Halliwick Dr Guide

MBTree

Introduction:

Welcome to The Halliwick Unit. You will be working with the Personality Disorder service as part of a team including nurses, therapists and doctors. There is a large caseload of patients and the service is based on Mentalization Based Therapy (MBT). Your role will be varied and well supported and we hope that you enjoy your time with us.

Before Joining:

Psych training

Recommended reading: Mentalization-Based Treatment for Personality Disorders: A Practical Guide Anthony Bateman and Peter Fonagy

Recommended course: ONLINE Intro to MBT with the Anna Freud Centre -this can be claimed back from the study budget

Email the team to introduce yourself and ask admin to set you up with the following:

  • shared drive access
  • shared email inboxes access
  • appropriate RiO access
  • swipe card for building entry

Your job:

  1. Initial assessments
  2. SCM individual
  3. MBT groups
  4. Medical reviews
    • Medications
    • Mid treatment reviews
  5. Duty days
  6. Meetings/workshops

Initial assessments

You will be allocated patients by the team managers, this usually equates to 1 new assessment per week if you are FT. Each assessment takes 2-3 appointments on average and each appointment is for 1 hour. Assessment needs to produce a structured assessment report, there is a brief Cluster B PD assessment guide to it, please read it before starting with assessments.

Before first appointment:

  • call patient to arrange first appointment
  • ask admin to send out a letter confirming appointment
  • include SCID screening questionnaire in appointment letter SCID screening questionnaire
  • read referral letter, RiO notes and risk assessment

During assessment:

  • Normal psychiatric history - same as in your previous jobs
  • Focus on Axis 2 symptoms:
    • AVOIDING ABANDONMENT – INTERPERSONAL RELATIONSHIPS & SOCIAL FUNCTIONING – SENSE OF SELF – IMPULSIVITY – DSH/SI – EMOTIONAL LABILITY/ MOOD DYSREGULATION – FEELINGS OF EMPTINESS – DISSOCIATIVE / BRIEF PSYCHOTIC SYMPTOMS
  • You may need to use a part or all of the SCID interview SCID interview
  • Think about a risk formulation and crisis plan for your patient
  • You may want to discuss them at the assessment workshop (we’d advise discussing all your new assessments when you start out)
  • Decide the outcome and let the patient know

Possible outcomes from initial assessments:

  • No personality disorder- discharge back to GP
  • Signposting to another service (e.g. MAP, PT, locality team, dual diagnosis)
  • Signposting to a charity such as Open Door
  • Giving a diagnosis of EUPD and referring for our treatments (SCM, MBTi, MBT)

After assessment

  • Write your assessment report, there is a proforma that you may find useful example proforma
  • Ask admin to send report to patient and GP
  • Complete risk assessment, crisis plan and care plan on RiO
  • transfer patient to appropriate list on RiO

SCM individual

Structured Clinical Management is a form of treatment offered to patients focused on specific interventions.

You will be assigned roughly eight patients at a time and see them for six 50-minute sessions with a two week break between each session. Goals of SCM are usually outlined within the assessment letter and these should be discussed with the patient the first day and brought to SCM supervision. Often work involves risk management, affect regulation or around creating a healthy relationship with mental health services.

There are many different paths you can take during SCM and helpful documents are found in the SCM portion of the shared drive.

Additionally it would be helpful to arrange an SCM introductory session with Ellen prior to beginning.

To do list:

  • When you receive your list of patients they should come with a small SCM summary aim, also read initial assessments prior to phoning.
  • Arrange for the first appointment date and send letter for this
  • In the first session arrange all future appointment dates, discuss the contract of SCM and begin to formulate a plan about the goals of the treatment as peoples goals may have changed since initial assessment.
  • Bring patients to SCM supervision as soon as possible to get feedback for your plan going forward.
  • Some patients may not have had their crisis plan , care plan and risk assessment done/updated, please ensure these are completed as SCM is a good opportunity to go into detail on patient crisis planning.
  • At the end of treatment you will be expected to produce a document outlining what you worked on with the patient in SCM and present this to them on their sixth session.

MBT Groups

You may want to gain some MBT experience whilst doing this job, as you will usually only be here for 6 months the best way to do that is by joining an MBT group as a co-facilitator. If this is something you are interested in, let your supervisior and the team managers know early on and they will do their best to accomodate you.

Patients in MBT attend 2 sessions per week (an individual and a group session). Each group is ideally run by 2 facilitators and there are 3 groups per week so there should be one that fits your availability.

The group is 1 hour 15 minutes and if you are on-call it is best to find someone to cover the bleep for that time.

To find out more about MBT please see “Before Joining” section.

Medical reviews

Medications You will be asked to review patients medications as part of your duty within the team. The NICE guidelines do not recommend any for of medications for EUPD, as such it can often be an ambiguous area. Mostly the aim of threatment within PD services would be to aim to reduce medications where not clinically indicated and to treat underlying psychological distress with available MBT/SCM therapies. It is helpful to discuss changes with the team and/or in supervision.

Mid treatment reviews As part of their MBT treatment all patients should be offered a mid treatment review at the beginning, middle and end of MBT. These reviews should be focused on physical health, medication reduction and gaining an overall sense of the effect that treatment has had on the patient.

Duty Days

You will be assigned to cover duty as part of the team. This involves checking all emails coming in through HPD enquiries, HPD referrals and monitoring the duty phone throughout the day. By the end of the day all mailboxes should be empty. Duty rota can be found on the staff rota which is in…

HPD enquiries This is the general mailbox for the team. Most emails can be forwarded to the relevant person they are directed to and then deleted from the mailbox. If there is no obvious person that the email is directed to you may need to sort the issue out or on your own or discuss with Cath or Joe for advice on how to proceed.

HPD referrals These mailboxes are for referrals from other teams which need to be screened. They are forwarded to the relative screeners depending on which locality they originate from. This can be found the Duty folder. Central Locality - Ellen/Cath West Locality - Joe North East Locality - Justyna/Joe SouthEast Locality - Cath

Duty Phone Each morning when on duty you will need to log into the duty phone and check for any voicemails received and action any jobs depending on what you find. To log into the phone as duty press the settings button, select Login/logout, enter user ID 37504 and password 1234. To check voicemail click the voicemail button.

Meetings/workshops

There is a daily check-in at 9.00am on zoom which lasts 10-15 mins.

Below is a timetable of the weekly supervisions and meetings. Currently these are held via MS teams and you will be sent the links when you start.

Monday Tuesday Wednesday Thursday Friday
MBT Supervision 12-13.30 SCM supervision 9.15-10.45 Clinical Meeting 11.30-13.00 MBT supervision 11-12.30
Assessment W/S 14.00-15.30 Assessment W/S 14.00-15.30

How to refer to other teams:

Below are a list of teams that you may need to refer a patient on to. The best way to do this is to discuss in assessment workshop and the team can then direct you where to go.

  • Psychotherapy Pathway (CAT, psychodynamic group and individual, CBT)
  • Dual Diagnosis
  • PTSD pathway
  • MAP (mood and anxiety pathway)

Supervision/teaching/annual leave:

Supervision Core trainees usually have their supervision on a Monday afternoon. SpR’s usually have their supervision on a Wednesday morning.

Teaching Your teaching is protected time and the team are aware of academic programme on a Wednesday afternoon.

Annual leave The easiest way to do this is to create a google calendar with all your oncalls, annual leave and study leave. You can then share the calendar with the team. There are usually no problems with getting leave but it is best to plan in advance.

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Psychotherapy SHO
CT 1-3 Trainee in Psychiatry

My professional interests are psychiatry related.

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