The Waterview helps people who have long-standing emotional and interpersonal problems resulting from personality disorder. We support people who have a formal diagnosis of a disorder or experience significant problems related to their personality.
The service is for:
- People who self-harm
- People who may cause harm to others and display violent behaviour
- People in chaotic or unstable relationships
- People who struggle to manage strong feelings
- People who have a history of using A&E and inpatient mental health services at times of crisis
We treat residents in the Kensington & Chelsea and Westminster catchment area and currently cannot accept referrals from outside this area. Two places are currently available to Harrow residents managed through the Harrow Psychotherapy Department.
We accept referrals from registered mental health professionals excluding primary care. We do consider referrals from Tier 4 primary care services on a case-by-case basis. Referrals from secondary care mental health teams should be made directly to the referral coordinator at the Waterview Centre. Please refer to guidelines for referrals. To refer a patient, we need the following information:
- Up to date risk assessment
- An explanation why our services could be beneficial
- MHCT clustering tool (in most instances, the client will be in cluster 6, 7 or 8)
- Details about other services the client has been referred to
- Details of any current alcohol and substance misuse
- Street homelessness, which may impact a clients ability to focus on interpersonal change
- If the client is aware of the referral
The Waterview Centre aims to help people who have long-standing emotional and interpersonal problems resulting from personality disorder. People may have been given a formal diagnosis of personality disorder or have very significant problems related to their personality.
The service is specifically designed for people with self-harming behaviour and chaotic or unstable relationships, especially those who have a history of using A&E or inpatient mental health services at times of crisis (people in clusters 6, 7 and 8).
We do not work with people with a primary diagnosis of schizophrenia or Bipolar I, but do work with people with anxiety and depression and other non-psychotic mental illnesses.
We do not work with people who are dependent on alcohol or other drugs, but do work with people who use alcohol and drugs in a harmful way i.e. binge pattern.
Current service provision does not provide treatment solely for people diagnosed with Anti-Social Personality Disorder but we do accept referrals for people who have other types of personality disorder with anti-social features.
We are contracted to provide treatment for people living in the boroughs of Kensington & Chelsea and Westminster, or whose GP are based in these boroughs. (Two places are currently available to Harrow residents managed through the Harrow Psychotherapy Department). Unfortunately we are currently unable to take other out-of-area referrals.
We accept referrals from any registered mental health professional but do not accept referrals from primary care. We consider referrals from Tier 4 primary care services on a case-by-case basis. There is no standard referral form required from CNWL services into the Waterview Centre, but when you do refer, please include the following information:
- An up to date risk assessment
- An indication of why treatment from the Waterview Centre could be helpful
- MHCT clustering tool (in most instances the client will be in cluster 6, 7 or 8)
- Information about any other services the client been referred to
- Details of current alcohol and substance misuse.
- Street homelessness – which might make it difficult for the person to focus on interpersonal change due to severe housing difficulties
- If the Service User is aware of the referral
During the assessment period, the Waterview Centre does not hold care co-ordination responsibility but can support service users under Lead Professional care by agreement with referring teams.
Service users attend between 2-4 individual appointments to assess the nature and severity of their personality difficulties, risk to self or others, capacity, motivation to use psychological treatment and if treatment has been helpful in the past. Service users also complete a questionnaire. A joint decision between staff and service user is made to decide the best course of treatment.
If after the assessment process, a long term treatment programme is indicated, we arrange a CPA transfer meeting within 6 weeks from the beginning of treatment. When care coordination is formally taken on, the consultant psychiatrist at the Waterview Centre becomes the responsible clinician.
Group based treatments are delivered at Woodfield Road. Brief intervention, consultation and advice are delivered by Waterview staff at local Community Mental Health Teams (CMHT). Brief intervention consists of 4-8 sessions of individual work and is tailored to the needs of the service user and includes psycho-education, risk and crisis management and solution focused work.
The Short-Term Psycho Educational Programme is an 8 session group based intervention programme. This weekly programme gives people information and advice about personality disorders, explores coping strategies and introduces people to the concepts of Mentalization and Mindfulness. The programme helps people develop a better understanding of themselves and their relationships with others.
The Short-Term Psycho Educational Programme will have educational aspects but will also provide group members with an opportunity to learn from each other’s experiences. There will be a maximum of 12 members in the group. The programme is helpful for those who have never engaged in a group or who are uncertain around group work. It also gives people a chance to find out what it is like to be in a group without having to make a commitment to longer term treatment. Group-based treatment can be challenging but can also help people realise they are not alone and that other people with long-term problems can recover. There is good evidence to suggest that group-based treatment combined with individual support is an effective approach to helping people who have personality disorder.
The aim of the programme is:
- To develop group members understanding of personality disorder
- To consider on-going difficulties related to personality disorder
- Develop understanding of how these difficulties may be managed
- To think about how your relationships can be improved
- To assess whether further treatment would be helpful.
Upon completing the programme, members will have a better understanding of their difficulties. The next steps following the programme may include:
- Attending The Waterview Centre’s 18 month treatment programme.
- Referral to other treatments such as creative therapies or substance misuse services.
- Considering services in the voluntary sector.
- Discharge to primary care services (back to the GP).
Mentalisation-Based Treatment (MBT) helps people with long-term emotional distress and difficulties in managing their relationship with others. Occasionally, stress management becomes difficult or things happen that make them feel uncomfortable. People find it difficult to work out what they or others are thinking and feeling. Individuals who have had a difficult start in life or have poor emotional health may find it even harder to do this. MBT improves peoples understanding of their thoughts and feelings, including how and why people react to them in certain ways.
How does MBT work?
The programme is 18 months long and there are two programme options. The first is a once a week MBT programme and the second is a twice a week combination of MBT and skills training based on Dialetical Behaviour Therapy. Group members will have a two week break over Christmas and New Year and there are options to pre-agree other short holidays. Members can also opt to end treatment early.
MBT is delivered in groups and is supplemented by individual sessions. Group sessions are a chance to learn from others and hear how they try and cope with difficulties and to understand one's own thoughts and feelings and the reaction other people give to them. It is likely, that people may experience strong feelings during group sessions and not understand why they had them. Other group members and group facilitators help one another to work out where the feelings came from.
People will experience thoughts about each other and vice versa. Knowing what other think can help to make one understand themselves better. An individual may experience distress based on what they hear, however, this recreates instances that happen outside the group treatment in an environment where they can be better understood.
MBT is not a quick fix solution. Someone may find it hard to express their feelings and deal with responses. This is normal. People will have good and bad days. It is important to go through the whole treatments as only then will the benefits be seen.
What happens after treatment?
Once the treatment programme is completed, people will be offered a limited out=service follow up for a year before they are discharged back to primary care services. Throughout this period, people are offered individual sessions under CPA or Lead Professional Care to support therapy, monitor treatment progress and provide help with occupational and social problems. The Team Psychiatrist provides medical input during these treatment programmes.
The following boundaries have been created by ex-service users. The boundaries keep the Waterview Centre a safe space for people. The boundaries cannot cover all events but provide an outline of what is helpful and unhelpful in people’s treatments.
We expect the following from people on the programme:
- Express what you think and feel
- Respect others views
- Respect diversity of race, gender, religious beliefs and more
- Respect confidentiality
- Be on time. Let the group facilitators and other members know if you are going to be late or a miss a session, at the earliest possibe opportunity. In the exceptional situation that there is only one patient in the group, session will end after 20 minutes.
- Voice concerns, if you are not happy about something at the Waterview Centre
What we do not tolerate from people on the programme:
- Offensive and threatening language
- Display of violence
- Contacting other users outside the centre
- Bring food or hot drinks to sessions
- Smoking on NHS gronds
- Using mobile phones during sessions (unless pre-agreed)
- Attendance under the influence of alcohol or drugs
Boundary breaches will be discussed in groups and/or individual sessions. This may lead to a greater understanding of someone’s difficulties and could form part of their care plan. However, boundary breaches may also affect other people using the centre, so those who repeatedly breach may be asked to leave treatment.
Violence and Aggression
Violence and aggression will not be tolerated and will result in treatment ending early.
Groups will start and finish on time. Yours and the group’s treatment will be better if you avoid missing sessions or coming late. If absence or lateness is unavoidable, please discuss this in advance with the group. If not, please leave a message for the group facilitators and other group members as early as possible. Consistent absence and lateness stops people benefiting from group therapy and impacts their progress. In the exceptional situation that there is only one patient in the group, session will end after 20 minutes.
Drugs and Alcohol
If staff believes that somebody is intoxicated, they will be asked to leave the building but can return in the future. Service users with a history of drug and alcohol problems are encouraged to continue to use drug and alcohol services whilst in treatment at the centre.
Respecting confidentiality ensures the safety of the group. For this reason surnames are not generally used and group members are asked not to talk about the group with anyone outside the service. Waterview staff will communicate regularly with each other on how group members are. Information is also shared with other services where there is a risk to your or others safety.
Experience shows that social contact between members outside the group affects the group’s progress, causes divisions and reduces trust. If any contact does occur, it is best to mention it in the group.
If someone is making use of another therapy or wishes to start one, they must let staff at the Waterview Centre know. It can be confusing and unhelpful to be engaging in more than one therapy at once. Waterview Centre can advise about this.
Services are available fMonday to Friday from 9am to 5pm, excluding public holidays.
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