Tuesday, 19 August 2014

Horses for Courses - One Therapy Cannot Fit All


This blog primarily shares my experiences of my practice of Dialectical Behaviour Therapy skills. After a lifetime of undiagnosed Borderline Personality Disorder symptoms, it was a huge relief to find a therapy that fitted with me and my needs. Having experienced as a Probation Officer the brick wall times of belief that BPD was 'untreatable', it seems that DBT has broken on Mental Health services as a sudden revelation, that 'something' can be done to offer a way forward for BPD sufferers. Great! A solution....except it's not that simple is it?

I know I bang on about how much I have benefited from DBT, but I am not so blinkered that I cannot conceived that this is not the whole or only therapy which can offer help for my condition. There is, nor can there be, one size fits all solutions for any Mental Illness - even if everyone engaged with Services had all of the same symptoms.

To advocate that DBT is the best and only way forward for everyone with a diagnosis of Borderline Personality Disorder, is to deny the complexities inherent in helping people to manage disorders and conditions which impact on every aspect of our beings. I was clear on discharge that completing the eighteenth months intensive therapy was only the first step in managing my BPD for the rest of my life. I have needed to address issues around my physical health following the impact of my emotional symptoms over the past 20 years.

Acquiring DBT skills also does not mean that I no longer suffer the symptoms of my condition. My discharge plan includes the continued prescribing of two medications to help me maintain my emotional stability. This is primarily to manage the accompanying Clinical Depression and Anxiety that I live with alongside the symptoms of BPD. I am only one person, I cannot hope to represent every person with the same or similar symptoms. Therefore, just because this combination of interventions is working for me at the moment, does not mean that it can be applied to all who may share my experiences of mental illness. Nor, does it mean that this combination will continue to maintain my stability forever. But for now, it is the right treatment path, for me.

A major problem faced by NHS Mental Health service providers is the pressure to 'justify' spending on intensive therapies. At this point numbers, rather than people, take priority and compete with what professionals know is best practice. Many NHS Trusts are hamstrung by funding issues which mean that they have to decide on one treatment pathway for individuals with the same diagnosis. Although research and practice indicates the complexities of helping human beings to manage complex conditions, funding issues seem to dictate basic, solutions. Or to put it simply, one size has to be made to fit all.


Reading other service users' experiences of what is on offer locally for BPD, I realise that in the UK there is a vast gulf between different parts of the country. In my area, I am lucky that there have been two evidence based therapy paths, both vastly different from one another, on offer via the local NHS Trust. Many other areas, are still grappling with managing people 'like me' without any specialised therapy on offer. I have gone through the trauma of 'failing' at one model, but thankfully there was another very different and more suitable model that has really helped me. How many people with various mental health conditions have that luxury?

Having said funding issues are the main reason for not considering a more integrated approach to Mental Health treatment, it is difficult to avoid the conclusion that such money saving approaches are short sighted. Certainly, if inpatient beds are perceived as being too expensive to continue to invest in, why is investment not then being made into developing a range of treatment options which can be adapted to individual needs? If you remove the 'place of safety' for people, where is there a safe place in the community if the one treatment on offer to some, is not effective.

I know I am looking at things rather simplistically, however, I am currently benefiting from the support of a physical fitness team run by the same Trust who run local Mental Health services. I get free gym and swim for three months along with an individual programme that is realistic and takes account of my emotional needs. I am in the process of dealing with my obesity in order to prevent long term illness and disease. A good investment? I think so, I feel so much better physically. In addition, taking care of my physical well being is one of the DBT skills for emotion regulation. Looking after my physical health is definitely supporting my ongoing practice of DBT and emotional stability.

We are all complex beings, unfortunately, the politics of funding seem to have swamped the instincts of best clinical practice and research. While the NHS is still in existence there is an opportunity for different teams to work together in co-operation with one another, rather than being made to compete for ever dwindling pots of money. If the focus can move away from numbers (referred to services, or successfully completing treatment compared with others) back to the whole person, there is maybe some hope that service users will be able to be treated more effectively.

Believe it or not, I actually recognise that just because DBT works for me in managing my BPD, does not mean that I expect it to work for everyone else with BPD. Although, I will keep sharing when I find something else that has worked for me in DBT...cos it excites me when I continue to be able to manage my emotions.