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Vicky Hall CEO
Cascade Care Ltd |
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‘No Longer a Diagnosis of Exclusion’, the Policy Implementation Guidance for the Development of Services for People with Personality Disorder, published in 2003 by the Department of Health, was in many ways a ground-breaking document. “No mental disorder carries a greater stigma than personality disorder” it rightly proclaimed.
Correctly, it identified that effective treatment of people with personality disorders is deliverable through a well constructed, well structured and coherent interpersonal treatment process.
At Cascade we have a long history of managing complex and often more challenging persons with PD. Over the years we have developed a model of care that is finely tuned to creating a balance between reinforcing good behaviour, and giving positive comments on progress made irrespective of how small or insignificant it may appear, and on having in place very clear and coherent boundaries that not only service users,
but also staff must maintain.
The demise over the past two years of a small number of personality centres nationally with regional forensic services, that the 2003 Policy Guidance Document intimated could be expected to become a permanent feature on the mental healthcare landscape, creates new opportunities for private sector providers like Cascade Care. I and my team welcome the opportunity to work with this demanding, and often most rewarding, of service user categories.
The patient management of sometimes highly challenging PD individuals, both at Cascade 5, and at other Homes in the group, is a hallmark of the care provided by Cascade that we continue to develop and improve.
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 Caring for Service Users with Personality Disorders
Service users with a primary diagnosis of PD require a dynamic and often more intensive care approach than those with generic mental health needs. Cascade 5, our adult male unit in East London, is one of Cascade’s Homes that offer specialist care for service users with PD.
Whilst life at Cascade 5 is no different to any other Cascade Unit – namely the provision of a structured, familial environment in which each individual feels valued – a high degree of vigilance by staff is required to respond to the often disruptive and sometimes manipulative behaviour that are familiar traits of PD Service users.
Staff, appointed for their interpersonal skills, are trained how to negotiate and show flexibility without compromising the clear boundaries that are laid down. Issues are dealt with immediately and not allowed to continue over a prolonged period. This coherent and structured approach, with all staff acting as ‘one voice’, delivers the day-by-day stability that is the required platform for effective therapeutic treatment to take place.
Alan – a profile of a former service user from Cascade 5
Alan came to Cascade 5 on step down from a psychiatric hospital where he had been detained over a long period of time, following a conviction for murder. Highly institutionalised, and very uncertain about how to manage his new freedom, it took many hours of patient counselling, and then, just talking, by staff for Alan to respond to the opportunity he had been given.
The team at the psychiatric hospital had already achieved much of the healing process. Now it was up to the team at Cascade to hold Alan’s hand, metaphorically, and prepare him to face up to the responsibility of living as an individual in the outside world.
Once Alan could see the map of the final stages of his recovery pathway, his progress accelerated. He left Cascade after two years. Since when he has travelled widely, including Holland and his native Caribbean. But he still makes a point, from time to time, of coming back to Cascade 5, to say a simple ‘thank you’. |
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