The effectiveness of the service user consultant role in specialist personality disorder services

Abstract

Purpose

This qualitative study considers the roles of service user consultants (SUCs) in six of the original 11 Department of Health (DH) Community Personality Disorder (PD) pilot services; how these roles differ from the active participation traditionally encouraged in therapeutic communities (TCs) around responsibility for self and others; how a service user (SU) becomes a SUC; what responsibilities they hold; the views of both staff members and SUCs on the role and the benefits and difficulties it creates; and how the role could be developed in a service‐specific and general way. It is of particular interest to consider the amount of time for which the SUC role is seen to be beneficial, and what support a SUC would need to leave the role.

Design/methodology/approach

Two qualitative interview schedules were developed to investigate issues highlighted in previous literature, one designed to be answered by staff members, another developed with a SUC from Cumbria for SUCs and administered by telephone. The research questions were designed to look at four main themes: How SUs become SUCs; SUC responsibilities within the service; views on the benefits and difficulties of the SUC role; and developing the role and moving forward. The context of each service was explored to reflect the uniqueness of each SUC role and service philosophy.

Findings

The SUC role continues to develop and is seen as having value, particularly as a “bridge” between SUs and staff members, and as a transitional stage in which the work of therapy can be consolidated. Problems remain in respect to: optimal levels of disclosure between other staff members and SUCs; the level and type of support needed to carry out the work and to remain well; acceptance of the role by professionals in other teams; and the extent to which SUCs are felt able to engage, or not, in direct clinical work.

Research limitations/implications

This is a qualitative study in which only just over half of the pilot services agreed to take part and in which fewer SUCs were put forward to take part as compared to other staff members. There are therefore potential problems in generalising these findings to other services which employ SUCs.

Practical implications

Within personality disorder services there is a perceived optimal level of disclosure and information sharing between other staff members and SUCs, and between SUCs and SUs, but this remains undefined. SUC responsibilities do not always include direct clinical work because of concerns to maintain their well being. There is evidence from a number of services that SUCs can safely and creatively engage in direct clinical work given suitable support and supervision. Staff members from other teams without experience of employing SUCs may not always understand the SUC role, may denigrate the experience of SUCs, or feel threatened by their incursion into training and clinical work. SUCs seem enthusiastic to work in other areas within their wider service to promote understanding of mental health and personality difficulties. In‐service supervision/mentoring can help to monitor and alleviate SUC distress.

Originality/value

The paper extends knowledge about the SUC role, as it has developed and diversified during the development of the DH Community PD Pilot Sites. Novel semi‐structured interview schedules have been developed.

Citation

D'Sa, A. and Rigby, M. (2011), "The effectiveness of the service user consultant role in specialist personality disorder services", Mental Health Review Journal, Vol. 16 No. 4, pp. 185-196. https://doi.org/10.1108/13619321111202340