Interventions with a primary focus on Phase 3

Personality disorder integrated care pathway
NHS Highland

For some people, Phase 1 work (perhaps with some Phase 2 work) will be sufficient to allow Phase 3 to occur without the involvement of services. However, some patients will benefit from a specific intervention to enable meaningful personal, interpersonal and social progress to occur.

Occupational Therapy (OT)

What is it:

Occupational Therapy is concerned with enabling individuals to live more productive and enjoyable lives in vocation, employment, social interactions and leisure, through the use of purposeful activities. The occupational therapist usually works as part of a multi-disciplinary team and can contribute to the overall care plan of individuals referred to the team. Each person is assessed individually, goals are identified together and a programme of activities is planned collaboratively. The individual is asked to identify outcomes which are
measurable to enable interventions to be evaluated, for example: “I want to be able to join an evening class”, “I will be able to discuss my feelings with my partner”, “I want to be able to do my own shopping and cooking” or, “I want to get an interesting job”. Activity programmes are reviewed regularly and adapted as necessary.

Activity is at the core of occupational therapy practice. If the therapist cannot engage the client in activity that has meaning and value for him, then there can be no meaningful assessment and no treatment implementation. Engagement is achieved by involving the client at all stages of the treatment process, by understanding what will motivate the individual, and by establishing an expectation that clients attending occupational therapy will be active in their own treatment processes. The activity must be purposeful and achievable for the person and take place in settings relevant for that person. Activities can take place on a 1:1 basis, in a group, or in both settings.

Summary of activity functions:

  • Activity is essential for the normal development of the individual. Without activity no personal development can take place, and inability to perform activities competently leads to a maladaptive development.
  • People use activity to explore the environment and to test their own position in it.
  • We become embedded in our social and cultural context through activity.
  • Activity helps to build a healthy personal and social identity.
  • Activity is intrinsically satisfying.
  • Activity is used to learn and practice skills that can be used for occupational performance.
  • People are able to adapt to changing circumstances through activity.
  • The individual can construct purpose and meaning in his life and gratify his needs through activity.
  • Relationships with others can be made through shared activity.

Who is it for:

OT is for anyone who wants to overcome physical, psychological or social problems arising from illness or disability. The person needs to be motivated to identify goals and to engage in activities.

Who is it not for:

As OT requires active participation for it to be effective, it will not work if the person is not ready to become involved in trying activities.

How can it be accessed:

OTs work in hospitals and in the community. Within mental health services, they are based in CMHTs (Community Mental Health Teams). A referral from a GP, psychiatrist or other worker is required. Self-referrals can be made in some teams and the person’s GP would be made aware.

CAS Day Service for People with Personality Disorder

What is it:

The usual length of treatment is 36 weeks. The CAS (Coping and Succeeding) Day Service for people with personality disorder is a community-based service which takes place each Friday from 09:30 to 15:30 at Rowans, New Craigs Hospital. CAS Day Service represents a tier 3, Phase 3 (integration or making connections) intervention. CAS, a co-produced service, has been developed and is delivered by a partnership of the Personality Disorder Service with service users and other stakeholders along Recovery principles. The service is primarily directed at helping an individual make connections with others and society and by doing so, enhance their self-identity, interpersonal and social connections.
CAS has a primary focus on Phase 3 and, to a lesser extent, Phase 2 but it is not an intervention with an emphasis on stabilisation. Other interventions (eg DBT or STEPPS) are more appropriate for stabilisation of harmful behaviours. Furthermore, some individuals, although behaviourally stable, may benefit from Phase 2-focused interventions, for example specific trauma work, before making best use of CAS.
The CAS Day Service includes elements of structured group work, self-directed time and social time. Broad themes covered in the core groups include promotion of physical health and well-being; living skills; self-management; and vocational rehabilitation. These themes are addressed by providing direct information and education; enabling direct introduction to new activities/behaviours; and making and highlighting links between people and services.
In the spirit of co-production, participants have a major role in planning and organising the content of the core groups and the day to day running of the service. Participants develop and work towards their own goals in the interpersonal, occupational, recreational and educational domains.

Who is it for:

Individuals with personality disorder or personality disorder in early remission (not solely people with borderline personality disorder) who are motivated to make changes and who do not carry current risk issues which would preclude safe placement in a community setting.

Who is it not for:

People who do not meet the general diagnostic criteria for personality disorder. People with current risk issues which preclude safe placement in a community setting — for example, people who present a significant risk of violence to others or a significant risk of harm to themselves. People who are unwilling or unable to usefully work cognitively, affectively and behaviourally, for example people with active substance dependence, brain injury or low weight anorexia nervosa.

How can it be accessed:

CAS is part of the Personality Disorder Service, a specialist service which accepts referrals from secondary and specialist mental health services. A self-referral option is currently being piloted. New participants can join the group at frequent intervals.

Vocational Support Service

What is it?

The Vocational Support Service aims to work in partnership with individuals who have experienced mental health challenges; supporting them on their vocational pathway. The service will help individuals to identify vocational goals and support the steps towards achieving them.

The Vocational Support Team will work individually with people to help explore opportunities such as volunteering, further education, gaining or sustaining paid employment. Support may also include identifying community activities, building self-confidence or improving skills with computers and other technology in terms of preparing people for vocational activities.

Who is it for?

The Service is for those individuals, aged 18 or upwards, who have had difficulty gaining or sustaining vocational activities due to mental ill health.  

Who is it not for?

This service is not for people who do not wish to move forward with vocational goals.

How can it be accessed?

The Vocational Support Team has two bases — one in Inverness and the other in Thurso. For more information or to receive a referral form please contact:

Vocational Support Team (Inverness)
Rowans 1
New Craigs
Leachkin Road
Inverness IV3 8NP
Tel: 01463 253 635 Email: nhshighland.vocationalsupport@nhs.net

Vocational Support Team (Thurso)
The Bungalow
Dunbar Hospital
Thurso KW14 7XE
Tel: 01847 896 831 Email: heather.jappy@nhs.net