Referrals

Referral criteria

The following guidelines are intended to help referrers make an informed decision about referral to the Therapy Services for People with Personality Disorders.

Referrers are encouraged to contact clinicians for discussion prior to referring.

If the patient is referred from Leicestershire Partnership Trust Clinician (ie: A Psychiatrist, RMN, CPN, Psychologist, Mental Health Practitioner or other) the referral letter must be joined by a Mental Health Core Risk Assessment which has been completed in full.

If the patient is referred from Primary Care services (ie: GP, IAPT clinicians, Mental Health Facilitators, Alcohol services or other) referrers are required to complete a Francis Dixon Lodge Referral Form, giving a full risk assessment. These are available on request.

Patients requiring a second opinion assessment are arranged appointments individually.

Triage

At weekly triage meetings referrals are discussed for suitability for group therapy. If the meeting decides that we need more information before the referral can be properly considered or that the referral is inappropriate the referrer is sent a letter either requesting further information or informing them the referral has not been accepted for therapy. The referral is closed on the patient data base. It is the referring clinician’s responsibility to keep the service user updated regarding the status of their referral. Referrers can contact triage staff for further discussion.

Engagement Groups

Engagement groups are not therapy groups. Most patients who are interested in our service are seen initially in an Engagement Group within 13 weeks after referral. The engagement group is an opportunity to meet other newcomers to the service and find out more about group therapy and personality disorders. If patients decide to pursue group therapy, they are then offered an individual assessment with a clinician/s. Waiting lists vary for the different groups available.

Indications for Treatment in Group Therapy

– Aged 18 years to 65 years.

– Patients have been informed about the diagnosis and the referral to Francis Dixon Lodge has been discussed with the patient

– Patients are aware we are a group therapy service, we see people individually for assessment for group therapy.

– Patients must be clustered 6,7 or 8 to be assessed for the service

– Histories of sexual , physical or emotional abuse , which have resulted in maladaptive coping mechanisms such as self harm or suicidal attempts

– Evidence of Personality Disorder diagnosis or traits.

– Anger or vulnerability are managed destructively.

– A willingness to be curious about the past and how this is related to current difficulties within interpersonal relationships.

– Some evidence of investment in another relationship, as this is a good indicator of capacity to engage in a therapeutic relationship

– Ability to set goals and work towards achieving them.

– A desire to understand oneself rather than just to feel understood by others, and a wish to grow emotionally.

– A wish to explore difficulties and some capacity to tolerate and contain emotional distress

– An ability to accept some personal responsibility for behaviours and the impact on others, and to begin to manage feelings in a different manner.

Do no harm.

Not everyone benefits from therapy groups. Some people are unable to explore the past, as the feelings evoked are intolerable which increases risk and further crises. These patients benefit from other interventions, such as, having more structure and routine in their lives.

What if the person does not seem suitable for therapy?

The Outreach Team has been developed to offer consultation and support to clinicians who are working with people affected by personality disorder. They also offer case discussion groups, staff discussion and debrief groups to CMHT, In patient Wards and other staff teams. They offer teaching and training to clinicians on request.