Spring House Psychotherapy and Personality Disorder Hub guide

What is Spring House?

Spring House offers community based support to those people who have been diagnosed with personality disorder (PD) and are currently receiving care from Mersey Care.

It has been established to provide a place of support, sanctuary and growth, based upon psychological approaches to psychiatric care that have been evaluated as effective in helping people with personality and relational difficulties.

Service users currently under the care of Mersey Care's community mental health teams (CMHTs) or the CMHT psychiatrist can be referred to Spring House, which is the base for three overlapping services, Psychotherapy Service, PD Hub Day and Safe Services and PD Case Management Team.

Psychotherapy Service

Psychotherapy is available for those service users who are ready to commit to a process of changing themselves through attending therapy regularly. Therapy modalities available at Spring House are:

Therapies for Borderline Personality Disorder

• Psychoeducational Group
• Structured Clinical Management (SCM) Group
• Mentalisation Based Therapy (MBT)
• Dialectical Behavioural Therapy (DBT)
• Compassion Focused Therapy (CFT).

Therapies for Trauma Processing

• Eye Movement Desensitisation and Reprocessing (EMDR)
• Narrative Exposure Therapy (NET)
• Trauma Focused DBT.

Conventional therapies

• Cognitive Analytical Therapy (CAT)
• Brief Psychodynamic Therapy (PIT)
• Family therapy.

The staff working in the Psychotherapy Service also offer consultations to other Trust teams, often related to systemic issues related to people with complex care needs.

PD Hub: Day and safe services and respite beds

The Day Service provides a timetable of weekly groups (creative, social and psychological), centred around a two day therapeutic community (TC) and two preparation groups that help prepare people for the TC.

It also hosts a monthly family and carers support group. There are groups on Wednesday and Sunday open to service users not in the Preparation or TC groups.

The Safe Service provides telephone and face to face support for those entering or in crisis, and associated brief focused therapy interventions (PIT, CAT, EMDR or NET). It also acts as a gatekeeper to three dedicated respite/crisis beds based at Stepping Stones (run in collaboration with the YMCA) for stays of up to a week.

PD Case Management Team

This service offers two years of intensive care co-ordination to support those service users who have high use of other services within the Trust (for example, inpatient units and A&E) and to prevent service users being sent to hospitals out of area.

It aims to help service users form attachments, develop stability and prepare them to join the Day Service and Safe Service and psychotherapy.

Those service users with the PD Case Management Team will receive their care from this service and have their psychiatric care transferred to the consultant psychiatrists working within the PD Hub who will offer periodic review appointments.

Overview of Day Service Therapeutic Community Preparation Groups

Our two separate preparation groups, one based in Spring House on Friday morning and the other at St John's Centre, Warrington in the middle of the day on Wednesday, run once a week over a half day. Membership is for up to a year.

The purpose of the groups is:

• To enable people who are intending to join the Spring House therapeutic community (TC), to prepare themselves and get used to the processes that the community uses
• To support one another in beginning the process of changing self destructive or unhelpful ways of coping - to investigate the possibility of changing and moving on
• To give an opportunity for people with similar problems to support one another.

When you join the group you will have a host/mentor support you for the first week, to help answer any questions you may have and help you find the kitchen, loos and explain what’s going on.

Groups are structured as:

• Pre brief for service user representatives: Opening community group
• Break
• Group social activity: Closing community group
• Shared lunch.

Overview of Day Service: Two day Theraputic Community (TC)

What is the service?

It’s a therapeutic community model of treatment, involving a structured programme of therapy and social groups, run along democratic principles over two days on both a Tuesday and Thursday. The purpose of the TC is to help people develop new ways of coping with difficult emotional and interpersonal issues, providing an opportunity for people with similar problems to support one another.

How does it work?

The service helps members discuss how they relate to one another individually as well as the group, assisting members to understand their difficulties, the meaning of their behaviours and the impact these have on their relationships. The approach empowers group members by raising self esteem, confidence and improving social functioning. The group is run by all members involved and is not primarily staff led. Members take on a variety of roles to help the group run.

People work together in an atmosphere of tolerance and understanding. Responsibility for the wellbeing of the group and its members is not confined to group facilitators but is a shared concern for the whole group. Group members are actively encouraged to help and support each other in addressing their own difficulties in the group.

A key group principle is the `culture of enquiry’. This means that all aspects of the running of the group from individual behaviour, to structures of the group and roles of staff, are open to enquiry from any group member.

How can it feel to be in the group?

The environment can at times be stressful because past experiences can be replayed in the group. Some members may believe that their behaviours are not problematic, others may disagree and this is dealt with by gentle challenge, feedback, group discussion and support. Engaging in the group in this way is valuable in helping people to think about their own behaviours and their response to other people’s needs.

Joining

Service users are able to join the 12 month two day TC after they have been in the Spring House preparation group for up to a year. If a member of the preparation group would like to join the two day TC group, they arrange a visit and then return to discuss why they would like to join. A vote is taken as to whether membership will be offered.

Meetings and support

The two day TC meets weekly at Spring House, running on two full days, Tuesday and Thursdays for up to 24 members.

The opening and closing community groups are chaired by a member of the group. There is also a secretary to administer the diary. The community groups have an agenda and start and finish promptly. The chair and secretary are elected roles that are allocated periodically and they meet with members of staff before and after the day to plan and run the community.

Each day has an opening meeting, psychotherapeutic and social therapy groups, informal time together and a closing group. Much of the everyday business of the community occurs via voting.

Rules and guidelines for the two day TC

Relationship problems and behaviours can often repeat themselves whatever the environment or situation. The TC group holds responsibility for discussing behaviours and managing difficulties.

The group is comprised of service users and staff and decisions are made by consensus or voting, so members have the power to decide on important aspects of the functioning of the group. Behaviours that make the group concerned, such as angry outbursts, are discussed and managed by the group as a whole.

Ending

After completing 12 months in the Spring House two day therapeutic community, there is ongoing support, initially through a six month Transitional Recovery Programme which meets twice a month supporting social integration, and then for a further 12 months in the Moving Forward group, which meets once a month for members who have completed the programme.

Attendance

If group members miss three consecutive days of the TC it indicates that an individual might be struggling in some way to take part in or attend the group. The group will write to the absent member to invite them back with a date to discuss openly their struggle to attend. As such, it is a tool to help people return and be in the group. This structure is designed to be supportive and is not punitive, but if you fail to attend and do not contact the group, you will be understood to have self discharged.

How do you join the services at Spring House?

Service users can be referred for psychotherapy and the PD Hub Day and Safe Service by any of the CMHTs using our single combined referral form. This has two parts, part one to be completed by the referring professional and part two by the service user. Following receipt of the referral form, an assessment is offered to determine which of the different services available at Spring House will be most appropriate.

The assessment will usually be over one or two meetings, lasting about an hour each. At the end of the assessment process, a letter or form will be completed by the member of staff and copies will be shared.
Those joining the PD Day and Safe Services will do so via the Readiness Group, which prepares service users for these services over a two week induction group, during which service users receive:

• An introduction into how the service works
• An overview of the Day Service Programme
• Preparation of how best to use the PD Day and Safe Services
• Orientation of the rules of behaviour to ensure that the service is kept safe (Acceptable Behaviour Procedure). These were written by service users.

At the end of the two week Readiness Group, members will have completed the paperwork (for example, PD Hub Day and Safe Service Assessment Form and Acceptable Behaviour Procedure). Additionally, goals for moving forward with the support of the service will have been set.

After this, service users will be members of the PD Hub but will need to join the Safety Planning Group to develop their own bespoke plan about how to manage crises. Those assessed as being ready for psychotherapy will join the waiting list for these interventions through a separate process.

The PD Case Management Team, receives referrals and undertakes assessments via a separate process, with the majority of referrals coming direct from the wards.

Spring House timetable

Overview of Safe Service

The Safe Service offers text/phone/video/drop-in support sessions, follow on brief psychological interventions and also acts as gatekeeper to three respite/crisis beds. Service users will be supported both through the immediacy of the crisis but also afterwards to plan what might be done differently in the future.

Text/phone/video call/support sessions are focused on:

• Preventing and helping resolve social and relationship difficulties that might arise
• Offering a cathartic space for service users to share their concerns so they feel validated and supported
• Promoting service users to manage and resolve difficulties themselves (with staff support)
• They are not for routine or non-urgent issues.

Follow-on Brief Psychological Interventions (5 to 10 sessions) are offered to provide more structured support over a slightly longer period. These sessions will involve a focus on:

• problem solving (part of Structured Clinical Management)
• processing psychological difficulties (Psychodynamic Interpersonal Therapy)
• formulation
• resolving trauma (Eye Movement Desensitisation and Reprocessing and Narrative Exposure Therapy).

Stepping Stones respite/crisis beds: the Safe Service also acts as gatekeeper to three dedicated respite/crisis beds based at the Stepping Stones service in Bootle (as a collaboration with the YMCA). Service users who are registered with the PD Hub will be eligible to be considered for respite/crisis stays of up to one week, to help them through a difficult period and as an alternative to hospital admission. The Acceptable Behaviour Procedure (see below) also applies to service users during their stay at Stepping Stones.

How is my care reviewed whilst I am with the Spring House Day and Safe Service?

Service users receiving care from the PD Hub Day and Safe Services will have a review of their progress after the initial six months and then every 12 months. This will be with a member of staff and will include:

• Celebration of achievements
• Update of safety plans
• Agreement about next steps on the pathway within the PD Hub (for example, which psychological groups will be attended and whether it is time to enter a more formal psychotherapy)
• Completion of the formal passport review form, including a plan of goals for the next year that is shared with service users and uploaded onto their electronic record.

What happens to those whose behaviour is challenging or impacts unduly on others?

To help ensure the PD Hub is a safe and supportive place for everyone to attend, guidance on what is considered appropriate behaviour has been written collaboratively by both service users and staff. All those attending the Readiness Group will go through this Acceptable Behaviour Procedure, which is signed ahead of formally joining the PD Hub.

Within the PD Hub, service users are encouraged to learn how to manage their difficulties themselves, with the support of the staff team. If a service user demonstrates a pattern of acting to place or locate the responsibility for their risk/safety solely upon the staff team (for example, phoning to inform the staff team about an intention to self harm in a way that creates undue anxiety), the staff will act to ensure risks are managed (duty of care provided by staff) but then set up a review with the service user to discuss a more collaborative way of engaging with the service.

Additionally, staff will discuss any behaviour they feel is challenging the culture at Spring House and will request a meeting to review this, if needed.

Our patients matter

Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver.

If you have any comments, compliments or concerns you can speak with a member of staff or contact our Patient Advice and LiaisonService (PALS) and Complaints Team.

Telephone: 0151 471 2377 Freephone: 0800 328 2941 Email: palsandcomplaints@merseycare.nhs.uk