Waterview Service

The Waterview provides a service for adults with complex emotional needs, who live and are registered with a GP within the boroughs of Westminster or Kensington and Chelsea.

The service is specifically for people with recent & significant self-harming behaviour (within the last 12 months) and chaotic / unstable relationships, especially those who have a recent history of using A&E or inpatient mental health services at times of crisis.

Current service provision does not provide treatment for people with a primary diagnosis of Antisocial Personality Disorder, but we do accept referrals for people who have other types of personality disorder with antisocial features.

We do not work with people with a current diagnosis of bipolar disorder or psychotic illnesses, but do accept referrals for people who experience anxiety, depression, neurodiversity and other non-psychotic mental health conditions in addition to having complex emotional needs.

We do not work with people who are physically dependent on alcohol or illicit drugs. However, we accept referrals for people who use alcohol and drugs in a harmful way i.e. binge use. Individuals referred to the Waterview Service may have difficulties with substance misuse and this would be explored within the assessment and considerations around the impact on engagement in therapy would be explored. We may ask that individuals who use substances frequently also use  a suitable substance misuse service.

The way we think, feel and behave, and is shaped by our life experiences – it forms how we see life and interact with others. A person with complex emotional needs may face significant difficulties with their thought processes, emotional regulation, and behavioural responses, that persist for a long time. These difficulties impact on many areas of their life, including employment, education, finances and housing. Our clients often report a long history of having accessed other services and therapies, but continue to experience poor mental health and difficulties forming and sustaining relationships.

Many but not all those referred to the service will have been diagnosed with ‘personality disorder’ or ‘Complex Post Traumatic Stress Disorder’. These problems often result in intense emotional distress, such as anger, anxiety, or very low mood. As a way of managing their distress, people may use drugs or alcohol, isolate themselves from everyone, “lash out” at others, become increasingly dependent on someone else,  self-harm or have thoughts of wanting to end their lives.

All referrals to the Waterview Service should be made via the client’s  Kensington & Chelsea or Westminster Hub.

The stepped care model is used by the Hubs to make a clinical decision as to which sort of treatment is currently the most appropriate for the person. The needs of people receiving Step 4 services are likely to be more complex. Although some of the treatment provided may be similar to Step 2 or Step, 3 the Waterview Service’s treatment programmes are more intense, and requires clients to engage for a longer period of time.

Other services within CNWL such as the Complex Emotional Needs pathways or voluntary sector services may be considered before the Waterview Service to best support the client with a less intense approach.

To make a referral to the Waterview Service, please complete our referral form (hyperlink) and email this to us at : waterview.cnwl@nhs.net

For further guidance on referrals, contact the team at: waterview.cnwl@nhs.net

Following a referral being received, the Waterview Service will complete an initial screening to ensure the client meets basic service criteria e.g. address & GP in KCW. Once screened successfully, the service user will be invited for an initial assessment.

During the assessment period, the Waterview Service does not hold clinical responsibility for the client, and they should maintain engagement with the referring Hub..

Service users attend 1-2 individual assessment appointments. This is an opportunity for the client to learn about what the Waterview Service offers, and for us to understand what the individual is currently struggling with, any harmful/risky behaviours, any previous treatments they have received, and their motivation to engage in an intensive therapy programme. Individuals will also be asked to complete some questionnaires (The Waterview Outcome Measures).

After these appointments, the Waterview Team will review the information gathered and will either decline the referral and make suggestions for alternative avenues for support.

Recommendations and plans following an assessment will be discussed with the service user. These may include:

• A decision that the Waterview Service is not the right one for the client at this time. We may refer service users to other services that may be more appropriate, such as arts therapies, substance misuse services, or organisations in the voluntary sector.

If the team recommend that the service user would benefit from longer-term therapeutic input, they will be offered a place on either the Mentalization Based Treatment programme or the Dialectical Behaviour Therapy programme.

• As well as their group allocation, service users will also be allocated a Lead Professional for 1:1 appointments, and any case management work – however the full team remain involved with all clients at the Waterview.
• We arrange a review within the first 6 weeks of therapy, at which point the consultant psychiatrist at the Waterview Service becomes the responsible clinician. 
• Service users’  care plans, goals, and Safety Management Plans are reviewed regularly throughout treatment – a full MDT review is held with the client at 6 months, 12 months and 18 months.

Mentalisation Based Treatment (MBT)

Mentalization-based therapy (MBT) is a type of long-term psychotherapy. Mentalization is the ability to think about thinking. It helps to make sense of our thoughts, beliefs, wishes and feelings and to link these to our actions and behaviours.

Mentalization is a normal capacity that we all use in everyday life. It underpins all human relationships. However, some people find it more difficult to mentalise in certain situations than others. 

MBT aims to improve a person’s capacity to mentalise. We focus on what is going on in their mind and in the minds of other people and link this to understand and alleviate problematic behaviours. 

Mentalising is best summed up as thinking about thinking. It is being able to understand our own mental state and that of other people and how this effects behaviour

Length of treatment.

Groups sessions last 90 minutes, the treatment programme is for 18 months.

Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a long-term, skills-based therapy, which was developed from cognitive behavioural therapy. “Dialectical” means trying to understand how two things that seem opposite could both be true. For example, accepting yourself as you are now, and there is a need to change your behaviour may feel contradictory. But DBT teaches that it is possible for you to achieve both these goals together, with the use of DBT Skills. These skills are taught in 4 modules – Emotion Regulation, Distress Tolerance, Inter-Personal Effectiveness, and Mindfulness.

DBT teaches individuals how to better understand and regulate their emotions, and respond to triggering situations in less harmful ways.  

Bus: 18, 28, 31, 328, 36, 607

Train: Overground

Tube: Hammersmith & City and Circle lines (Westbourne Park)

Some clients are supported by Carers and family, and within the boroughs of Kensington & Chelsea and Westminster Carers support is available:

Carers Network

www.carers-network.org.uk

Carers network support carers in Westminster, Hammersmith & Fulham and Kensington & Chelsea:

Carers Network was established in 1991 to support unpaid carers. Carers Network support people caring for partners, family members, friends and neighbours aged over 18 with disabilities and long-term conditions or experiencing frailty due to old age.

They provide one-to-one assessments, an information and advice service, support groups and drop-in sessions. In addition, have a programme of events, activities and training.

Carers Network’s services are available free of charge to unpaid carers living in the City of Westminster.

Contact Carers Network on 020 8960 3033 | info@carers-network.org.uk

Carers UK Adviceline

Carers UK provides useful practical information, support and guidance for unpaid carers.

T: 0808 808 7777 (Mon–Fri, 10am–4pm)
E: advice@carersuk.org
W: www.carersuk.org

Visit the CNWL page.

You can also feedback to us using the friends and family survey. Find out more about the survey and complete it here (Link to Waterview form).

Click on the AccessAble above for more information