With regard to the participants' experiences of the Gwylfa Therapy Service, responses did not relate to specific professional groups but to the overall service. In this analysis, five themes were identified: Respect,
Professionalism, Therapy, Support, and Practicalities. Respect had 10
statements and on 7 statements, all seven patients agreed. On 3 statements, 6/7 patients agreed. Professional had 6 statements. All seven patients
agreed on all six statements. Therapy had 11 statements with all seven patients agreeing on 5 statements, 6/7 patients agreeing on 5 statements and 5/7 agreeing on one statement. Support generated 6 statements, and on one statement all 7 patients agreed, on 3 statements 6/7 agreed, and on 2
statements, 5/7 agreed. Finally Practicalities had 5 statements, all seven patients agreed on 1 statement, 6/7 agreed on 2 statements, and 5/7 agreed on 2 statements. More details as to the themes and the statements are presented in Table 6.1.
Table 6.1.
Patients'Experiences o f Gwyifa Therapy Service and Level o f Consensus Theme 1. Respect
I am not judged 7 agreed
I am accepted for who I am 7 agreed
I am not punished 7 agreed
I am not laughed at 7 agreed
The team is honest and sympathetic 7 agreed
The service is humane 7 agreed
I am totally involved in my treatment 7 agreed
I am treated as a person and not a label 6 agreed
You are allowed to talk things over 6 agreed
Table 6.1. continued
Theme 2. Professionalism
What is discussed remains confidential 7 agreed
The team has better knowledge and understanding
about mental health 7 agreed
There is good communication between team members 7 agreed
There is good communication between team members
and patients 7 agreed
I have regular appointments 7 agreed
I have regular access to team members 7 agreed
Theme 3. Therapy
It is a more direct and personal service 7 agreed
The therapy is well structured 7 agreed
It helps you build relationships with others 7 agreed
It is productive 7 agreed
It is consistent 7 agreed
It is appropriate to needs 6 agreed
It is well paced 6 agreed
It is self-empowering 6 agreed
The service facilitates goal achievement 6 agreed
It is useful being taught skills 6 agreed
It is individualised 5 agreed
Table 6.1. continued
Theme 4. Support
I am supported by team members 7 agreed
I am supported by other patients 6 agreed
I can see I'm not the only person with these problems 6 agreed
You can share your experiences with others 6 agreed
You can gain hope from other people's achievements 5 agreed
Others understand where you are coming from 5 agreed
Theme 5. Practicalities
The places are limited 7 agreed
There is a lot of work 6 agreed
The chairs are uncomfortable 6 agreed
Table 4.1. continued
Travelling is difficult 5 agreed
Dislike early starts 5 agreed
6.4. Discussion
The results of this Delphi survey of the views of borderline personality
disorder patients on the general and specialist services they have received is illuminating. Broadly speaking, these patients desire respect and to have their needs acknowledged, understood and met by a professional service. These reasonable requirements are not, it seems, always perceived as being fulfilled. The police were perceived as kind and helpful, but not responsive to needs, which suggests a need for training of police in mental health issues.
General Practitioners were generally understanding and helpful, but pressed for time and misunderstood the level of crisis, suggesting a need for some revision of how they provide a service for people with borderline personality disorder. General hospital staff were perceived as being disrespectful, disdainful, and dismissive, and there appears to be an urgent need here for education and training. The more specialised psychiatric hospital staff and Community Psychiatric Nurses were viewed as more helpful, but with room for improvement. Other specialist staff (Psychologist, Counsellor) were rarely mentioned, but were viewed satisfactorily.
These views are important in their own right in that all professionals who deal with borderline personality disorder patients should do so respectfully and to the best of their abilities, within their own professional remit. Another consideration is that these are the services through which the patient passes in order to reach a specialist service, such as the Gwylfa Therapy Service. To avoid distress, damage and disaffection from clinical services, the patient needs to be treated well at all levels of service. In the National Institute for Mental Health in England's (2003b) 'Personality Disorder Capabilities
Framework', skills for working with people with personality disorder are considered relevant to a whole range of agencies, including those within the criminal justice system, health care, social services, and housing. 'Whole- systems' workforce development is recommended, with targeted training for specific staff groups. This research makes it clear where training is most needed.
Despite some negative experiences of previous services, respondents' views about the Gwylfa Therapy Service were positive, the consensus being that the Gwylfa Therapy Service respects the individual, operates professionally,
provides a useful therapy, and enables users to identify with and offer support to each other. This suggests that the Gwylfa Therapy Service is getting things right and could be used as a resource for training and support of other staff.
The limitations of this study are that it was conducted on a small sample of service users, which limits its representativeness, though the goal was to see if it was possible to apply Delphi methodology and garner results that
appeared to have face validity and that could help in future service planning and evaluation. But nonetheless, the small sample does limit what can be said about the findings and whether it can be applied to other settings.
However, the sample did consist of all patients engaged in therapy with the Gwylfa Therapy Service and so were the views of the entire group at that time. The results, however, may be of limited generalisability, pertaining only to the particular geographical location in which this study was conducted. Services in other regions should collect views locally. Another limitation is that the survey was conducted when all the participants were actively involved in therapy and it was conducted when patients attended for a therapy session with group facilitators present. Participants may, therefore,
have responded according to the demands of the situation, with a bias in favour of Gwylfa Therapy Service and possibly providing overcritical views about the services sought and/or received before the Gwylfa Therapy Service. Furthermore, patients' responses may reflect their current clinical functioning, which may vary from time to time. It may be useful to plot patients' views of the Gwylfa Therapy Service in relation to periods of good and poor self regulation.
Despite these limitations, this study presents the first steps towards the Gwylfa Therapy Service listening to and using service users' views. Listening to service users is only a first step in user involvement, and there are many other ways of involving users as experts in service planning and delivery (Crawford et al., 2003). Involving service users can improve the quality of services, accessibility of information, and staff attitudes, with consequent benefit to patients (Crawford, Manley, Weaver, Bhui, Fulop, & Tyrer, 2002). These benefits are clearly needed in relation to patients with borderline personality disorder.
This study begins to shed light upon the education, training and supervision needs of staff from services that come into contact with patients with
borderline personality disorder and the Delphi method appears to be an appropriate method to try to uncover what these needs might be. Future research into how education, training and supervision needs are met and assessing the effectiveness of such methods will prove useful. Further, the
way these services may be better integrated with each other and Gwylfa Therapy Service is identified as requiring more attention. Helping
professionals to listen to, respect, and respond more professionally to vulnerable patients will facilitate a more effective and humane system of assessment, treatment and referral both within and outside of specialized services.
In summary the findings presented here identify what service users value in the treatment they receive, namely respect, professionalism, a service that meets their needs, and personal support. Opinions regarding non-specialist services indicated that, overall, police, General Practitioners, Community Psychiatric Nurses, Psychologists and Counsellors were viewed positively, and psychiatric hospital staff were viewed positively but with room for
improvement. General hospital staff were viewed unfavourably. Users' views of the Gwylfa Therapy Service were favourable. This study begins to shed light upon the education, training and supervision needs of staff from services that come into contact with patients with borderline personality disorder. Furthermore, the way these services may be better integrated with each other and Gwylfa Therapy Service is identified as requiring attention. Care must be taken to avoid distressing, damaging and disaffecting patients as they pass through general services en-route to a specialist team.
Clinical evaluation
Chapter 7. A comparison o f wom en who continue and discontinue