The Diagnosis of Personality Disorder Issues of Diversity

1
The Diagnosis of Personality Disorder Issues of
Diversity EqualityHenderson Hospital

• Objectives
• Examine the diagnosis of personality disorder and
  patient profile.
• Review some evidence of specialist treatment
  among the ethnically diverse patient groups.
• Examine the NIMHE Policy Guidance on services
  needs for Personality Disorder patients.
• Encourage feedback from participants on the way
  forward

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Structure of Work shop on Personality Disorder
and issues of equality diversity

• 1. What is Personality Disorder?
  15mins
• The diagnosis Prevalence
  Patient profile
• 2. Relevant research and recommendations
• Ethnic diversity and equality of access to
  specialist therapeutic community treatment of
  severe personality disorder (R.Geraghty
  F.Warren Psych. Bulletin 2003,27453-456 )
  15mins
• 3. NIMHE Policy Guidance on Personality
  Disorder (DoH) 15mins
• Henderson Services - Assessment, TC
  ,Training,Consultation, Research.
• PG Certificate on Working with
  patients with PD PDTDGs online learning
• 4. The Way Forward Summary
• Question and answers Explore possible solutions
  to meeting the needs of diverse patients with PD
  15mins
  
  

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What is Personality Disorder?

• Group Task
• Discuss with a partner for five minutes
• What is personality disorder?
• Who gets personality disorder?
• How is personality disorder treated?
• Group feedback Answers on flip
  -chart

4
Definition of Personality Disorder

• ( ICD-10 ) world health organisation 1992
• A severe disturbance in the
  charactereological condition and behavioural
  tendencies of the individual, usually involving
  several areas of the personality, and nearly
  always associated with considerable personal and
  social disruption.
• DSM-IV (American psychiatric association 1994)
• An enduring pattern of inner experience and
  behaviour that deviates markedly from the
  expectations of the individuals culture, is
  pervasive and inflexible, has an onset in
  adolescence or early adulthood, is stable over
  time, and leads to distress or impairment.

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Prevalence of Personality Disorder among Ethnic
Groups

• Paucity of studies. Prevalence of ethnic minority
  unknown
• Blacks over represented in coercive psychiatric
  services prison. (Fernando et al 1998)
• For data DOH (1999) Raleigh V. (2000) CRE fact
  sheet (1999)
• Prison male population 82 white 72 black
• Prison Female Population 72white 78 black
  (Moran )

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Defining the difficulties of PD

• Enduring patterns of dysfunction, of emotional
  distress and behaviour.
• Thinking - (ways of perceiving and interpreting
  self, other people, events).
• Feelings (the range, intensity, changeability,
  and appropriateness of emotional response).
• Interpersonal functioning (ways of relating to
  others).
• Impulse control (ability to react to and manage
  impulses appropriately (Host)

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Sub Categories of PD

• Cluster A
• Odd Eccentric - Paranoid,
  Schizoid, Schizotypal
• Cluster B
• Dramatic, emotional, - Histrionic,
  Narcissistic, borderline, antisocial
• Cluster C
• Anxious, fearful - Avoidant, dependent,
  Obsessive compulsive

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Possible explanation for ethnic differences

• Biases of assessment and diagnosis
• Correlation of indices of socioeconomic
  deprivation
• Staff attitude and biases in making diagnosis
• Lack of access to existing services due to bias
  in assessment tools, cultural stereotypes and
  research

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A Patient Profile

• Co-morbidity and multiple diagnosis
• Poor sense of Boundaries
• Homelessness
• Problems with identity gender sexuality
  selfhood
• Feelings of emptiness, aloneness, rejection
• Violence and offending behaviours
• Self harm and suicidality
• Addictive behaviours alcohol, drugs, gambling,
  spending, risk taking
• Eating problems
• Revolving door admissions

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NIHME Policy Guidance onPersonality Disorder

• Personality Disorder
• No longer a diagnosis of Exclusion
• NHS
  www.nimhe.org.uk

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Policy Implementation Guidance

• Existing Services
• Staff Selection, supervision, education and
  training
• Specialist services MDT, Residential and Day
  Units
• Forensic Services Personality Disorder Centres

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Henderson Services and treatment of Personality
Disorder

• Henderson Hospital
• Henderson Outreach Service
• Consultancy Assessment Training Research
• PG.Cert. Working with PD patients
• Personality Disorder Training Development Group
  Online Learning Environment

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The Way Forward
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References

• Cochrane, R and Sashidharan, S (1996) Mental
  health and ethnic minorities review of
  literature and implications for services, in
  Centre for Reviews and Dissemination Report 5,
  Ethnicity and Health Reviews of Literature and
  Guidance for Purchasers in the Areas of
  Cardiovascular Disease, Mental Health and
  Haemoglobinopathies. NHS Centre for Reviews and
  Dissemination, York University York, 105-26.
• Cooke, D J et al. (1998). Psychopathy Across
  Cultures in Cooke, D.J. et al, (eds).
  Psychopathy Theory, Research and Implications
  for Society, 13-45 (1998). Kluwer Academic
  Publishers. Printed in the Netherlands.
• CRE Fact Sheet Commission for Racial Equality
  Fact Sheet (1999). London.
• Fernando, S. Ndegwa. D. Wilson, M. (1998).
  Forensic Psychiatry, Race and Culture.
  Routledge London and New York.

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• Marsella, A.J., and Kameoka V.A. (1989). Ethno
  cultural issues in the assessment of
  psychopathology. In S. Wesler (Ed.), Measuring
  Mental Illness psychometric assessment for
  clinicians. Washington DC American Psychiatric
  Press.
• Sainsbury Centre for Mental health (2002)
  Breaking the Cycles of Fear - A review of the
  relationship between mental health services and
  the African-Caribbean community.
• Department of Health (1999). A systematic review
  of research relating to the MHA 1983. London
  Department of Health.
•  Marsella, A.J., and Kameoka V.A. (1989). Ethno
  cultural issues in the assessment of
  psychopathology. In S. Wesler (Ed.), Measuring
  Mental Illness psychometric assessment for
  clinicians. Washington DC American Psychiatric
  Press.
• Sainsbury Centre for Mental health (2002)
  Breaking the Cycles of Fear - A review of the
  relationship between mental health services and
  the African-Caribbean community.
• Department of Health (1999). A systematic review
  of research relating to the MHA 1983. London
  Department of Health.

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• Koffman J, Fulop N J, Pashley D Coleman K
  (1997). Ethnicity and use of acute psychiatry
  beds one-day survey in North and South Thames
  Regions. British Journal of Psychiatry 171,
  238-241.
• Parkman S., Davies S., Leese M., Phelan M. and
  Thornicroft G. (1997). Ethnic differences in
  satisfaction with mental health services amongst
  representative people with psychosis in South
  London. PriSM Study 4, British Journal of
  Psychiatry 171 (supplement 3), 260-264.
• Raleigh V.S. (2000). Mental Health in Black and
  Ethnic Minorities An Epidemiological
  Perspective in Kaye, C. Lingiah, T. (Eds)
  (2000) Race, Culture and Ethnicity in Secure
  Psychiatric Practice Working with Difference.
  London JKP.