Sutton and Merton Complex Needs Service
Sutton and Merton Complex Needs Service
Our service supports adults aged 18+ who meet criteria for a diagnosis of emotionally unstable personality disorder (EUPD), also known as borderline personality disorder (BPD), and frequently engage in self-harm and suicide behaviours.
Some people might describe and understand these difficulties as ‘complex emotional and relational needs’, whilst others prefer the label of ‘personality disorder’. We do refer to the diagnosis of EUPD as this diagnostic label is required to access our service.
We offer two evidence-based therapies: Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Therapy (MBT). For those individuals who have similar difficulties – who do not self-harm or engage in suicide behaviours – there is the option of psychodynamic psychotherapy.
We are a multidisciplinary team made up of doctors, psychologists, MBT therapists, DBT therapists, and therapists completing training with our team.
What is Emotionally Unstable Personality Disorder (EUPD)
The diagnosis of emotionally unstable personality disorder can also be known as ‘borderline personality disorder’ (BPD), which is the diagnostic name used in the USA. EUPD is characterised by difficulties in regulating emotions, managing relationships, and experiencing extremely distressing emotions that are difficult to tolerate. These difficulties can cause substantial distress and significantly impact on a person’s life in all contexts: at home, socially, at school and at work. People who struggle with these difficulties may have found unsafe ways to cope with the distress they experience. Many people have experienced traumatic events growing up and so may have developed certain thinking patterns and coping strategies which are understandable in that context. Some of these difficulties start to emerge in adolescence and might persist into adulthood. Therefore, you might not receive the diagnosis before the age of 17/ 18 years of age.
Individuals who meet criteria for a diagnosis of EUPD may typically experience difficulties in the following areas:
Myths about Emotionally Unstable Personality Disorder
Meeting criteria means there is something wrong with your personality
FALSE! Meeting criteria for a diagnosis of EUPD, or any other personality disorder, does not mean you have a ‘disordered personality’. Rather, ‘personality disorder’ is a broad term to describe that you may struggle with your sense of self, managing your emotions and in your relationships with others.
Individuals with a diagnosis of EUPD will never get better
FALSE! There are now multiple effective, evidence-based treatments for people who meet criteria for EUPD, including Dialectical Behaviour Therapy and Mentalisation Based Therapy which we provide at our service.
I have BPD, does this mean I am on the borderline of meeting criteria?
The term ‘borderline’ does not mean you ‘almost’ meet criteria for this personality disorder. Rather, it refers to how mental health workers in America have historically defined symptoms relating to this diagnosis. In the UK, we use a different system for classifying mental health problems, so we call it emotionally unstable personality disorder.
People with a diagnosis are manipulative/ troublemakers
FALSE! We all have social needs which we want to meet. Some people, because of their life experiences, may have learned they need to ‘shout louder’ to be heard or noticed by others.
Marsha Linehan, creator of DBT, tries to address this misunderstanding and stigma by explaining “If they are so good at manipulating, why do they end up in therapy and hospitalized? They must be very lousy manipulators, or that is not what they are trying to do!”
Only women can have a diagnosis of EUPD
FALSE! People of any gender can meet criteria for a diagnosis of EUPD, however more women receive a diagnosis.
Referrals
You will have been referred to Sutton and Merton Complex Needs Service (CNS) by your local community mental health team, such as CAMHS or an adult team. Your team may have identified that you experience difficulties with managing emotions, managing relationships and/ or feel suicidal and engage in self-harm.
What happens after your referral
All referrals are discussed in our referrals meeting to determine whether we are the most appropriate team to meet your needs. If so, you will be placed on our waiting list for an individual assessment with a member of our team and will receive a letter explaining this. As with many NHS services, waiting times can be long. We try to prioritise those referrals from CAMHS, and young adults up to 19 years old, as we acknowledge the challenges of transitioning into adult mental health services. You will be seen as soon as a clinician from our team becomes available. Once a clinician has been allocated, they will be in contact to arrange a first assessment appointment. Whilst on our waitlist, you will continue to be supported by your current team and should access them as required.
Family Connections™
We know that caring for individuals with complex emotional needs can be difficult and that family members can feel isolated. Research and evidence tell us that the support loved ones provide is important for the recovery journey of our clients. Family Connections™ is a 12-week evidence-based group program that helps your family support you in the changes you are making and learn how they can work with you to meet your therapy goals. The aim of the group is to educate significant others on emotional dysregulation and interpersonal functioning, learn skills to manage their own emotional responses and support their loved ones, as well as provide peer support through group membership. This group is currently only open to significant others (18yrs+) of clients who are 16-25 years old, with emotional dysregulation difficulties with or without a diagnosis of EUPD, and who are under either child or adult mental health. At present, for loved ones to be eligible for the group, clients need to be receiving either DBT informed or DBT treatment from either CAMHS or adult mental health services. It is up to you, the client, to choose if and who you might like to be invited to join this group. We understand that some people might not want their families, friends or carers to attend. This group is a confidential space for clients’ loved ones.
I am very thankful for this opportunity to exist. It facilitated a lot more open and honest conversations with (sibling).
Sibling of a 23-year-old client
ConfidentialityÂ
Confidentiality is about the information you share with the team being kept private from other people. There may be times it would be helpful for other people in your life to know some of this information. You can tell us what information you would like shared and what people you consent to sharing it with. It is important to know you can decide later to remove your consent for your personal information to be shared with other services and those involved in your care.