A Personality Disorder Oasis In The UK
After a south UK based consultation in 2009 discussing the future of Personality Disorder (PD) services which involved 62 Primary Care Trusts the Cassells Hospital in Richmond Surrey will still be viable. "The Cassells" as it is often referred to has often dealt with childhood severe (post trauma affective) Personality Disorders in "Tier 4" level.
Some very pained people and families will breathe a sigh of relief about that . Additionally it has been decided some four outreach teams will be working in 4 regions of the southern UK . That is a new development for 2010 .
As a national specialist service the Cassel has a proven track record of assessing and treating adults, young people and families with intractable personality and family problems. The ESPD Service (Emerging & Severe Personality Disorders) and the Families Services both provide unique flexible care packages with residential, day and outreach services.
Wandsworth NHS Board Trust papers (27th January 2010) show that :
Further information on the procurement process, bed numbers and location of the services is not yet available, but will be reported to the Board when it is agreed. In the meantime PCTs are expected to continue to commission Tier 4 services from their current provider, which, in this PCT’s case is the Cassell Hospital.. "
The broader picture of change has been set within a context in which the Cassells and closely related world famous Henderson Hospitals were part of a nationally commissioned service supported by UK Primary Care Trust purchasing-in services. PD Users of services though have formed along with Govt, a 2003 paper, which it appears is having reshaping consequences several years after it was published :
The "Independent" newspapers to recap, put some of the dynamics of the story succinctly in 2007 :
The planned closure of Britain's leading national hospital for people with complex personality disorders was condemned as "inhumane" yesterday by mental health workers.
For 60 years, the Henderson Hospital in Sutton, Surrey, has provided a unique form of residential care to people with severe psychological difficulties who are among the most difficult cases known to medicine.
Its patients are mostly young women who, after traumatic childhoods often involving horrific sexual abuse, have become bent on self-destruction through prolonged bouts of self-harming, cutting and burning themselves.
The independent also pointed out the very high costs per person to keep them in a ward like situation and some current thinking leans toward earlier intervention (arguably cheaper and more timely ) in the community, so that people do not reach the level of severity of effect that is often termed "Tier 4" ..
People are not born "Tier" 4 - its a set of descriptors that reflects a individuals social evolution and often lack of supportive therapy help for years. That has all too often been in an NHS context of poor therapy supply for PD types . Exclusion from service-help thus has been the case .. Patient Choice and a matched budget following the patient for that should surely have been the way forward for many people . However the current mind set of Govt and vested interests is to make the private sector supplies almost off limits . But a 100 k per patient and supporting overheads too is that still the way forward for all PD types .. ?
The hospital is to close because the South-West London and St George's Mental Health NHS Trust says it cannot afford to keep it open. Two other therapeutic residential centres, the Cassell Hospital in Richmond, Surrey, and Main House in Birmingham, are also under threat because they are no longer funded as a national service. Instead, they rely on primary care trusts to pay the costs of treatment, which can run to 100,000 a year per patient.
Do not give the locations of the regions where outreach services will be stationed they state only :
"The review was led by the South East Coast Specialised Commissioning Group on behalf of the 62 PCTs in the south of England. A Joint Committee of these PCTs met in November 2009 to consider the feedback from the public consultation, including the 54 PCTs who responded.
The consensus decision of the joint committee was that the new future service model which will be developed will have 1 residential unit and 4 regional outreach teams based in each of the 4 regions. "
It appears in the UK we will have to wait to see what happens with the 4 regions getting new PD "community inclusive" services, but keeping the specialist hospital to deal with children and young people in severe distress is no mirage and that may be their only supportive oasis ..
Further Interesting Reading :