regulate emotions, thoughts, behaviours
  • Identify situations when skills will be useful
  • Practice and problem solve the use of these skills, identifying blocks and overcoming these
  • Identify goals and reasons to try the new skills, as well as helping during difficult times.

 

I would like to:

Useful psychosis resources:


Useful BPD resources:
  • Download my crisis plan

  • Download pharmacological guidelines for BPD and Anti-Social PD

  • Download Transform BPD pathway

  • Download BPD community care diagram 

  • Download BPD acute care crisis diagram

  • Download BPD acute care pathway diagram

  • Download BPD care pathway for community care