The SPeDi Trial (Sheffield Personality Disorders)
One of the main activities in the Psychological Therapies strand is a randomised controlled trial of psychotherapy for Borderline Personality Disorder (BPD). The trial is being conducted in the context of a new clinical service that has been developed by Sheffield Care Trust.
People with severe & complex psychological problems referred to by the label `borderline personality disorder´ experience acute distress and multiple difficulties – such as self-harm and repeated suicide attempts, panic, depression, anger problems and trouble with relationships. Our project aims to deliver and test improvements in services for people with these difficulties (who have at times been stigmatised and marginalised in mental health services). Mental health professionals, researchers and service users are working together to achieve this.
Two different approaches are being compared. People receive either care from a Community Mental Health Team whose team members have had special training, or psychological therapy. The therapy methods (cognitive behavioural or cognitive analytic) were pioneered in the UK. People coming into the project agree to be randomly allocated to one or the other, and are carefully followed up to find out how they get on in terms of improvements in their well-being, relationships and quality of life, using standardised measures. In addition, service users are collaborating on exploring the experiences people have in these services, whether helpful or unhelpful.
As well as improving provision for these clients, the project aims to answer several important research questions to inform future NHS services. Is it beneficial to offer individual therapy over and above good quality care from a CMHT? Which treatment programmes are most acceptable to service users? People in this client group often report negative experiences of care and many drop out of therapy, so it is important to focus on their experiences. In addition to service user involvement with the randomised trial, a parallel study addresses these issues directly, through qualitative methods. Other questions include which process factors predict outcomes, such as therapist competence, therapeutic alliance and specific techniques; and which client characteristics make a difference (e.g. history of early childhood abuse & trauma). To have a chance of answering these questions we need to follow up 132 people.
The trial service has recently recruited its first participants. To get useful evidence on which to plan services, we needed to set up a randomised trial in a realistic service setting and include the perspective of service users, which is usually neglected. This requires an extensive range of partnerships between care staff, therapists, researchers and service users, and development of an organisational culture within a mental health service to meet both clinical and research requirements.