Nottinghamshire Mentalization Based Treatment (MBT) Service
Formally known as the Nottinghamshire Personality Disorder and Development Network. The move away from personality disorder in the title was to engage people in the service, as people often struggle with the personality disorder label. The title also suggested that the service worked with all personality disorder types which is not the case. The new title now emphasises our use of the MBT approach (this is clinically researched to be the most effective treatment for personality disorder, namely borderline and anti-social personality disorder/traits).
Accessing our services
Referrals to the Notts MBT service are made via Secondary Mental Health Services following their assessment. In some cases we will accept direct referrals from IAPT and primary care services but we would recommend a discussion with the team prior to making any referral. Unfortunately due to changes in commissioning and the development of the Cluster 8 Pathway, we no longer accept direct GP referrals. We will need the service user to remain open to the referring service until the referral is discussed/accepted as it may be that we do not go on to offer an initial assessment and we may make recommendations which require the referrer’s action.
If you wish to be referred to the Notts MBT Service you will need to discuss this with a healthcare professional such as your GP, community psychiatric nurse, psychiatrist, or other mental health professional.
We have a Contact system available every afternoon (1pm – 5pm). This system is available for clinicians, service users and other services who work with service users accessing our service or presenting with difficulties linked to personality traits. A clinician within the Notts MBT service will be available to manage calls regarding people in crisis, crisis services, clinical services and those ‘in the gap’ (i.e. not yet referred, referral rejected etc.), to offer advice/info and onward referral. It is also a route to accessing clinical advice for staff/teams/services.
What do we do?
We provide a community service of individual assessments and group therapy for people with complex personality difficulties. We work with Service Users who are motivated towards change and who feel able to make use of group therapy.
Our service users often have longstanding difficulties in relationships, early experiences of trauma, poor early attachments, and a pronounced difficulty in managing overwhelming emotions. Not everyone who uses our service has a diagnosis of personality disorder, but all will have significant issues with personality traits which are:
- persistent - there all the time
- pervasive - spread across most areas of their lives
- problematic - causing difficulty for themselves and others
We do not routinely offer care-coordination, but work closely with those services that do. We do not prescribe medication nor do we diagnose personality disorder.
We provide both Mentalization based groups (recommended by National Institute of Care and Excellent [NICE]) and psycho-education groups. These vary in length from 12 weeks to 1 year. We provide group therapy, as it has been proven to have the most effective treatment (positive outcome) with this patient group. Service Users benefit from developing appropriate relationships with others who have similar experiences to themselves.
One of the groups, based in Nottingham City, is aimed specifically at young people who have emerging personality difficulties which are of a far greater degree and significance to those of most teenagers and young adults.
The service covers Nottingham City and Nottinghamshire County. Services are offered in Nottingham City, Mansfield, Worksop and Newark.
What is mentalization based treatment?
Mentalizing is about: Recognising and managing your own thoughts and feelings; Recognising and understanding what other people may be thinking and feeling; Interpreting feelings, actions and behaviours as being meaningful; Attending to mental states such as thoughts, beliefs, desires and feelings.
A person who struggles to mentalize will have difficulties: in building and maintaining relationships; to manage some strong and overwhelming emotional experiences and feelings and get back to a more manageable state.
Sometimes when a person is distressed or experiencing strong emotions, their ability to recognise and manage their own thoughts and feelings, and to recognise and understand what other people may be thinking and feeling, is greatly reduced. This often means that a person may: Find it difficult to think clearly about their own and other people’s behaviour; To understand others behaviour towards them, which can lead to conflict; Have difficulties in building and sustaining relationships
Mentalization Based Treatment (MBT) aims to help a person: understand their own thoughts and feelings; develop their ability to recognise and understand what other people might be thinking and feeling; reduce the chance of misinterpreting the intentions of other people; Manage overwhelming emotional experiences which may have led to unsafe behaviour in the past.
Cluster 8 Pathway
The purpose of the Cluster 8 Pathway is twofold. First, this enables the specialist group to offer ongoing advice and consultation to clinicians in determining the best pathway of intervention in relation to a service user’s needs. Secondly, it enables specialists in Personality Disorder within Nottinghamshire Healthcare NHS Trust to have oversight of all the elements of the Cluster 8 pathway. This includes being aware of resource versus demand within the pathway and identifying issues to consider for the ongoing Personality Disorder strategy development.
Cluster 8 and Nottinghamshire MBT Service
Cluster 8 is assessed through the HoNOS PbR tool, this threshold involves 1) traits of personality disorder causing a chaotic and challenging lifestyle through severe difficultly managing distress and interpersonal relationships, 2) moderate or severe risk to self and/or potential/actual risk to others (i.e. impulsive anger, violence, life-threatening behaviour, significant self-harming), and 3) difficulties engaging with services (i.e. dropping out of contact/treatment, hostile engagement, avoiding service involvement, multiple contacts with numerous services).
We are one treatment option within the Cluster 8 Pathway. Service Users assessed as meeting the criteria for Cluster 8 and who are appropriate for the Notts MBT Service will ideally: have established some stability (i.e. stable housing in order to provide a secure base, drug & alcohol use better managed and will not interfere with therapy, a more consistent level of engagement with service); they are expressing a wish to engage in therapy and expressing a readiness to engage with therapy (taking into account the above); and have some skills to tolerate distress in order to able to withstand an exploratory group therapy. Whilst service users are not expected to have become masterful in managing their distress, they are expected to have some skills to tolerate overwhelming distress that would inhibit their ability to engage in an exploratory therapy (e.g., use of distraction, appropriate help-seeking, self-soothing, able to ground self, ways to relax etc.). Exploratory therapy does require Service Users to discuss distressing events in the present and to hear similar events brought by other group members. Therefore Service Users will need some level of skill to manage this process and not to become overwhelmed by it.
We offer training within Nottinghamshire Healthcare NHS Foundation Trust. We also deliver bespoke training (please contact the Operational Team Leader to discuss this further) and one day training to a range of statutory/non-statutory/third sector services.
Information for health professionals
Please contact us on 0115 876 0162 if you wish to discuss a possible referral to our service.
How to refer someone to this service
We accept referrals from Secondary Mental Health Services i.e. Local Mental Health Teams and other Mental Health Services, unfortunately we are no longer able to accept direct GP referrals. Referrals can be received directly to the service or via the Cluster 8 Pathway. Referrals where the CORE assessment (RiO) documentation has not been competed would need to be on our referral form, and should include a recent risk assessment, child safeguarding information and past and current circumstances (please contact us on 0115 8760162 for a copy of the most up-to-date referral form). The service does have a number of exclusion criteria and so we would recommend contacting the service to discuss further if you are uncertain of these.
Dr. Amanda Tetley (Clinical Lead/Highly Specialist Clinical Psychologist)