The Complex Emotional Needs (CEN) and multi-disciplinary team (MDT) provides top-up (sometimes known as ‘wrap around') support to the care already provided by the Community Mental Health Teams.
This is for people with a primary diagnosis of a personality disorder, who struggle to recover and present with high risks, involving multiple admissions and use of urgent care or emergency services.
The MDT also aims to develop and support appropriate therapy pathways and training across the whole system, to improve care, prevent escalation in presentations, and address stigma and systemic barriers to service user experience and outcomes.
Our service users often have other difficulties alongside a diagnosis of a personality disorder which requires a number of teams to work together.
This can make it challenging for services to engage service users effectively in their recovery journey. Many struggle to manage their emotions, have symptoms of trauma and struggle to navigate life and relationships. They present as having chaotic lifestyles and can resort to self-harm as a way of coping.
The type or level of involvement depends on the presence on a number of factors. These include the level of involvement from what is known as our 'core services' (medics, care programme approach and care co-ordinators within the community mental health team), risk levels, clinical and social needs, the service users and carers current circumstances and their willingness to apply themselves to treatment.
We can provide:
- Consultation and supervision – We can work behind the scenes with the community mental health team, bringing a fresh perspective and renewed hope. We do this by reviewing current care plans and re-formulating the person’s difficulties with an emphasis on trauma informed, psychological, occupational and social aspects of the person’s care.
We liaise closely with those currently involved, offering informal and formal supervision, arranging and attending meetings and working to pull all aspects of care together, to form a ‘joined up’ understanding and approaches.
- Specialist assessment, risk formulation and care planning – Alongside consultation, we can provide assessment and formulation which is specifically tailored to those with complex emotional needs, where a more comprehensive psychological based assessment is required to inform care plans and positively manage risk presentations.
- Direct clinical work – We are a small team and therefore must work alongside colleagues to boost the frequency and intensity of contacts for our service users. The aim is to assertively engage our service users, including hospital in-reach to prevent crises, address barriers and bring about stability and adherence to care plans.
This may involve helping them understand their difficulties, trauma psychoeducation, dialectical behavrioural (DBT) therapy informed practice, behavioural family therapy, structured clinical management or cognitive behavioural therapy (CEN).
- Access to CEN specific psychological therapies – We help to increase access and availability of Trust wide psychological therapies for CEN.
We have close links with our DBT teams and can offer faster access to DBT, eye movement desensitisation and reprocessing (EMDR), CBT for trauma, compassion focused therapy, narrative trauma therapy and cognitive analytic therapy.
- Support for carers – We have developed links with the Trust wide carers team, and aim to directly support carers through forums, training and one to one support. We will also in-reach into formal care providers helping them develop care plans and offer training.
- Crisis support - Although we will not offer alternatives to duty, crisis resolution and home treatment team (CRHT) or mental health liaison services (MHLS), we can work alongside these offers, to help shape responses, increase understanding of both chronic and acute risk and positive risk management strategies.
We can also work with urgent care response, police and West Midland Ambulance Service to support staff, offer training, or help write bespoke care plans. We will also work closely with patients to offset their need to use these services in the first instance, managing crisis in a more preventative way.
- Training – taking advice from Health Education England and NHS England, we are developing an ongoing training programme and will respond to requests, to provide training that is tailored specifically to the needs of your team. We aim to offer personality disorder awareness training and risk formulation and management for CENs, as two examples.
- Clare Barnes - Service Lead
- Dr Marie Payne – Consultant Clinical Psychologist
- Jane Collins - Sandwell Clinical Lead
- Lisa Fleming – Dudley Clinical Lead
- Justine Crane - Wolverhampton Clinical Lead
- Miya Ayub – Walsall Clinical Lead