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Eileen Skellern Awards

Eileen Skellern worked with both Tom Main at the Cassel Hospital and Maxwell Jones at Belmont Hospital and was a pioneer in psycho-social nursing and the therapeutic community.For a number of years, the CHCT has supported many of the Cassel psycho-social nurses in the challenging clinical work by subsidising personal psychotherapy in order to further their training and expertise. This has had a meaningful impact on developing and retaining our nursing staff.We are seeking to broaden the appeal and to create a dedicated category of grants and sponsorship for junior nurses at the Cassel Hospital so that they can develop their ability to work relationally. Applications for grants will be available for training and education in addition to personal therapy fees.

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The Service User Involvement Fund

The Service User Involvement Fund has been established to support the development and employment of people with the lived experience of difficulties associated with diagnoses such as personality disorder and complex trauma. The Trust has committed to providing funding of £2000 each year as a pump primer. This, and any further funds raised through it, will support both current and ex- service users in progressing towards sustained employment by funding activities which support their development as peer support workers or experts by experience. This could include one-to-one support, mentoring, reflective practice and access to education and training. It will also fund the employment of people with the lived experience of personality disorder and complex trauma to deliver and develop training and consultation interventions across the NHS and other providers.

The establishment of the Service User Involvement Fund reflects the increasing recognition that supporting service users to progress towards sustainable employment is a fundamental part of ensuring mental health services meet the needs of those they serve.

The Cassel Day Service

We are supporting the development of an innovative new day service based at the Cassel Hospital. The service will provide psychosocial treatment for people in the London boroughs of Hammersmith and Fulham, Ealing and Hounslow who struggle to engage effectively with traditional mental health services. This group of service users often spend long periods of time in acute inpatient hospitals or rely heavily on crisis services. Such a pattern of service use has a tendency to cause harm and results in poor long-term outcomes. The design and delivery of the service is wholly co-produced which means that it harnesses the skills and expertise of those who have a lived-experience of trauma and who understand its impact on people’s lives. Peer workers and service user consultants will work alongside a range of clinicians to provide a one-day weekly therapeutic day programme providing psychological education and group activities. The service will use the Cassel Hospital grounds for a range of therapeutic activities.

The aim of the service is to improve a range of health and social care outcomes for a group of service users who are often described as ‘hard-to-reach’. This includes increased subjective well-being and quality of life, improved relationship with self and others, reductions in self-harm and suicidal acts and reduced reliance on crisis services.

The Cassel Personality Disorder Day Service Study (CEDASS)

We are supporting the development of a research study exploring the effectiveness of specialist day services for people with personality disorder and complex trauma. Personality disorder is a mental health condition affecting 4.4% of the adult population. These disorders severely impact an individual’s outcomes, with sufferers dying on average 18 years earlier. It is estimated that between 45 and 77% of those who commit suicide have a personality disorder and whilst 80% were in contact with mental health services, only 5% had been in contact with specialist personality disorder services. In 2003, a seminal paper “Personality Disorder: No Longer a Diagnosis of Exclusion” was published by the Department of Health. It established pilot services across the country to develop best practice and provide the opportunity for evaluation. Since then, increasing evidence has supported the development of NICE guidance in 2008 and more lately 2015 which echoed the call for specialist services. In 2015 the National Personality Disorder Service Survey found that only 55% of people had access to specialist services and when they did the quality and capacity of such services was unlikely to meet guidance.

More recent research brings weight to longstanding concerns that mainstream services are ineffective when operating alone. A lack of a meaningful alternatives means patients use acute psychiatric inpatient services frequently, require lengthy hospital stays or become reliant on crisis services as well as A&E, primary care. This disorganized engagement with services is extremely costly, of little therapeutic benefit and often harmful. There are a small number of peer reviewed publications examining the effectiveness of such services but a substantial body of unpublished literature also exists. It is therefore time that a metanalysis was conducted so as to bring this data together and to bring the full weight of the scientific evidence to what has become a very topical issue.

This will be the first meta-analysis of clinical and cost outcomes of specialist personality disorder day services in the United Kingdom. The overall objective of this project is to build a health economic case for investment in specialist services for individuals with severe personality disorders.

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