21/09/2016
Keir Harding
Cheshire & Wirral
Partnership Trust
@keirwales
 Not
the best service
 Not
the best staff
 (I
will ask you some questions as we go
along. Type quick or I will feel
awkward!)
 Have
a think….
 What
might you expect to see?
 What
might be the core features?
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21/09/2016
 10
Members
staff at a time
 All decisions made by voting
 Members run the group – Chair,
secretary, link, housekeeper,
health&safety
 Thursdays 10-3
 All time spent together
 2/3
 R&R
– Extra time to reflect on actions that
worry people. Need to convince people
you are thinking about it.
 Assessment
– Extra time to think about what
is stopping you getting here. Need to
convince people you’re addressing it.
 Participation
– People feel you’re not using
the group ‘properly’. 4 weeks to address it.

Links Meet
 10.00
– 10.45 Business
 11.15-12.30

 1.15
– 2.15 Group 3
 2.30-3.00

Talk time
Links Meet
After group
Links Meet
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21/09/2016
 Members
are experts at living with their
difficulties.
 We act based on discussion and
consensus.
 We act as equals.
 Everything can be talked about.
 We balance caring for individuals and
each other.
•Group therapy
•Peers help you
•Other perspectives
•Safe
•Encouragement
•Doing things
differently
•Connection
(Remember this one!!!)
•Understanding
•Use our experiences
•Less alone
•Value for money
•Empowered
•We change things to
suit our needs
•Choice
•Equal with staff
•We are the experts
•Responsible
•Not ‘something that’s
done to us’.
Lees, Manning, & Rawlings,
2004
Mitchell, Wilson, & MacKenzie,
2007
2002
Smith, Gates, & Foxcroft, 2006
Nice Guidelines BPD
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21/09/2016
The qualitative findings indicate underlying
changes in thinking that may account for
some of the measurable changes in
members' mental health and functioning
 Services enable individuals to address two
main problem areas: relating to others and
self-harm.
 The study suggests that once-weekly TCs
provide an effective therapeutic approach
to the problems associated with personality
disorder.
 Hodge et al 2010


Significant improvements in both the mental
health and social functioning of service users.
Changes in patterns of self-harm and service use
were suggestive of possible underlying
improvements. We also found evidence of the
possible offset of costs within 16 months of an
individual leaving one of the services.
Conclusions: This study suggests one-day
therapeutic communities may be both clinicallyand cost-effective for people with personality
disorder
 Barr et al 2010

 What
is a TC?
is the magic?
 Who joins?
 Ethics?
 Where
 Evidence?
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21/09/2016
 Gask
2013
 General
principles of management
include consistency, reliability,
encouraging autonomy, and the sensitive
management of change
A sense of belongingness is correlated with
improved self-esteem and overall wellbeing. The capacity for responsible agency
is central to behavioural change.
 TCs are typically used in fields where
positive outcome requires both personal
growth and behavioural change.
 We suggest that TCs are uniquely placed to
demand such growth and change of their
members

• Supported
•Understood
•Connection
•Connected
•Connected?
•Connected
•Need to share
•Get out what you
put in
•Support
•Understanding
•Friendship
•Connection
•Accepted
•Hard to accept care
•Liked for yourself
•Cant help everyone
all the time
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21/09/2016
 Graded
 Focus
Activity
on what people want and need to
do
 Putting
thoughts into words
words to get what you want/need
 Keep client active in problem solving
 Using
 What
will you DO to survive/get life more
like you want?
 Think
again…
 What
would be the biggest challenges to
setting up a service like this in an area
that has never experienced this way of
working?

A specialist personality disorder service
A
clinician who had worked in a day TC

A
strong association with a formal,
structured therapy.
 No
money
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21/09/2016
 Conference
with ex TC service users
 Highlighting
that “doing things to
people” didn’t work for all.
 Recruiting

allies
Lower expectations
 Recruit
staff
 Venue
A
good enough service is better than a
gold standard one that doesn't exist
 Visit
places that are doing it.
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21/09/2016
 Convince
people to give you their time
for no immediate reward
 Evangelise
 Secondment
 Working
 “If
opportunities
differently
you build it they will come”
 Great
facilities Vs Costing nothing
 Lunch
 Phone
 WE WILL TALK
 What
ABOUT IT!!!!
will you do if....
 Learning
that rationale decisions can be
made
 Events
are things to learn from rather
than to be avoided
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21/09/2016
 Rules
that hammer home personal
responsibility
 Structure
designed with service users. A
failure?
 Steering
group – Reflect the reality that
we are hosted by the NHS.
 Expectations
 Are
we being tricked
 Old
shoes are really comfortable
 Thinking
hats on…
 What
might a good enough member of
staff do in a service like this?
 Role? Way
of being?
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21/09/2016
•Listen
•No judgement
•Question/Prompt
•Model something
•How to talk and
listen
•Explore things
•Question the usual
ways of doing things
 Have
•Don’t do things for
you
•Allow people to sit
with difficulty
•Slow things down?
•Step back?
•Increase
responsibility
you told...Vs ...is ****ing useless
 Direction Vs
 Being
Learning what happens
good Vs being neglectful
 Genuine
 Equal
 Silent
 Reflective
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21/09/2016
 Hearing
a voice “kill your mum”
self to protect mum
 3 days without sleep
 Told no one else
 “Do something!!!”
 Kill
 Resisted
being handed the phone
talking about it
 Noticed the fury
 Kept
 “Make
someone see her!”
 The
group have set up a whatsapp
account
 Initially very supportive
 Eventually fraught & terrifying
 Steering group
 Rules for the use of the app?
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21/09/2016
 Emphasised
 Noticed
the ‘outside contact rule’
that relationships could also be
difficult
attempt to control
 Is being on whatsapp compulsory?
 No
 Anything
 Any
can be talked about...
thoughts?
 Views?
 Questions?
 Comments?
Keep the conversation
going!
[email protected]
@KEIRWALES
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