Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...

 
Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
Personality
Disorder Services
> Medium Secure
> Low Secure
> Tier 4 PD (NHSE)
> PD Intensive Support
> Highly Specialised PD (CCG)
> PD / Disordered Eating Dual Diagnosis
> Community Rehabilitation

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Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
Welcome                                                                                                                                   Click the buttons to find
                                                                                                                                          out more about our
                                                                                                                                          Personality Disorder Services
Cygnet Health Care was established in
1988. Since then we have developed a
                                                                                                                                       Introduction
wide range of services for individuals with   Our expert and highly dedicated care       We maintain a good relationship with our
mental health needs, autism and learning      team of 10,000 employees empower           quality regulators and undergo regular        Our Model of Care
disabilities within the UK. We have built     2,864 individuals across 150 services to   inspections, with 82% of our services         Our myPath Care Model
a reputation for delivering pioneering        consistently make a positive difference    rated ‘Good’ or ‘Outstanding’. We also        Global Assessment of Progress
services and outstanding outcomes for         to their lives, through service user       operate an internal system of quality care,   (GAP) Outcomes
the individuals in our care.                  focused care and rehabilitation.           treatment and positive outcomes.              Example DBT Pathway
                                                                                                                                       Outcomes
                                                                                                                                       Medium Secure
                                                                                                                                       Low Secure
                                                                                                                                       Tier 4 PD (NHSE)
                                                                                                                                       PD Intensive Support
                                                                                                                                       Highly Specialised PD (CCG)
Contents                                                                                                                               PD / Disordered Eating Dual Diagnosis
                                                                                                                                       Community Rehabilitation
 Introduction                                  02         Highly Specialised PD (CCG)                                                  Case Study
 Our Model of Care                             06         Cygnet Acer Clinic, Derbyshire                18                             Map
 Our myPath Care Model                         07         Cygnet Alders Clinic, Gloucestershire         19                             Service User Reviews
 Global Assessment of Progress (GAP) Outcomes 08          Cygnet Aspen Clinic, South Yorkshire          20                             How to Make a Referral
 Example DBT Pathway                           09         Cygnet Hospital Bierley, West Yorkshire       21
 Outcomes                                   10-11         Cygnet Hospital Maidstone, Kent               22
 Medium Secure                                            PD / Disordered Eating Dual Diagnosis
 Cygnet Hospital Bury, North West              12         Cygnet Nield House, Cheshire                  23
 Low Secure		                                             Community Rehabilitation
 Cygnet Hospital Clifton, East Midlands        13         Gledholt Mews and Coach House, West Yorkshire 24
 Cygnet Hospital Derby, East Midlands          14         Case Study                                25-26
 Tier 4 PD (NHSE)                                         Map                                           27
 Cygnet Hospital Beckton, London               15         Service User Reviews                          28
 Cygnet Hospital Ealing, London                16         How to Make a Referral                        29
 PD Intensive Support
 Cygnet Hospital Beckton, London               15
 Cygnet Hospital Kewstoke, South West          17

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Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
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                                                                                                                                               Personality Disorder Services

                                                                                                                                            Introduction
                                                                                                                                            Our Model of Care
                                                                                                                                            Our myPath Care Model
                                                                                                                                            Global Assessment of Progress
                                                                                                                                            (GAP) Outcomes
                                                                                                                                            Example DBT Pathway
                                                                                                                                            Outcomes
                                                                                                                                            Medium Secure
                                                                                                                                            Low Secure
                                                                                                                                            Tier 4 PD (NHSE)
                                                                                                                                            PD Intensive Support
                                                                                                                                            Highly Specialised PD (CCG)
                                                                                                                                            PD / Disordered Eating Dual Diagnosis
                                                                                                                                            Community Rehabilitation
                                                                                                                                            Case Study
                                                                                                                                            Map
                                                                                                                                            Service User Reviews
                                                                                                                                            How to Make a Referral

Introduction
O     ur national network of specialist personality disorder services
      offers over 250 beds across 13 services which provide
medium secure and low secure, emergency, tier 4 inpatient,
                                                                        Our services offer a range of interventions including Dialectical
                                                                        Behaviour Therapy (DBT) and Schema Focused Therapy, along
                                                                        with a number of additional interventions to enhance service
highly specialised CCG funded personality disorder, dual                users’ recovery journey. Managed Care Pathways are used to
diagnosis PD and disordered eating and community                        improve clinical effectiveness with a view to move service users
rehabilitation services.                                                through the integrated personality disorder pathway and back
                                                                        to independent community living.
Each of our personality disorder services offer a highly structured
environment designed to promote recovery. Care and support is
provided in therapeutic environments by comprehensive multi-
disciplinary teams.

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Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
Our service user profile:                                                                                  Click the buttons to find
                                                                                                           out more about our
 >   Diagnosis of personality disorder and associated mental health needs                                  Personality Disorder Services
 >   May have forensic history
 >   May present with co-morbid presentations:                                                          Introduction

     •   Self-harm
                                                                                   18+ years            Our Model of Care
                                                                                                        Our myPath Care Model
     •   Self-neglect                                                                                   Global Assessment of Progress
                                                                                                        (GAP) Outcomes
     •   History of substance misuse
                                                                                                        Example DBT Pathway
     •   Complex needs
                                                                                                        Outcomes
     •   Disordered eating                                                                              Medium Secure
 >   May have a history of trauma and/or abuse                                                          Low Secure
                                                                                                        Tier 4 PD (NHSE)
 >   May have experienced previous placement breakdowns
                                                                                 Male/Female            PD Intensive Support
                                                                                                        Highly Specialised PD (CCG)
                                                                                                        PD / Disordered Eating Dual Diagnosis
                                                                                                        Community Rehabilitation
                                                                                                        Case Study
                                                                                                        Map
                                                                                                        Service User Reviews
                                                                                                        How to Make a Referral

                                                                            Mental Health Act Status:
                                                                             Detained or Informal

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Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
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                                                                  out more about our
                                                                  Personality Disorder Services

                                                               Introduction
     Our services at a glance:                                 Our Model of Care
                                                               Our myPath Care Model
          >    High staffing ratios
                                                               Global Assessment of Progress
          >    Dialectical Behaviour Therapy (DBT)             (GAP) Outcomes
                                                               Example DBT Pathway
          >    Schema Focused Therapy
                                                               Outcomes
          >    Substance misuse / addictions treatment         Medium Secure
          >    Self-harm treatment                             Low Secure
          >    Daily living skills                             Tier 4 PD (NHSE)
                                                               PD Intensive Support
          >    Cognitive Behavioural Therapy                   Highly Specialised PD (CCG)
          >    Anxiety management                              PD / Disordered Eating Dual Diagnosis
          >    Community and social involvement                Community Rehabilitation
                                                               Case Study
          >    Vocational initiatives
                                                               Map
          >    Specialist PD pathway                           Service User Reviews
                                                               How to Make a Referral

    Our multi-disciplinary teams:
      >       Consultant Psychiatrists and Specialty Doctors
      >       Psychology
      >       Occupational Therapy
      >       DBT practitioners
      >       Nurses
      >       Health care support workers
      >       Social workers
      >       Substance misuse practitioners

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Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
Our Model of Care                                                                                                                                                                                                 Click the buttons to find
                                                                                                                                                                                                                      out more about our
                                                                                                                                                                                                                      Personality Disorder Services

             N                                                                                                                                                                                                     Introduction
             e I will live in an environment that enables me
             w                                                                                                                                                                                                     Our Model of Care
My Past
             B                                                                                                                                                                                                     Our myPath Care Model
                  I will be supported by specially trained staff
             e                                                                                                                                                                                                     Global Assessment of Progress
                                                                                                                                                                                                       My Future
             g
             i
                                                                                                                                                                                                                   (GAP) Outcomes
                  The team supporting me will be resilient and striving
             n                                                                                                                                                                                                     Example DBT Pathway
             n
             i                                                                                                                                                                                                     Outcomes
                  A specific model of care will be provided which offers a flexible
             n                                                                                                                                                                                                     Medium Secure
             g                                                                                                                                                                          Stage Five
             s                                                                                                                                                                                                     Low Secure
                                                                                                                                                                                 Transition & Discharge
                                                                                                                                                                                   Preparing to move on            Tier 4 PD (NHSE)
                                                                                                                                                                                  >Relapse prevention              PD Intensive Support
                                                                                                                                                                                  >Collaborative                  Highly Specialised PD (CCG)
                                                             Stage Three                                                  Stage Four                                              update on risk
                                                                                                                                                                                  assessments and                  PD / Disordered Eating Dual Diagnosis
                                                            Stabilisation                               Active Treatment and Rehabilitation
                                                              Feeling safe                            Individualised therapy and improving quality of life
                                                                                                                                                                                  behavioural support
                                                                                                                                                                                                                   Community Rehabilitation
                                                                                                                                                                                  plans to share

                                                       >Psycho-education             >Choice of individualised therapy          >Sharing of skills learned in therapies with    with future                      Case Study
                                                                                                                                                                                  support providers
                                                        groups (DBT Skills,            such as:                                   staff in reflective practice and CPA                                             Map
  Stage One                      Stage Two              problem solving,              • Modular Dialectical Behaviour            >If required, specialist multi-model            >Engaging family/
                                                        managing emotions,              Therapy (DBT)                             interventions to minimise future risks
                                                                                                                                                                                  carers to                        Service User Reviews
 Preadmission                 Assessment                hearing voices etc.)                                                                                                      support with
   Preparation               and Admission                                            • Mentalisation Based Therapy (MBT)         of harm to self and/or others e.g.:
                                                                                                                                                                                  discharge planning               How to Make a Referral
                            Getting to know you
                                                       >Mindfulness                   • Cognitive Analytical Therapy (CAT)        • Substance Misuse relapse prevention
                                                                                                                                                                                  >Skills generalisation
>Pre-admission                                        >Relaxation                    • Interpersonal Therapy (IPT)               • Life Minus Violence - Enhanced
                           >Establish                                                                                                                                            to the community
assessment                                             >Implementation                • Schema Focussed Therapy (SFT)               (LMV-E)
completed
                            therapeutic                                                                                                                                           >‘ Moving On’ group
                            relationship
                                                        of sensory strategies
                                                                                      • Compassion Focussed Therapy (CFT)         • Life Minus Violence for Harmful Sexual
(including review                                                                                                                                                                 >Discharge planning
                                                       >Vocational and                                                              Behaviour (LMV-HSB)
of clinical records,       >Undertake baseline                                       • Cognitive Behavioural Therapy (CBT)
                                                        skills training                                                           • Fire-Setting Intervention
receipt of essential        psychometric                                              • EMDR
                            assessments                >Occupational                                                                Programme (FIP-MO)
documentation                                                                         • Combined Individual and group
such as HCR-20,            >Medical
                                                        goal setting                                                              • Seeking Safety (Managing Substance
                                                                                        psychoanalytic approaches
START, PBS plan,            assessment and             >Ongoing Reflective                                                         Misuse for clients with a history
                                                        Practice, Training and
                                                                                      • Psychosocial nursing                        of trauma)
etc.)                       MDT discharge
                                                        advice on systemic            • NICE guideline recommended               >Thinking Minds (Cognitive Skills Training)
>Pre-admission care        planning
                                                        support through                 medication regime
plan created               >Occupational                                                                                        >Skills generalisation with OT
                                                        updating PBS plan             >Occupational skills building
>Face to                    assessment of daily                                                                                  >Community reintegration, on-going
                            living skills and
                                                        for staff                     >Explore educational                        identity work
face assessment
                                                                                       /vocational pathway
> Advance                  sensory needs                                                                                        >Educational/ vocational pathways
 provision of ward         >Engaging family
 and hospital               and carers
 information to            >Collaborative
 person in care and         formulation
 their family. Discuss      development to
 consent of family/         share with team via
 carer involvement.         reflective practice
>Completion of             sessions and used
PCP tools and               to inform PBS plan
advanced                   >Assessment of
preferences                 physical health
                           >Care planning

                                                                                 Enabling and Nurturing Environment

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Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
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                                                                                   Personality Disorder Services

Our myPath
                                                                                Introduction
                                                                                Our Model of Care
                                                                                Our myPath Care Model

Care Model                                                                      Global Assessment of Progress
                                                                                (GAP) Outcomes
                                                                                Example DBT Pathway
To ensure we cater for each person’s journey and achieve long-term              Outcomes
results, we have created a unique approach to care for people with              Medium Secure
personality disorder. Our aim is to support clients to work towards a goal of   Low Secure
discharge in to community or step down settings following completion
                                                                                Tier 4 PD (NHSE)
of treatment.
                                                                                PD Intensive Support
myPath is our unique overarching care model which serves to monitor             Highly Specialised PD (CCG)
service user engagement levels, manage their records, assess individual         PD / Disordered Eating Dual Diagnosis
progress and formulate a personalised and dynamic care plan with
                                                                                Community Rehabilitation
measurable targets.
                                                                                Case Study
Within our personality disorder services, myPath is structured to support       Map
individuals who require specialist therapeutic interventions including
Dialectical Behaviour Therapy (DBT) and Schema Focused Therapy. It is           Service User Reviews
designed to help service users tackle their symptoms and progress with          How to Make a Referral
their lives. In addition, these services support with preparation for an
independent life within the community, or for moving on to
mainstream rehabilitation.
For each individual, a daily risk assessment is completed, which enables
dynamic responses to individual presentation within any 24 hour period
enabling immediate support to be provided. Each individual is offered
a minimum of 25 hours meaningful activity, which is evidenced and
documented within an individualised activity timetable based around
understanding mental health needs, effective coping strategies and
reinforcing daily living skills. Each individual’s care pathway is reviewed
in full by the multi-disciplinary team on a weekly basis and guided by
a dynamic care plan which is closely linked to our specialist outcome
tool, the Global Assessment of Progress (GAP). In our personality disorder
services, the GAP allows us to measure an individual’s progress during their
admission, plot the positive developments and changes in well-being whilst
formulating plans over potential future risks for longer term management. In
applying myPath, the team around the individual is able to be responsive
in their approach and use myPath to determine length of stay, ensuring
that people move as quickly as possible to the most appropriate and least
restrictive environment.

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                                                                                                      out more about our
                                                                                                      Personality Disorder Services

                                                                                                   Introduction
                                                                                                   Our Model of Care
                                                                                                   Our myPath Care Model
                                                                                                   Global Assessment of Progress
                                                                                                   (GAP) Outcomes

Global Assessment of
                                                                                                   Example DBT Pathway
                                                                                                   Outcomes
                                                                                                   Medium Secure

Progress (GAP) Outcomes                                                                            Low Secure
                                                                                                   Tier 4 PD (NHSE)
                                                                                                   PD Intensive Support
The Global Assessment of Progress (GAP) is our specialist outcome tool used within our             Highly Specialised PD (CCG)
Personality Disorder services. The tool allows us to measure an individual’s progress throughout   PD / Disordered Eating Dual Diagnosis
their placement, plot the positive developments, setbacks and changes in wellbeing but also
                                                                                                   Community Rehabilitation
identify the warning signs of any possible deterioration, whilst informing care planning and
being transparent about future risks.                                                              Case Study
                                                                                                   Map
60                                                                                                 Service User Reviews
        n=94
                                                                                                   How to Make a Referral

40                                                       9.0
                                                          or 22%
                                                                                  52

                                        43             average increase
                                                           in score
                                                            p
Personality Disorder Services - Medium Secure Low Secure Tier 4 PD (NHSE) PD Intensive Support Highly Specialised PD (CCG) PD / Disordered Eating ...
Example Dialectical                                                                                   Click the buttons to find
                                                                                                      out more about our

Behaviour Therapy Pathway
                                                                                                      Personality Disorder Services

                                                                                                   Introduction
                                                                                                   Our Model of Care
    Pre-admission assessment                                                                       Our myPath Care Model
     > Including assessment of willingness and capacity to engage in DBT and                       Global Assessment of Progress
           the suitability of the programme in meeting the service user's needs                    (GAP) Outcomes
                                                                                                   Example DBT Pathway
                                                                                                   Outcomes
    Admission
                                                                                                   Medium Secure
     > Psychological / DBT assessment and formulation                                              Low Secure
     > Assess motivation to engage in DBT                                                          Tier 4 PD (NHSE)
     > Explain 4-miss rule (if a service user misses 4 consecutive sessions they                   PD Intensive Support
           have ‘opted out’ of DBT)                                                Refer back to   Highly Specialised PD (CCG)
       >   Baseline outcome measures administered
                                                                                   psychology      PD / Disordered Eating Dual Diagnosis
                                                                                   for other       Community Rehabilitation
                                                                                   intervention    Case Study
                    If motivated                               If not motivated                    Map
           Presentation and                                                                        Service User Reviews
                                                           Motivation work
       allocation at DBT consult                                                                   How to Make a Referral

    DBT programme pre-commitment work
     > Service user and therapist sign DBT contract
     > Agree DBT enrolment date in line with next module start

    Begin comprehensive DBT
     > One standard treatment cycle = 2 x 6 month rounds
     > Psychometric measures to be readministered every 6 months

           Individual                 Skills Training                    Skills
            Therapy                       Group                        Coaching

    Completion of DBT
     > Psychometric measures to be readministered at end of programme

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                                                                                             out more about our
                                                                                             Personality Disorder Services

                                                                                          Introduction
                                                                                          Our Model of Care
                                                                                          Our myPath Care Model
                                                                                          Global Assessment of Progress

Outcomes
                                                                                          (GAP) Outcomes
                                                                                          Example DBT Pathway
                                                                                          Outcomes
Sample DBT outcomes from New Dawn Ward,                                                   Medium Secure
Cygnet Hospital Beckton                                                                   Low Secure
                                                                                          Tier 4 PD (NHSE)
The outcome measures collected map to the difficulties associated
                                                                                          PD Intensive Support
with Emotionally Unstable Personality Disorder and the areas that the
DBT programme aims to address.                                                            Highly Specialised PD (CCG)
                                                                                          PD / Disordered Eating Dual Diagnosis
Data is collected before enrolment in the DBT programme, at 6 months
                                                                                          Community Rehabilitation
(following the first cycle of DBT skills modules) and again at 12 months
(following completion of the second cycle of skills modules.)                             Case Study
                                                                                          Map
                                                                                          Service User Reviews
40                                                                                        How to Make a Referral

20

 0
                          Pre Program                         6 Months   12 Months

The Rosenberg Self-Esteem Scale measures a person’s level of self-esteem based on their
perceptions of themselves, both individually and comparison with others. Scores range
from 0-30, with higher scores indicating a higher level of self-esteem.
An increase in scores may suggest that individuals have developed a more positive
orientation towards their self-worth over the course of the DBT programme.

Data presented from 20 service users who completed 12 months of DBT.

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120                                                                                              out more about our
                                                                                                 Personality Disorder Services
100
                                                                                              Introduction
 80                                                                                           Our Model of Care
                                                                                              Our myPath Care Model
60                                                                                            Global Assessment of Progress
                                                                                              (GAP) Outcomes
40                                                                                            Example DBT Pathway
                                                                                              Outcomes
20                                                                                            Medium Secure
                                                                                              Low Secure
 0                                                                                            Tier 4 PD (NHSE)
                          Pre Program                         6 Months   12 Months
                                                                                              PD Intensive Support
The Difficulties in Emotion Regulation Scale (DERS) assesses typical levels of emotion        Highly Specialised PD (CCG)
dysregulation across 6 domains. Higher scores indicate higher levels of
                                                                                              PD / Disordered Eating Dual Diagnosis
emotion dysregulation.
                                                                                              Community Rehabilitation
Overall scores indicate a reduction in overarching emotion dysregulation difficulties, also   Case Study
noted on each of the measured domains. This suggests that individuals have a greater
                                                                                              Map
awareness, clarity and acceptance of their emotions.
                                                                                              Service User Reviews
                                                                                              How to Make a Referral
120

100

 80

60
                                                                                                     Average length
40                                                                                                      of stay is
20
                                                                                                     13
 0
                          Pre Program                         6 Months   12 Months
                                                                                                    months
                                                                                                       Across Tier 4 and CCG
The Five Factor Mindfulness Scale measures five facets of mindfulness: observing,                       PD services (2019/20)
describing, acting with awareness, non-judging of inner experience and non-reactivity
to inner experience.
Overall increases are noted in relation to mindfulness and this is found across all five
measured facets.

Data presented from 20 service users who completed 12 months of DBT.

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Cygnet Hospital Bury, North West                                                                                            Click the buttons to find
                             Buller Street, off Bolton Road, Bury, North West BL8 2BS                                                                    out more about our
                                                                                                                                                         Personality Disorder Services
                             Medium Secure
                                                                                                                                                      Introduction
                                 18+ years          Male              26 beds in 2 wards                                                              Our Model of Care
                                                                                                                                                      Our myPath Care Model
                                                                                                                                                      Global Assessment of Progress

C    ygnet Hospital Bury offers a dedicated personality disorder            The model of treatment is based on the principles of the recovery         (GAP) Outcomes
     service on two wards, Columbus and Madison, in a medium                model including psychological therapies, occupational therapy,            Example DBT Pathway
secure setting. Both wards deliver care for men with enduring               social therapy, physical healthcare and medication.                       Outcomes
mental health needs, co-morbidity and behaviours which                                                                                                Medium Secure
                                                                            Staff are trained to provide a pattern of care that continuously
challenge in a calm, therapeutic environment with a focus on
                                                                            challenges maladaptive patterns of behaviour and provides                 Cygnet Hospital Bury, North-West
service user experience, shared care and safety.
                                                                            ongoing opportunities to learn and try out more adaptive                  Low Secure
There are five core treatment phases used                                   courses of action and we use the myPath framework to focus                Tier 4 PD (NHSE)
across both wards:                                                          interventions towards a service user’s future life outside hospital.      PD Intensive Support
1       Preadmission/Preparation                                                                                                                      Highly Specialised PD (CCG)
                                                                            Service user survey results                                               PD / Disordered Eating Dual Diagnosis
2       Assessment and admission/Getting to know you
                                                                            Each service user at Cygnet Hospital Bury is given the opportunity        Community Rehabilitation
3       Stabilisation/Feeling safe                                          to complete an individual satisfaction survey.                            Case Study
4        ctive treatment and rehabilitation/individualised therapy
        A                                                                                                                                             Map

                                                                               93%
        and improving quality of life
                                                                                                                                                      Service User Reviews
5       Transition and discharge/Preparing to move on                                                                                                 How to Make a Referral
                                                                               of individuals
Therapies and activities                                                       have confidence and
                                                                               trust in the nursing staff
Each service user has a treatment plan and a weekly therapeutic
                                                                                                                                                     Our facilities:
                                                                                100%
timetable which can include:
    >   Individual and group psychology
                                                                                                                                                      > En-suite bedrooms
    >   Counselling for drug and alcohol misuse                                 of individuals feel they are given choices, and are                   > Gym
                                                                                involved with choosing the types of therapies
    >   Anger management                                                        /groups that are provided to them
                                                                                                                                                      > Laundry
    >                                                                                                                                                 > Occupational therapy kitchen

                                                                                 86%
        Social skills development
    >   Daily living skills development
                                                                                                                  of individuals have always          > Therapy garden
                                                                                                                  felt safe during their time
    >   Healthy living                                                                                            at Columbus Ward

    >   IT skills training
    >
    >
        Education and vocational development
        Group games and activities
                                                                                                                            100%
                                                                                                                             of individuals feel
                                                                                                                             ward staff are caring
                                                                                                                             and supportive

                                                                            *Results taken from Columbus Ward 2020 service user surveys

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Cygnet Hospital Clifton, East Midlands                                                                            Click the buttons to find
                             Clifton Lane, Clifton, Nottinghamshire, East Midlands NG11 8NB                                                    out more about our
                                                                                                                                               Personality Disorder Services
                              Low Secure
                                                                                                                                            Introduction
                                    18+ years    Male              24 beds across 2 wards                                                   Our Model of Care
                                                                                                                                            Our myPath Care Model
                                                                                                                                            Global Assessment of Progress

C    ygnet Hospital Clifton is a 24 bed specialist low secure           The hospital is set out across two wards:                           (GAP) Outcomes
     service for men with a personality disorder, who also present                                                                          Example DBT Pathway
                                                                        Ancaria Ward is the admissions/initial treatment ward, which
with complex mental health needs and behaviours                                                                                             Outcomes
                                                                        focuses on rehabilitation, in preparation for moving on into the
that challenge.                                                         community or supported living.                                      Medium Secure
At Cygnet Hospital Clifton we create opportunities for sustained                                                                            Low Secure
                                                                        Acorn Ward focusses on rehabilitation, to prepare for amove into
positive behavioural change. We achieve this by applying a              the community or supported accomodation.                            Cygnet Hospital Clifton, East Midlands
consistent approach where the men in our care feel                                                                                          Cygnet Hospital Derby, East Midlands
encouraged to develop positive interpersonal skills to                  At Cygnet Hospital Clifton we aim to sequence                       Tier 4 PD (NHSE)
reduce challenging behaviours.                                          interventions according to Professor Livesley’s integrated
                                                                                                                                            PD Intensive Support
                                                                        treatment model. The therapeutic milieu aims to ensure
Our interventions and approaches are matched according                  consistency and optimal conditions for growth and change in a       Highly Specialised PD (CCG)
to individual needs informed by dynamic case formulation.               positive and effective environment.                                 PD / Disordered Eating Dual Diagnosis
Our team constantly adapt their engagement techniques                                                                                       Community Rehabilitation
and the personnel delivering specific interventions to maximise         Prison Transfers                                                    Case Study
engagement and create optimum opportunity for progress to be
made with the men in our care.                                          We also offer a specialised three month prison transfer             Map
                                                                        programme, for stabilisation and assessment of prisoners whose      Service User Reviews
Alongside appropriate pharmacological treatments to stabilise           mental health needs cannot be met in the prison environment.
diagnosed mental illness, we support the men in our care with                                                                               How to Make a Referral
a range of psychology-led interventions. These aim to develop           We provide a rapid response to referrals, and a speedy
self-regulation skills facilitating the improved control of             assessment within the prison environment. Following admission,
impulsive behaviours.                                                   we offer a comprehensive inpatient assessment process including
                                                                        robust risk assessment, detailed treatment planning, and           Our multi-disciplinary team:
                                                                        recommendations for onward moves.
                                                                                                                                            > Consultant Forensic Psychiatrist
  Cygnet Hospital Clifton has
  helped me with my recovery                                                                                                                > Forensic Psychologist
  by challenging my behavioural                                                                                                             > Occupational Therapist
  problems and changing my
  thoughts to move to a more                                                                                                                > Social Worker
  positive way, giving me more                                                                                                              > Nurse leads
  confidence to deal with different                                                                                                         > Social Therapy leads
  disappointments, changing my
  ways of thinking and giving me
  responsibility with (a course on)
  the Recovery College.
  - Service user

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Cygnet Hospital Derby, East Midlands                                                                                Click the buttons to find
                         100 City Gate, London Road, Derby, East Midlands DE24 8WZ                                                           out more about our
                                                                                                                                             Personality Disorder Services
                          Low Secure
                                                                                                                                         Introduction
                              18+ years          Female           16 beds                                                                Our Model of Care
                                                                                                                                         Our myPath Care Model
                                                                                                                                         Global Assessment of Progress

A   lvaston Ward at Cygnet Hospital Derby is a 16 bed specialist       Enabling Environments Award                                       (GAP) Outcomes
    low secure service for women with a primary diagnosis                                                                                Example DBT Pathway
of emotionally unstable personality disorder. The ward can             Alvaston Ward has achieved the Enabling Environments
                                                                                                                                         Outcomes
support women with highly complex needs and those who have             Award from the Royal College of Psychiatrists’ Centre for
                                                                       Quality Improvement.                                              Medium Secure
experienced previously unsuccessful placements.                                                                                          Low Secure
                                                                       Enabling Environments is awarded to services who have
The primary pre-cursor to an admission to Alvaston Ward is that                                                                          Cygnet Hospital Clifton, East Midlands
                                                                       demonstrated an outstanding level of best practice in creating
the person is ready to engage in a therapeutic programme.                                                                                Cygnet Hospital Derby, East Midlands
                                                                       and sustaining a positive and effective social environment. To
Service users may have a history of involvement in the criminal                                                                          Tier 4 PD (NHSE)
                                                                       achieve the award Alvaston Ward had to meet and exceed ten
justice system or may present with significantly challenging                                                                             PD Intensive Support
                                                                       core standards based on:
behaviour, severe self-neglect and vulnerability.
                                                                                                                                         Highly Specialised PD (CCG)
The ethos on Alvaston Ward is to provide assertive treatment of
                                                                        >   Belonging
                                                                                                                                         PD / Disordered Eating Dual Diagnosis
a person’s condition. The multi-disciplinary team helps individuals     >   Boundaries                                                   Community Rehabilitation
address their issues and proactively use Dialectical Behaviour
Therapy (DBT) and Schema Therapy. The DBT programme is
                                                                        >   Communication                                                Case Study
adapted to the needs of the service users and is tailored for           >   Development                                                  Map
individuals who may have educational or learning difficulty issues,                                                                      Service User Reviews
such as dyslexia, which may act as barriers to the standard
                                                                        >   Involvement
                                                                                                                                         How to Make a Referral
DBT programme.                                                          >   Safety
                                                                        >   Structure
                                                                        >   Empowerment                                                 Our facilities:
                                                                        >   Leadership                                                   > En-suite bedrooms
                                                                        >   Openness                                                     > External secure courtyard
                                                                                                                                         > Fully equipped gym
                                                                                                                                         > Art room
                                                                                                                                         > IT classroom
                                                                                                                                         > Therapy kitchen

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Cygnet Hospital Beckton, London                                                                                   Click the buttons to find
                             23 Tunnan Leys, Beckton, London E6 6ZB                                                                            out more about our
                                                                                                                                               Personality Disorder Services
                              Tier 4 PD (NHSE)            PD Intensive Support
                                                                                                                                            Introduction
                                    18+ years    Female             33 Beds in 2 Wards                                                      Our Model of Care
                                                                                                                                            Our myPath Care Model
                                                                                                                                            Global Assessment of Progress

C     ygnet Hospital Beckton has two specialist personality            New Dawn Ward is our 18 bed specialist Tier 4 Personality Disorder   (GAP) Outcomes
      disorder wards, New Dawn Ward and Upping Ward. Our aim           service. Women can be admitted to New Dawn Ward if they              Example DBT Pathway
is to support individuals’ recovery and integration back into the      have a diagnosis of personality disorder, exhibit self-harming       Outcomes
community, as quickly as possible. We have a multi-disciplinary        behaviour and are able to accept the need for help. Service
                                                                                                                                            Medium Secure
team of specialists and offer a very broad range of therapies.         users can be informal or detained under the Mental Health Act.
                                                                                                                                            Low Secure
Upping Ward is our 15 bed Intensive Support Service for women          The service is structured so that there are two distinct areas in    Tier 4 PD (NHSE)
with a diagnosis of personality disorder and complex mental            the ward aligned with the care pathway; pre-engagement and
                                                                                                                                            Cygnet Hospital Beckton, London
health needs. The service pathway provides a robust programme          engagement. Following admission, a 12 week assessment period
                                                                       is undertaken to establish needs and determine the appropriate       Cygnet Hospital Ealing, London
of care for women with challenging high risk behaviour who
experience difficulties with engagement or motivation with             treatment pathway. Upon completion of the 12 weeks’                  PD Intensive Support
therapeutic programmes. We aim to meet the needs of these              assessment, a clear pathway will be formulated with the service      Cygnet Hospital Beckton, London
women, who may have had previous inappropriate placements,             user and discussed in their first CPA (Care Programme                Cygnet Hospital Kewstoke, South West
in a less restrictive setting.                                         Approach) meeting.
                                                                                                                                            Highly Specialised PD (CCG)
                                                                                                                                            PD / Disordered Eating Dual Diagnosis
                                                                                                                                            Community Rehabilitation
   Therapy Programme/Approach                                                                                                               Case Study
   Across both Upping Ward and New Dawn Ward, we use a variety of different therapeutic models which are delivered in a                     Map
   systemic and integrated way. The model used at Upping Ward embraces a wide range of evidence-based interventions such
                                                                                                                                            Service User Reviews
   as DBT, CBT, Schema, mindfulness along with alternative therapies such as art therapy and music therapy in order to respond
   to service user underlying needs (affective, behavioural, cognitive, physiological and spiritual) through flexibility and effective      How to Make a Referral
   therapeutic programs that will facilitate the process from engagement and assessment to rehabilitation, discharge and recovery.
   Dialectical Behaviour Therapy (DBT) is the main programme          the needs of individuals particularly where the service user
   of therapy used on New Dawn Ward. The care pathway is              may have an area of cognitive difficulty that impacts their
   structured in phases which includes a comprehensive clinical,      ability to engage and process. There are various options
   psychometric assessment and formulation within 4-6 weeks           available on how this is delivered for people experiencing
   of admission.                                                      attention, concentration or motivational difficulties including
                                                                      conversational, experiential learning and visual aid approaches.
   Adherent DBT pathway Features two cycles of skills training,
                                                                      This is then supported with further individualised practice on
   weekly 1:1 therapy, ad hoc skills coaching and 1:1 crisis
                                                                      a 1:1 basis.
   management therapy. Service users who are motivated and
   show commitment to DBT will undertake the full programme.          Alternative therapeutic interventions We also provide
                                                                      alternative NICE Guideline recommended therapies including
   Adapted DBT pathway We recognise that standard DBT is
                                                                      Cognitive Analytic Therapy (CAT), psychodynamic techniques
   not suitable for everyone, so we also provide an adapted
                                                                      and Schema Therapy.
   programme, based within the DBT framework but tailored to

15 | Personality Disorder Service                                                                                                                                Back       Next
Cygnet Hospital Ealing, London                                                                                         Click the buttons to find
                         22 Corfton Road, Ealing, London W5 2HT                                                                                 out more about our
                                                                                                                                                Personality Disorder Services
                          Tier 4 PD (NHSE)
                                                                                                                                             Introduction
                              18+ years            Female           9 beds                                                                   Our Model of Care
                                                                                                                                             Our myPath Care Model
                                                                                                                                             Global Assessment of Progress

N   ew Dawn Ward at Cygnet Hospital Ealing is a 9 bed                                                                                        (GAP) Outcomes
    specialist Tier 4 service, providing treatment, care and                                                                                 Example DBT Pathway
support for women with a personality disorder who are ready to                                                                               Outcomes
engage in therapy.                                                                                                                           Medium Secure
Our service can support women who have a diagnosis of                                                                                        Low Secure
personality disorder and who need either:                                                                                                    Tier 4 PD (NHSE)
 >   A short-term crisis intervention utilising a DBT model                                                                                  Cygnet Hospital Beckton, London
     (i.e. emergency referrals)                                                                                                              Cygnet Hospital Ealing, London
 >   A longer term therapeutic treatment programme utilising                                                                                 PD Intensive Support
     the principles of DBT with skills coaching and                                                                                          Highly Specialised PD (CCG)
     individual therapy.                                                                                                                     PD / Disordered Eating Dual Diagnosis
New Dawn Ward offers a programme that is well-structured to                                                                                  Community Rehabilitation
give service users the opportunity to address and deal with their                                                                            Case Study
problems in a safe environment. Cygnet Hospital Ealing also                  Therapies and activities                                        Map
provides a specialist Eating Disorder service on Sunrise Ward, so
service users have access to a dietician if required. We have
                                                                              > Dialectical Behaviour Therapy (DBT), including daily         Service User Reviews
                                                                                  Skills Training and Skills Homework Group
close links with Cygnet Lodge Kenton which can be used as a                                                                                  How to Make a Referral
‘step-down’ unit from the New Dawn service.                                   >   Daily activities offered by the occupational therapy
                                                                                  team, including self-nurturing, cooking, creative
Planning for discharge starts at admission and all treatment
                                                                                  and walking groups
and interventions are geared towards preparing a person for
successfully and positively leaving the service. After discharge,             >   Specialist groups including body image and
                                                                                                                                          When I had extremely difficult times,
contact will be maintained with the service user’s own                            healthy relationships (run for a set number of weeks)   the team didn’t give up on me and
Community Mental Health Team to offer ongoing support                                                                                     move me on. The DBT the ward taught
and advice.
                                                                              >   Drama therapy with music and                            really helped me. - Service user
                                                                                  creative therapies
                                                                              >   Service users suggest ward activities through a
                                                                                  fortnightly community meeting
                                                                              >   Carers group once a month
                                                                              >   Monthly leavers group for individuals who have
                                                                                  been discharged from the ward to come and
                                                                                  speak about their experiences post-discharge
                                                                              >   Family Therapy
                                                                              >   Yoga and massage

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Cygnet Hospital Kewstoke, Weston-super-Mare                                                                       Click the buttons to find
                             Beach Road, Kewstoke, Weston-super-Mare, South West BS22 9UZ                                                      out more about our
                                                                                                                                               Personality Disorder Services
                              PD Intensive Support
                                                                                                                                            Introduction
                                    18+ years        Female         15 beds                                                                 Our Model of Care
                                                                                                                                            Our myPath Care Model
                                                                                                                                            Global Assessment of Progress

K   nightstone Ward at Cygnet Hospital Kewstoke is our new 15         Through our Care Pathway at Knightstone Ward, we are able to          (GAP) Outcomes
    bed Intensive Support Service for women with a diagnosis          help support and treat women who present with complex needs,          Example DBT Pathway
of personality disorder and complex mental health needs. The          including emotionally unstable personality disorder (EUPD)            Outcomes
service helps women with challenging high risk behaviours,            and significant self-harm.                                            Medium Secure
who experience difficulties with engagement or motivation
                                                                      By offering a robust, safe environment and skilled staffing team we   Low Secure
with therapeutic programmes. We aim to help meet the needs
                                                                      are able to help women who previously may have had difficulties       Tier 4 PD (NHSE)
of these women, who may have previously had inappropriate
                                                                      engaging in therapeutic programmes. Our care pathway will             Cygnet Hospital Beckton, London
placements, by offering a less restrictive setting underpinned by
                                                                      focus on an integrated programme structure, which will enable
our robust service pathway and programme of care.                                                                                           Cygnet Hospital Ealing, London
                                                                      a focus on positive pre-engagement, offering a variety of
                                                                      approaches. The main aim of Knightstone Ward is to help prepare       PD Intensive Support
                                                                      the individuals in our care with the required appropriate skills to   Highly Specialised PD (CCG)
     Service user profile:                                            move to a Tier 4 pathway or step-down services, discharges to         PD / Disordered Eating Dual Diagnosis
                                                                      community services or independent living where appropriate.           Community Rehabilitation
      > Women, aged 18+ years
                                                                                                                                            Case Study
      > Detained under the Mental Health Act                                                                                                Map
      > Primary diagnosis of personality disorder                                                                                           Service User Reviews
                                                                          Therapeutic approaches
      > Presenting with complex high risk                                 and assessments:                                                  How to Make a Referral
           needs including:
           •   Significant self-harm
                                                                           > Dialectical Behaviour Therapy (DBT)
           •   Emotionally unstable                                        > Cognitive Behavioural Therapy (CBT)
               personality disorder (EUPD)                                 > Schema Focused Therapy
       >   Demonstrating difficulties with engagement or
                                                                           > Occupational therapy assessment
           motivation with therapeutic programmes
                                                                                  and interventions
       >   May have a history of repeated
                                                                              >   Psychological formulations
           hospital admissions or previous
           placement breakdown                                                >   Music therapy
                                                                              >   Art therapy
                                                                              >   Mindfulness
                                                                              >   Sensory assessments
                                                                              >   Complementary therapies including reiki
                                                                                  and aromatherapy
                                                                              >   Wellness Recovery Action Plan (WRAP)

17 | Personality Disorder Service                                                                                                                                 Back      Next
Cygnet Acer Clinic, Derbyshire                                                                                     Click the buttons to find
                          Worksop Road, Chesterfield, Derbyshire, East Midlands S43 3DN                                                      out more about our
                                                                                                                                             Personality Disorder Services
                          Highly Specialised PD (CCG)
                                                                                                                                          Introduction
                              18+ years           Female              14 beds                                                             Our Model of Care
                                                                                                                                          Our myPath Care Model
                                                                                                                                          Global Assessment of Progress

A    cer Lower at Cygnet Acer Clinic is a 14 bed rehabilitation                                                                           (GAP) Outcomes
     service providing assessment, treatment and rehabilitation                                                                           Example DBT Pathway
                                                                            Service user profile:
for women with personality disorder and complex needs.                                                                                    Outcomes
                                                                             > START assessments                                          Medium Secure
Rehabilitation is provided in a therapeutic environment, with
a level of security matched to individual needs. The aim of the              > Integrated approach combining different		                  Low Secure
treatment, rehabilitation and re-socialisation programme is to                      models of therapy (CBT, DBT and                       Tier 4 PD (NHSE)
prepare the people in our care either for transfer to conditions of                 Schema informed)                                      PD Intensive Support
lesser security, or for a life in the community.
                                                                                >   Pre-engagement group                                  Highly Specialised PD (CCG)
Our dedicated clinical teams provide a multi-disciplinary                                                                                 Cygnet Acer Clinic, Derbyshire
                                                                                >   Personality Disorder psychoeducation
approach to rehabilitation. This includes psychology (including                                                                           Cygnet Alders Clinic, Gloucestershire
forensic psychology input) occupational therapy, social work and                >   Mindfulness
                                                                                                                                          Cygnet Aspen Clinic, South Yorkshire
vocational training.
                                                                                >   Systems Training for Emotional Predictability 		      Cygnet Hospital Bierley, West Yorkshire
                                                                                    and Problem Solving (STEPPS)
                                                                                                                                          Cygnet Hospital Maidstone, Kent
    Therapeutic approaches                                                      >   Wellness Recovery Action Plan (WRAP) and 		           PD / Disordered Eating Dual Diagnosis
                                                                                    ‘My Safety Plan’                                      Community Rehabilitation
    and assessments:
                                                                                >   Comprehensive community links to support 		           Case Study
     > Dialectical Behaviour Therapy (DBT)                                          vocational/educational, self-care and 		              Map
     > Cognitive Behavioural Therapy (CBT)                                          leisure opportunities
                                                                                                                                          Service User Reviews
     > Schema Focused Therapy                                                                                                             How to Make a Referral
     > Occupational therapy assessment
          and interventions
      >   Psychological formulations
      >   Music therapy                                                                                                                I have been discharged for nearly
      >   Art therapy
                                                                                                                                       four months now and I am doing
                                                                                                                                       so much better than I ever thought
      >   Mindfulness                                                                                                                  I would. And this is because of the
      >   Sensory assessments                                                                                                          staff at Acer believing in me when I
                                                                                                                                       didn’t. The skills I have learnt help me
      >   Complementary therapies including reiki
                                                                                                                                       everyday. Acer has given me my
          and aromatherapy
                                                                                                                                       life back and for that I will be forever
      >   Wellness Recovery Action Plan (WRAP)                                                                                         grateful! - Former Service User

18 | www.cygnethealth.co.uk                                                                                                                                      Back      Next
Cygnet Alders Clinic, Gloucestershire                                                                                        Click the buttons to find
                             155 Podsmead Road, Gloucestershire, South-West GL1 5UA                                                                       out more about our
                                                                                                                                                          Personality Disorder Services
                              Highly Specialised PD (CCG)
                                                                                                                                                       Introduction
                                    18+ years       Female                20 beds in 3 wards           Part of the Welsh Hospital Framework            Our Model of Care
                                                                                                                                                       Our myPath Care Model
                                                                                                                                                       Global Assessment of Progress

C    ygnet Alders Clinic is a 20 bed rehabilitation service                  Through this eclectic approach, and with a focus on the                   (GAP) Outcomes
     providing assessment, treatment and rehabilitation for                  importance of therapeutic relationships, we deliver an integrated         Example DBT Pathway
women with personality disorder and complex needs. Cygnet                    combination of pharmacologic and psychotherapeutic                        Outcomes
Alders Clinic is on the Welsh Hospital Framework with specialist             interventions. The aim is to address the core features of personality     Medium Secure
service status.                                                              disorder: problems with emotional regulation, interpersonal
                                                                                                                                                       Low Secure
                                                                             functioning, and self-identity and to prepare the women in our
We provide a specialist psychologically informed personality                                                                                           Tier 4 PD (NHSE)
                                                                             care for a transition to life in the community.
disorder pathway across three living areas; from Severn, for                                                                                           PD Intensive Support
assessment and stabilisation, through to Avon, where service                 Therapeutic interventions and psychological formulations are              Highly Specialised PD (CCG)
users move to as they engage and progress with their treatment               tailored to individual need and utilise techniques drawn from
                                                                                                                                                       Cygnet Acer Clinic, Derbyshire
pathway; and finally Coln, for a focus on community transition.              major therapeutic orientations such as:
                                                                                                                                                       Cygnet Alders Clinic, Gloucestershire
Our approach                                                                   >   Dialectical Behaviour             >   Compassion Focused
                                                                                                                                                       Cygnet Aspen Clinic, South Yorkshire
                                                                                   Therapy (DBT)                         Therapy (CFT)
At Cygnet Alders Clinic we adopt an integrated modular                                                                                                 Cygnet Hospital Bierley, West Yorkshire
approach to treatment for women with a diagnosis of personality                >   Cognitive Behavioural             >   Mentalization Based
                                                                                   Therapy (CBT)                         Treatment (MBT)               Cygnet Hospital Maidstone, Kent
disorder, accounting for diagnostic differences, NICE guidelines
                                                                                                                     >   Schema Therapy                PD / Disordered Eating Dual Diagnosis
and the work of Livesley (2004).
                                                                                                                                                       Community Rehabilitation
                                                                                                                                                       Case Study
                                                                                                                                                       Map
                                                                 Our pathway
                                                                                                                                                       Service User Reviews
                                                                                                                                                       How to Make a Referral
                 Severn                                               Avon                                                   Coln
             Assessment and
               Stabilisation                                    Core Treatment                                      Consolidation
                                                                                                                                                     Alders has changed my life…After
     >   Safety                                        >    Exploration                                    >   Integration
                                                                                                                                                     18 years of being in hospital I finally
     >   Containment                                   >    Change                                         >   Synthesis                             have a future! - Service User
     >   Emotional and behavioural                     >    Cognitive, interpersonal,                      >   Relapse prevention
         control and regulation                             occupational and specific                      >   Transition
     >   Crisis management                                  psychosocial interventions
                                                                                                           >   Discharge planning
     >   Individualised psychological                  >    Individualised psychological
                                                                                                           >   Multi-agency working
         formulation                                        formulation
                                                                                                           >   Increased independence
                                                                                                           >   Resilience

19 | Personality Disorder Service                                                                                                                                             Back      Next
Cygnet Aspen Clinic, South Yorkshire                                                                                      Click the buttons to find
                         Manvers Road, Mexborough, Doncaster, South Yorkshire, Yorkshire & Humber S64 9EX                                          out more about our
                                                                                                                                                   Personality Disorder Services
                          Highly Specialised PD (CCG)
                                                                                                                                                Introduction
                              18+ years          Female             16 beds                                                                     Our Model of Care
                                                                                                                                                Our myPath Care Model
                                                                                                                                                Global Assessment of Progress

C
                                                                                                                                                (GAP) Outcomes
    ygnet Aspen Clinic is a specialist service for women with a        Therapeutic approaches and assessments
    diagnosis of personality disorder and associated complex                                                                                    Example DBT Pathway
                                                                       Our therapeutic interventions are tailored to individual presenting
needs. We provide assessment, stabilisation, treatment and                                                                                      Outcomes
                                                                       needs, based on comprehensive psychological formulations
rehabilitation for up to 16 women.                                                                                                              Medium Secure
                                                                       undertaken on admission. The assessment tools we use include:
Our service users may have complex trauma histories or have                                                                                     Low Secure
experienced regular placement breakdowns. At Cygnet Aspen               >     Structured Clinical           >   Chart of Interpersonal          Tier 4 PD (NHSE)
Clinic we provide a collaborative, multi-disciplinary approach to             Interview for PD                  Reactions in Closed Living
                                                                                                                                                PD Intensive Support
care and treatment with a focus on recovery and co-production                 (SCID-5-PD)                       Environments (CIRCLE)
                                                                                                                                                Highly Specialised PD (CCG)
with service users.                                                     >     Millon Clinical Multiaxial    >   Aspects of Identity             Cygnet Acer Clinic, Derbyshire
                                                                              Inventory (MCMI)                  Questionnaire (AIQ)
Our approach – a modular treatment pathway                                                                                                      Cygnet Alders Clinic, Gloucestershire
                                                                        >     Difficulties in Emotion       >   Warwick-Edinburgh               Cygnet Aspen Clinic, South Yorkshire
 >   At Cygnet Aspen Clinic we operate an integrated modular                  Regulation Scale (DERS)           Mental Well-being Scale
     approach to treatment for women with a diagnosis of                                                                                        Cygnet Hospital Bierley, West Yorkshire
                                                                                                                (WEMWBS)
     personality disorder, accounting for diagnostic differences,       >     Beck Anxiety Inventory                                            Cygnet Hospital Maidstone, Kent
     NICE guidelines and the work of Livesley (2004).                         (BAI), Beck Depression        >   Model of Human                  PD / Disordered Eating Dual Diagnosis
                                                                              Inventory (BDI), Beck             Occupation Screening
 >   Our multi-modal treatment pathway consists of a range of                 Hopelessness Scale (BHS)          Tool (MOHOST)
                                                                                                                                                Community Rehabilitation
     therapeutic models including Dialectical Behaviour Therapy                                                                                 Case Study
     (DBT), Trauma-focused Cognitive Behavioural Therapy (TF-           >     The Awareness of Social       >   Assessment of                   Map
     CBT), Trauma-focused Compassion Focused Therapy                          Inference Test (TASIT)            Communication and
                                                                                                                Interaction Skills (ACIS)       Service User Reviews
     (TF-CFT) and Schema Therapy techniques.
                                                                                                                                                How to Make a Referral

                        Regulation and
                          modulation

                                                                                                                                             I cannot express how amazing the
                                                                                                                                             staff here are! They saved me from
     Interpersonal                             Identity                                                                                      myself and took the responsibility to
                                                                                                                                             keep me safe until I could do it for
                                                                                                                                             myself. I will never be able to thank
                                                                                                                                             them enough for the way they helped
                                                                                                                                             me and the huge impact they have
                                                                                                                                             had on my life. - Service User

20 | www.cygnethealth.co.uk                                                                                                                                            Back      Next
Cygnet Hospital Bierley, West Yorkshire                                                                     Click the buttons to find
                             Bierley Lane, Bradford, West Yorkshire, Yorkshire & Humber BD4 6AD                                          out more about our
                                                                                                                                         Personality Disorder Services
                              Highly Specialised PD (CCG)
                                                                                                                                      Introduction
                                    18+ years         Female           16 beds                                                        Our Model of Care
                                                                                                                                      Our myPath Care Model
                                                                                                                                      Global Assessment of Progress

B  owling Ward at Cygnet Hospital Bierley is a 16 bed specialist                                                                      (GAP) Outcomes
   service for women with highly complex needs associated                    Other therapies and activities:                          Example DBT Pathway
with a diagnosis of emotionally unstable personality disorder.                                                                        Outcomes
The service aims to support service users to learn effective                  > Mindfulness                                           Medium Secure
emotional management, to reduce emotional dysregulation                       > Wellness Recovery Action Plan (WRAP)                  Low Secure
and to manage their own mental health and recovery.
                                                                              > Daily Living skills                                   Tier 4 PD (NHSE)
Bowling Ward provides a highly structured environment. All                                                                            PD Intensive Support
service users have individualised ward therapy programmes,                    > Recovery College                                      Highly Specialised PD (CCG)
alongside a personal programme of activities and interests. The               > Comprehensive community links to support              Cygnet Acer Clinic, Derbyshire
Therapies Department use a whole-person approach to work with                    vocational/educational, self-care and
service users to identify which treatments are most helpful to their                                                                  Cygnet Alders Clinic, Gloucestershire
                                                                                 leisure opportunities
recovery based on assessment of their needs.                                                                                          Cygnet Aspen Clinic, South Yorkshire

Bowling Ward works upon the principles of positive risk-taking and                                                                    Cygnet Hospital Bierley, West Yorkshire
encouraging self-management. Service users are encouraged                                                                             Cygnet Hospital Maidstone, Kent
to make steps towards independence whilst having access to the                                                                        PD / Disordered Eating Dual Diagnosis
Dialectical Behaviour Therapy (DBT) programme and the support                                                                         Community Rehabilitation
of the Bowling Ward team. The aim is to enable and empower                                                                            Case Study
service users to move towards independence and recovery
                                                                                                                                      Map
through practicing the skills they’ve achieved in a
safe environment.                                                                                                                     Service User Reviews
                                                                                                                                      How to Make a Referral

                                                                                                                                   Before I went onto Bowling Ward I was
                                    Fully comprehensive DBT programme: 5 treatment modes                                           intent on destroying myself, if it wasn’t
                                                                                                                                   for DBT I wouldn’t be where I am
                                                                                                                                   today. - Service User

     Skills training                     Individual            Skills coaching          Structuring the             Therapist
         group                            therapy                                        environment               consultation

The DBT programme on Bowling Ward received an “Excellence in DBT Award” in 2017 from the Association of Psychological Therapies.

21 | Personality Disorder Service                                                                                                                            Back      Next
Cygnet Hospital Maidstone, Kent                                                                                          Click the buttons to find
                         Gidds Pond Way, Weavering, Maidstone, Kent, South-East ME14 5FY                                                          out more about our
                                                                                                                                                  Personality Disorder Services
                          Highly Specialised PD (CCG)
                                                                                                                                               Introduction
                              18+ years          Female               16 beds                                                                  Our Model of Care
                                                                                                                                               Our myPath Care Model
                                                                                                                                               Global Assessment of Progress

R
                                                                                                                                               (GAP) Outcomes
    oseacre Ward is our service for women with a personality             Our therapeutic approaches:
    disorder at Cygnet Hospital Maidstone, a newly built state-of-                                                                             Example DBT Pathway
                                                                         Our therapeutic interventions are tailored to individual presenting
the-art facility situated in the Kent Medical Campus. Roseacre                                                                                 Outcomes
                                                                         needs, based on comprehensive psychological formulations
Ward is designed to a Tier 4 specification but commissioned by                                                                                 Medium Secure
                                                                         undertaken on admission. The assessment tools we use include:
CCGs. Building on the expertise of the other personality disorder
                                                                                                                                               Low Secure
services within the Cygnet Health Care portfolio, Roseacre Ward           >     Dialectical Behaviour Therapy (DBT), including 1:1 sessions
further complements our comprehensive national network of                       and group skills training. DBT is a proactive behavioural      Tier 4 PD (NHSE)
specialist services for women with this diagnosis.                              therapy, requiring active engagement, designed to support      PD Intensive Support
                                                                                individuals to manage distress, regulate emotion and           Highly Specialised PD (CCG)
Roseacre Ward is highly specialised in terms of the programmes
                                                                                develop adaptive coping.                                       Cygnet Acer Clinic, Derbyshire
we operate, and the service is supported by Dialectical
Behaviour Therapy (DBT). Our comprehensive multi-disciplinary             >     Care planning is supported by a model of Positive              Cygnet Alders Clinic, Gloucestershire
team includes a Consultant Psychiatrist, Clinical Psychologist,                 Behaviour Support (PBS) and each service user will have a      Cygnet Aspen Clinic, South Yorkshire
Occupational Therapists, DBT Therapists and a nursing and                       personalised, co-produced Positive Behaviour Support plan      Cygnet Hospital Bierley, West Yorkshire
support work team. The aim of the service is to support individuals             in place to inform their care and treatment pathway.
                                                                                                                                               Cygnet Hospital Maidstone, Kent
to manage their mental health, develop coping strategies,
reinforce daily living skills and prepare for a return to
                                                                          >     The service is also supported by our tried and tested          PD / Disordered Eating Dual Diagnosis
                                                                                myPath model. To ensure we cater for each individual’s         Community Rehabilitation
independent life.
                                                                                journey and achieve long-term results, we have created
                                                                                                                                               Case Study
The service operates in partnership with Kent and Medway                        a unique approach to care for people with personality
NHS and Social Care Partnership Trust. This partnership helps                   disorder. myPath ensures the delivery of high quality and      Map
integrate the Hospital into local and regional care pathways and                inclusive care which is continually evaluated through robust   Service User Reviews
community services, with the focus on care close to families and                operational and clinical governance frameworks.                How to Make a Referral
friends, shortest length of hospital stay, and reducing the
chances of re-admission.
                                                                              Our facilities:
Just wanted to say thank you so much to all the staff                          > En-suite bedrooms
at Cygnet. I’m doing really well in the community. I’ve                        > Outside space including ward garden and
started volunteering and I’m over 270 days self harm                                 communal roof terrace
free. The care I received was amazing and I can’t
thank the staff enough for helping me get to where I                             >   Therapy kitchen
am now. - Former Service User                                                    >   Quiet room
                                                                                 >   Gym and external exercise area
                                                                                 >   Extensive therapy space including Recovery College
                                                                                     classrooms
                                                                                 >   Library and movies room

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Cygnet Nield House, Cheshire                                                                        Click the buttons to find
                             Barrows Green, Bradfield Road, Crewe, Cheshire, North West CW1 4QW                                  out more about our
                                                                                                                                 Personality Disorder Services
                              PD / Disordered Eating Dual Diagnosis
                                                                                                                              Introduction
                                    18+ years        Female           15 beds                                                 Our Model of Care
                                                                                                                              Our myPath Care Model
                                                                                                                              Global Assessment of Progress

C   larion Ward at Cygnet Nield House is a complex personality                                                                (GAP) Outcomes
    disorder service for women with a dual diagnosis of                                                                       Example DBT Pathway
personality disorder and co-morbid disordered eating. Both                  Our therapies and interventions:                  Outcomes
aspects can be treated simultaneously, with the appropriate                  > Compassion focused therapy (CFT)               Medium Secure
specialist therapeutic input provided.
                                                                             > Cognitive Behavioural Therapy (CBT)            Low Secure
Clarion Ward adopts a phased treatment pathway which aims                                                                     Tier 4 PD (NHSE)
to help the individual service user understand and plan their                > Informed Dialectical Behaviour Therapy (DBT)   PD Intensive Support
journey through treatment. The service focuses on the need for               > Acceptance and Commitment Therapy (ACT)        Highly Specialised PD (CCG)
treatment to be collaborative with service users taking account of
individual needs, combining targeted behavioural therapies and               > Schema focused therapy                         PD / Disordered Eating Dual Diagnosis
                                                                                                                              Cygnet Nield House, Cheshire
interventions which lead to an increased post discharge quality of           > Skills groups
life and functioning thus reducing the risk of relapse.                                                                       Community Rehabilitation
                                                                             > Social skills interventions                    Case Study
                                                                             > Creative groups                                Map
     Our multi-disciplinary team:                                            > Mindfulness                                    Service User Reviews
      > Consultant Psychiatrist                                              > Specifically for disorder eating:              How to Make a Referral

      > Psychologist                                                           • Enhanced Cognitive Behaviour
      > Occupational Therapist                                                      Therapy (CBT-E)

      > Dietitian                                                               •   Specialist Supportive Clinical
                                                                                    Management (SSCM)
      > Registered Mental Health Nurses (RMN)
      > Registered General Nurse (RGN)
      > Healthcare Support Workers

My mum is getting help at Nield house, it’s amazing!
We’re FaceTiming every day and me and my siblings
are seeing positive changes in her already and she’s
not even been there for a week yet. The therapeutic
activities you do are brilliant. The fact you have an
hairdressers within the facility is amazing.
- Family Member

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Gledholt Mews and Coach House, West Yorkshire                                                                                   Click the buttons to find
                         34 Greenhead Road, Huddersfield, West Yorkshire, Yorkshire & Humber HD1 4EZ                                                     out more about our
                                                                                                                                                         Personality Disorder Services
                          Community Rehabilitation
                                                                                                                                                      Introduction
                              18+ years            Female                6 single occupancy self-contained flats                                      Our Model of Care
                                                                                                                                                      Our myPath Care Model
                                                                                                                                                      Global Assessment of Progress

G    ledholt Mews and Coach House is our service for adults                 community settings. The team consists of nurses, psychologist,            (GAP) Outcomes
     with mental health needs or a personality disorder who                 psychology assistants, occupational therapist, speech and                 Example DBT Pathway
have been able to progress through the hospital pathway and                 language therapists as well as 24/7 support from the nursing              Outcomes
arelooking for the next stage in their rehabilitation journey. This         team. This means that we are able to meet the changing                    Medium Secure
service has been designed around individuals from Kirklees                  needs of our residents as they progress through their care
                                                                                                                                                      Low Secure
in partnership with Kirklees CCG with the aim is to help these              pathway, while ensuring their safety is maintained and their
individuals along their path towards independent living.                    independence supported.                                                   Tier 4 PD (NHSE)
                                                                                                                                                      PD Intensive Support
                                                                            Residents are encouraged to cook independently (with or without           Highly Specialised PD (CCG)
The service provides supported residential care to individuals who
                                                                            staff support) in the Activities of Daily Living (ADL) kitchen or their
are ready to take responsibility for the continuation of their own                                                                                    PD / Disordered Eating Dual Diagnosis
                                                                            own self-contained flats, however the kitchen staff are available
rehabilitation and recovery in a safe environment, whilst living in                                                                                   Community Rehabilitation
                                                                            for assistance and to prepare meals in the large on-site kitchen.
the wider community.
                                                                                                                                                      Gledholt Mews and Coach House,
The service focuses on continuing practicing life skills and coping                                                                                   West Yorkshire
strategies. We concentrate on community based activities, the                                                                                         Case Study
use of public transport, education and vocational therapy, job                  Our facilities:
                                                                                                                                                      Map
placements, work experience and development of hobbies and                       > 6 personality disorder community rehabilitation                    Service User Reviews
interests. Located less than a mile away from Huddersfield Town                      self-contained flats, each featuring a lounge/diner,
centre with excellent transport links further afield, there are plenty               kitchen and en-suite bedroom                                     How to Make a Referral
of community based facilities nearby. For those individuals looking
for green space, there are a couple of options within a 5 minute                 >   Garden with outdoor seating
walk, Greenhead Park and Gledholt Woods, popular for                             >   Multi-faith room
relaxing walks.
                                                                                 >   Activities of Daily Living (ADL) Kitchen
We have in-house MDT wrap around service that is designed to
support the individual in our care throughout their journey with                 >   Dining room and lounge
us and is designed to capture and manage risk and relapse in                     >   Activity room
                                                                                 >   Tribunal / meeting room
                                                                                 >   Assisted bathroom

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Case Study

                                    Em m a ’ s J o u r n ey                 *                                                                 Click the buttons to find
                                                                                                                                              out more about our
                                                                                                                                              Personality Disorder Services

                                                                                                                                           Introduction
                                                                                                                                           Our Model of Care

                                    Roseacre Ward at Cygnet Hospital Maidstone, Kent                                                       Our myPath Care Model
                                                                                                                                           Global Assessment of Progress
                                    Highly Specialised Personality Disorder Service for Women                                              (GAP) Outcomes
                                                                                                                                           Example DBT Pathway
                                                                                                                                           Outcomes
                                                                                                                                           Medium Secure
Emma’s history                                      When Emma came to us                               When I came to Cygnet               Low Secure
                                                                                                       Maidstone I was detained under      Tier 4 PD (NHSE)
Emma had a very difficult childhood, with           When first admitted Emma struggled to
                                                                                                       Section 3 of the Mental Health      PD Intensive Support
an unstable family home she witnessed               cease self-harming, needing additional
                                                    one-to-one care to keep safe. However,
                                                                                                       Act and I had a very difficult      Highly Specialised PD (CCG)
domestic abuse as well as alcoholism.
                                                    just two months into her admission, Emma           start. I used to get angry a lot,   PD / Disordered Eating Dual Diagnosis
Emma started deliberately self-harming              had settled and was engaging in groups to          self-harming, punching walls,
                                                                                                                                           Community Rehabilitation
in her mid-teens, the same time that her            help her tolerate distress.                        head-banging and ligaturing
                                                                                                                                           Case Study
eating disorder took hold. In her twenties                                                             – anything I could do to get rid
                                                                                                                                           Map
she suffered from domestic abuse                    We supported Emma to learn new ways of             of the pain I felt emotionally.
from her partner for over eight years.              coping where she was able to progress to           Back then I didn’t know that’s      Service User Reviews
Emma struggled to structure her time –              groups which allowed her to develop skills         what I was doing, it was just my    How to Make a Referral
life consisted of working, going home               in regulating emotions, with more general          way of coping.
deliberately self-harming (DSH), uneasy             skills in interpersonal effectiveness following.
sleep, and then returning again to work             Mindfulness sessions formed the basis for the
the next day.                                       impressive progress she made in the other
                                                    areas of the DBT programme.
After ten years’ intermittent contact with
psychiatric services, including an extended         We took time to learn about Emma’s
period on a Psychiatric Intensive Care              interests and arranged a personalised
Unit (PICU), Emma was in her early 30s              gym programme and introduced other
when she was referred to Cygnet. She                activities such as a Shop and Cook group,
was diagnosed with Emotionally Unstable             to allow Emma to learn to choose a healthy
Personality Disorder (EUPD) and indications         balanced diet.
that a significant element of her distress was
linked to post-traumatic stress. She spent          At times, Emma experienced intense
eight months on acute and PICU wards in             emotions which left her feeling unable
her most recent admission, but came to              to cope and defeated. We gave Emma
us highly motivated to engage with the              strategies to channel and express such
Dialectical Behaviour Therapy                       feelings and she was also able to explore
(DBT) programme.                                    and change her relationship with
                                                    alcohol through the substance misuse
                                                    sessions provided.

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