All Party Parliamentary Group for
Mental Health
Notes of meeting: March 2004
Portcullis
House, Westminster
Tuesday
30th March 2004
Members
present: Dr
Lynne Jones MP (Chair), Dr Evan Harris MP, Baroness Masham of Ilton and Doug Naysmith MP.
Observers: Martin Aaron (JAMI), Matin Ball (Maca),
Nick Bosanquet (Imperial College), Philip
Dixon-Phillips
(Nigel Fisher (SW London Mental Health Trust), Roger Freeman (Royal College of
Psychiatrists), Tom Hamilton (Maca), Caroline Hawkings (Turning Point), Sally Hughes
(Mind), Sheree Parfoot (CAPITAL), and Agnes
Wheatcroft
(Royal College of Psychiatrists).
Therapeutic
Communities and Possible Treatments for Personality Disorder
Speakers:
·
Dr
Kingsley Norton Consultant
and Director of Henderson Hospital
·
Dr
Rex Haigh Chair
Association of Therapeutic Communities
Sarah
Paget
from the Community of Communities Project and Dr Jan
Birtle
(Main House Therapeutic Community, Birmingham & Solihull MH Trust) also attended and
answered questions after the talks.
Dr Kingsley Norton:
Dr
Norton outlined the difficulties surrounding the diagnosis of personality disorder,
particularly the stigma attached to it, including prejudice held by the medical
profession. The diagnosis is also sometimes used to exclude people from receiving
treatment. The condition is enduring rather than episodic and may be the result of
previous abuse.
Personality
Disorder (PD) can be hard to diagnose, as often there are other conditions present. Also
the person can have unrealistic expectations of treatment, a mistrust of professionals and
ambivalence towards receiving help. The principles behind treatment are:
·
To
see the patients as having complex needs
·
Recognise
their strengths and weaknesses
·
Support
pro-social development
·
Pursue
clear goals
·
Present
a realistic image of the world
·
Explore
causes and triggers of behaviour
·
Mirror
distress and discord to explore responses
·
Empowered
staff
·
Make
a change if the treatment or location does not work for the patient
·
Provide
a seamless service
Dr
Rex Haigh:
Dr
Haigh addressed the issue of whether PD can be treated, explaining that therapeutic
communities (TCs) have been treating PD since the Second World War when group therapy
experiments began with soldiers. Patients who join TCs are usually called
‘members’; they have collective responsibility for what goes on in the community
including a say in whether new members are accepted. There have been many types of TCs
including drugs and alcohol and social psychiatry communities and therapeutic housing. The
TCs can also treat young offenders and sex offenders.
There
is evidence that these communities provide a very effective treatment as well as being
cost-effective. Research is currently being collated for future publication.
The
Royal College of Psychiatrists’ Research Unit hosts the Community of Communities
project which aims to improve the regulation of TCs and share best practice.
Q&A:
Lynne
Jones asked what a typical day would be like in a TC. Dr Norton replied that the day would
be taken up with a community meeting which would be chaired by one of the members. Then
there would be smaller group meetings. The community would be brought together if there is
discord. Drugs are rarely used in TCs. The staff work in multidisciplinary teams including
psychiatrists, occupational therapists and psychologists.
Doug
Naysmith asked how people are chosen and find out about TCs. The speakers explained that
health professionals tell their patients about TCs or patients can self-refer themselves.
There will then be a group vote in the community about whether to accept the person.
Baroness
Masham asked what the relationship is between PD and schizophrenia. The speakers explained
that there are three types of PD including schizoid paranoia and so there is some overlap.
Evan
Harris asked what evidence there was to prove the successful outcomes of TCs and whether
psychiatrists were united on supporting them. Dr Haigh noted that there has been
meta-analysis and randomised controlled trials. Jan Lees said that TCs do not work for
everyone but that they can be very effective. The Community of Communities project aims to
establish a more uniform model for the structure of TCs.
The
Group discussed the question of treatability, which arose in the current Draft Mental
Health Bill. The speakers noted that the treatment can be effective when used with people
detained in prison though in general TCs are not coercive. The Group also spoke about the
stigma attached to PD and how this exists in the health service as well as amongst the
public.
Lynne
Jones thanked the speakers for their time.
Date
of the Next Meeting: 27th
April (details will be circulated)
back
to mental health
