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With NICE's latest quality standard on personality disorders putting more emphasis on therapy instead of drugs, we take a look at some of the training and support available for mental health staff.

"There are no drugs that are established as effective in treating or managing borderline or antisocial personality disorder." That's the conclusion of the National Institute for Health and Care Excellence (NICE) in its new quality standard on personality disorders, published in June.

NICE advocates structured clinical assessment and care plans, including talking therapies. However, diagnosis, categorisation and management are notoriously difficult, mainly because of the wide-ranging and challenging nature of personality disorders and their symptoms. Therefore, it's widely acknowledged that adequate support and specialist training is needed for nurses, psychiatrists, psychologists and psychotherapists to ensure we have a mental health workforce with the skills and confidence to deal effectively with the challenges.

In 2007, the Department of Health and the Ministry of Justice commissioned the development of a national Knowledge and Understanding Framework (KUF) to help mental health staff work more effectively with personality disorders. Over the past three years regional funding has supported training for mental health professionals working in NHS primary care, community mental health services and the prison service.

As well as developing the skills, knowledge and understanding of mental health professionals, the framework is also intended to challenge the stigma and negative attitudes toward personality disorder. In 2000 research by the Department of Mental Health Nursing at City University found that mental health nurses saw personality disorder patients as 'difficult to treat' and were 'pessimistic about the efficacy and outcome of treatment'. They also considered themselves 'poorly trained to care for these difficult patients'. 

A decade and a half later, thanks to the KUF, there's much more training and support available. Personality disorder awareness training is available in NHS mental health settings across the UK (see the Institute of Mental Health website). Other providers include mental healthcare innovator Growing Better Lives which runs Living and Learning residential courses. 

A best practice model of care for offenders is being developed at Rampton Hospital's Personality Disorder Service. where psychological interventions are provided within a framework of individualised, needs-led and consistent multi-disciplinary care. The service provides assessment expertise and management support to other mental health teams, especially those in HM Prison Service establishments and Medium Secure Unit facilities.

Despite having a relatively low profile in the mental health landscape, personality disorders are more prevalent than schizophrenia or bipolar disorder, affecting between one and two per cent of the UK's adult population. According to the National Institute of Mental Health, borderline personality disorder sufferers make up 50% of mental health inpatients and 40% of those receiving community mental health services. In the absence of any proven medication, continuing to widen knowledge and skills amongst mental health professionals seems to be the most productive strategy to deal with this complex condition.

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