The Waterview Service is based in Westbourne Park. We help people who experience long-standing emotional and interpersonal difficulties associated with a diagnosis of personality disorder.
Services are available Monday to Friday from 9am to 5pm, excluding public holidays.
The Waterview provides a service for adults with a diagnosis of personality disorder, 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 and significant self-harming behaviour (within the last 12 months) and chaotic and/or 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 Anti-Social Personality Disorder, but we do accept referrals for people who have other types of personality disorder with anti-social features.
We do not work with people with a current diagnosis of Bipolar or psychotic illnesses, but do accept referrals for people who experience anxiety, depression and other non-psychotic mental illnesses secondary to the diagnosis of personality disorder.
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 would be made around the impact on engagement in therapy. We may ask that individuals who use substances frequently should enegage with a suitable substance misuse service.
Our personality is the way that we think, feel and behave, and is shaped by our life experiences – it forms how we see life and interact with others. An individual with a personality disorder 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 relationships, employment, education, finances and housing.
Our clients often report a long history of having accessed other services and therapies, but continue to experience difficulties associated with a personality disorder. These problems often result in intense emotional distress, such as anger, anxiety, or very low mood. As a way of managing their distress, individuals may use drugs or alcohol, isolate themselves from everyone, “lash out” at others, become increasingly dependent on someone else, or engage in self-harming behaviours.
More information on personality disorder can be found at:
All referrals to the Waterview Service should be made via the Kensington and Chelsea or Westminster Hubs.
The Hubs use the Stepped Care Model to make a clinical decision as to which sort of treatment is currently the most appropriate for the person. Stepped Care is a system of delivering and monitoring treatments, so that the least intrusive method of care possible is delivered to patients first; only ‘stepping up’ to intensive services as clinically required.
The treatment programmes at the Waterview Service are more intense, and require clients to engage for a longer period of time.
Other services within CNWL such as the Complex Emotional Needs pathway 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 this referral form and email this to us at: firstname.lastname@example.org
For further guidance on referrals, contact the team at the email address above.
Once a referral is received, the Waterview Service will complete an initial screening to ensure the client meets basic service criteria (such as an address and GP within the boroughs of Westminster or Kensington and Chelsea). 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 will attend 1-2 individual assessment appointments. This is an opportunity for the client to learn about the Waterview Service, and for us to understand what the individual is currently struggling with, including harmful behaviours, previous treatments they have received, and their motivation to engage in an intensive therapy programme. Individuals will also be asked to complete questionnaires (The Waterview Outcome Measures).
After these appointments, the Waterview Team will review the information gathered. We will either decline the referral and make suggestions for alternative avenues for support; or invite the client to our 8-week Short-Term Psycho-Education Programme.
The Short-Term Psycho-Education Programme (STP) is a group-based intervention that runs for eight sessions. This weekly programme gives people information about personality disorders, explores coping strategies and introduces the group to the concepts of Mentalization-Based Treatment and Dialectical Behaviour Therapy. The programme helps people to develop a better understanding of themselves and their relationships with others.
The STP has educational aspects and will also provide group members with an opportunity to learn from each other’s experiences. There will be a maximum of 10 members in the group. The programme is helpful for those who have never engaged in a group or are uncertain about group work. It gives people a chance to find out what it’s like before making a commitment to longer term treatment. The STP is an intervention in itself, and also forms part of the assessment for the Waterview Service.
The aim of the programme is:
- To develop an understanding of personality disorder
- To consider ongoing difficulties related to personality disorder
- Developing an understanding of how these difficulties can be managed
- To assess whether further treatment would be helpful
After the Short-Term Psycho-Education Programme (STP) programme, service users will be invited to attend another appointment with their assessor. This session will explore the service user’s experience of attending the STP and engaging in a group. Recommendations and plans going forward will be discussed with the service user.
After this appointment, the Waterview Team will discuss the service user’s engagement in the STP and consider the service user’s view of their STP experience. At this stage, the team may decide that there is a more appropriate service for the individual such as creative 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 Mentalisation Based Treatment (MBT) pathway or the Dialectical Behaviour Therapy (DBT) pathway.
- Service users will also be allocated a Lead Professional for their 1:1 therapy appointments and any case management work. However, the full team remain involved with all clients at the Waterview.
- We arrange a transfer of care meeting within the first six 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 six months, 12 months and 18 months.
Mentalisation Based Treatment (MBT)
Mentalisation-based therapy (MBT) is a type of long-term psychotherapy. Mentalisation 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.
Mentalisation is a normal capacity that we all use in everyday life and 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 as well as in the minds of other people, and link this to understand and alleviate problematic behaviours. It is being able to understand our own mental state and that of other people and how this affects behaviour.
Length of treatment
MBT is delivered in groups. Group sessions last 90 minutes, and the treatment programme runs 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 accepting there is a need to change your behaviour. 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 four 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.
Length of treatment
Group sessions last for 2 hours and 15 minutes (including a 15 minute break). The treatment programme runs weekly for 18 months.
Bus: 18, 28, 31, 328, 36, 607
Tube: Hammersmith & City and Circle lines (Westbourne Park)
Some clients are supported by carers and family, and within the boroughs of Westminster, Kensington and Chelsea support is available:
The Carers Network support carers in Westminster, Hammersmith and Fulham as well as Kensington and Chelsea. They 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 UK provides useful practical information, support and guidance for unpaid carers.