Research: Thematic Analysis of staff views of guidance for working with

borderline personality disorder in crisis and suicide prevention training.

Kate Sloan

Nurse Practitioner in PsychotherapyScottish Personality Disorder Network

Thematic analysis of staff views

Crisis presentations of patients with a diagnosis of borderline

personality disorder

Seeking help at points of emotional distress

They in be seeking hospital admission

At this point of crisis staff have to assess risk and act accordingly

holding in mind the patient, systems we work within and more

recently hold in mind how we influence HEAT targets

Guidance NICE 2009

Maintain a calm and non-threatening

attitude

Use empathy and open ended questions

including validating statements to identify

the onset and course of the current

problems

Seek to stimulate reflection about solutions

Avoid minimising the persons stated reason

for the crisis

Refrain from offering solutions before

receiving full clarification of the problems

Seek alternatives to admission

STORM-Suicide Prevention Training

Assessment WorksheetCrisis Management Worksheet

Problem solving WorksheetCrisis Preventions Worksheet

Rational outline

Patients experience high levels of distress resulting in seeking help as

a result of self harm or when experiencing suicidality thoughts

Patients may seek hospital admission to gain relief from distress which

has created debate and controversy about its efficacy

The prevalence within mental health population is reported at 50% not

including co-morbid diagnosis

In Scotland the ISD suggest recurrent admissions with a personality

disorder diagnosis is 24.5%

Local IHTT services have 14% with a diagnosis of EUPD

research questions

What are the views of mental health practitioners who work within

secondary care services that respond to crisis presentations, on

both the practice guidelines and suicide prevention training

outlined within the literature for patients diagnosed with EUPD

What other interventions are utilised by mental health practitioners

that are not included within the data collection tool and the rational

for the interventions

Does the guidelines within the literature support practitioners

when seeking alternatives to admission

How do the guidelines and training inform local practice guidelines

Methodology

Qualitative- understanding the views and perceptions of the subjects

Subject group - mental health staff who have to respond to crisis

Data collection - focus group, capture the context engage a discussion

Data collection tool - created a series of questions based on guidance

and training

Ethics - Sensitive clinical issue

Data analysis - thematic analysis

Reliability and validity

Reduce bias - how subjects are recruited, who facilitates the group, who

transcribes

Transparency - how data is managed

Reduce researcher influence

The results

Prevention of crisis

The organisations role in managing crisis

Maintaining the therapeutic alliance

Managing risk of suicide - practitioners anxiety

Prevention of crisis

Prevention

Organisational systems adverse to therapeutic

care

Providing a consistent therapeutic experience

Early interventio

n

Organisation

Organisation role in managing

crisis

Problems within the

system

Do we have the

resources

Maintaining the therapeutic

alliance

Therapeutic ruptures

Development of knowledge and

skills

Management of risk- practitioner anxiety

Stopping suicide

Doing the right thing

Collaborative joint crisis management plans Moran et al , 2010

Evidence based treatments

Structured clinical management

Theoretically informed model for daily clinical practice

Agreed local guidance

Access to specialist treatments

Strengths and limitations

Did gather view and perspectives

Not generalisable

Fewer numbers than desired