Creating the conditions for change
Effective transformation relies on leadership and culture that actively supports change. Progress happens when leaders create safe environments where people feel confident to share ideas, innovate, experiment, and learn. The Scottish Approach to Change has more detail around the essentials of leadership and culture.
Identifying key stakeholders will support gathering diverse perspectives and understanding, for example how third sector and community organisations connect with statutory services.
Engaging a broad range of stakeholders can reveal challenges, highlight opportunities for improvement, and build a shared understanding of the different roles involved.
For example, staff engagement in phase one of PDIP highlighted several key challenges, including issues related to diagnosis, training, staff pressures, relationship management, and service design. When engaging stakeholders you should also consider the needs of specific communities and those with protected characteristics.
Stakeholder Engagement and Mapping from EIP Implementation Guide
Offers detailed advice and resources for engaging stakeholders when creating new services.
Personality Disorder Improvement Programme Companion Report
April 2023
Information on the outcomes and methods of a broad range of staff engagement carried out in phase 1 of PDIP (full outcomes on pages 31-37).
Designing and refining pathways of care
Business Cases
Producing a strong business case is a key task when promoting the need for a new service or full implementation of a service. The EIP Implementation Guide has useful guidance and resources for setting up a new service. The resources also contain guidance and examples around writing an effective business case, which can help support commissioning and identify service gaps where things need to change.
Pathway Reviews
Pathway reviews are a great way to foster deeper insights into:
- whether your service is meeting the needs of your service users
- whether the pathway has changed over time, and
- whether there are areas where improvements can be made.
These reviews can show how pathways operate in practice, stages of a person’s journey, how staff understand the pathway, and the challenges experienced. They can also support further improvements, including greater focus on lived and living experience and developing the need for staff training.
In PDIP, these reviews were used with pathfinder boards to deepen understanding and support pathway implementation. This involved several months of collaborative working with senior clinicians, managers, and staff to describe how pathways functioned in practice. The outcome was clearer visual representations of complex patient pathways (within existing service structures) and how they align with existing staff skills, capacity within services and links with non-statutory services.
Early Intervention in Psychosis Implementation Guide
This resource is helpful for teams designing and developing new services. Although it focuses on early intervention for first episode psychosis, the guidance is relevant to service development for other complex mental health conditions, particularly understanding systems, stakeholder mapping and workforce planning.
Writing a business case for pathway or service development: points to consider
This resource aims to provide practical guidance on what to include in your business case. The resource pulls together learning from other business cases developed for pathways supporting people with complex mental health.
NHS Lanarkshire Personality Disorder Pathway Proposal
This is a resource that can be used in conjunction with the above resource to compile an effective business case for a new service.
Greater Glasgow and Clyde BPD interventions
Example of interventions used for people with a diagnosis of borderline personality disorder from the NHS Greater Glasgow and Clyde Borderline Personality Disorder pathway.
NHS Dumfries & Galloway Structured Clinical Management pathway
NHS Forth Valley Emotional Regulation, Emotionally Unstable Personality Disorder and Complex Trauma Pathway guidelines
2024
NHS Forth Valley EUPD pathway
2024
A useful example of how pathways can be visually depicted, using information captured during pathway reviews. These visualisations and the review process were facilitated with service design input.
These are useful examples from NHS Forth Valley’s pathway containing information on screening, assessment, diagnosis and formulation, stages of treatment, crisis interventions, discipline specific guidance, staff training resources and interfaces with primary care and third sector.
West Lothian HSCP EUPD+cPTSD pathway
Another useful example of how pathways can be visually depicted, using information captured during pathway reviews. These visualisations and the review process were facilitated with service design input.
NHS Highland Personality Disorder Integrated Care Pathway
This is a useful example of an integrated care pathway for personality disorder from NHS Highland, which provides information on assessment, diagnosis and formulation, psychosocial interventions, medications, crisis management and education and awareness.
The integrated pathway promotes consistent, person-centred and recovery-focused care across community and inpatient services, helping ensure individuals receive timely, compassionate and effective support.
NHS Highland Personality Disorder Service
The NHS Highland Personality Disorder Service (PDS) is a specialist outpatient service that supports adults with personality disorder by providing consultation, assessment and targeted psychosocial interventions.
This resource outlines the services available through the PDS, services not currently provided by the PDS, and how clinicians can access referrals and support.
Staff development and training
Staff need the right skills, confidence and time to provide effective, compassionate care. When staff feel supported and confident in their roles, people using services are more likely to feel supported in their recovery. Staff development can include cost‑effective options such as mentoring, upskilling as well as local or national training. It is critical to have leaders within local systems who champion change and take on a specific and active tole as a responsible officer to support change.
The resources provide examples of the different types of training and tools that have been used in different services in Scotland. There is also a range of trauma focused documents, briefing papers and peer learning workshops available through the National Trauma Transformation Programme.
Case study: NHS Dumfries and Galloway – Training and development: Supporting staff to deliver services
This is a useful resource if you would like to explore a cost-effective, in-house approach to staff training. The case study gives an overview on how the staff training was lead and implemented in a service where there were constraints and a lack of resources. Includes key learning, top tips and next steps for the pathway.
NHS Greater Glasgow and Clyde Coordinated Clinical Care (CCC) core training for the management of borderline personality disorder
This resource provides an overview of Coordinated Clinical Care, outlining training needs, aims of training and appropriate staff groups, time commitments and training delivery. This should be viewed in conjunction with the resource on evaluation of the CCC training.
British and Irish Group for the Study of Personality Disorder (BIGSPD): Co-production of Coordinated Clinical Care: A Borderline Personality Disorder (BPD) Training Programme presentation slides from the BIGSPD 2025 conference
This resource is taken from a presentation given at the 2025 BIGSPD conference on the approach taken in NHS po Greater Glasgow and Clyde BPD service to CCC and how the training programme was co-produced and co-delivered by people with lived and living experience.
Evaluation of a DBT-Informed Multidisciplinary Training Programme Using a Quality Improvement Approach
This resource illustrates the design and evaluation of a DBT informed multidisciplinary training programme used in the NHS Greater Glasgow and Clyde DBT service with staff groups including those in CMHTs, crisis and unscheduled care, psychological therapies, older adults.
Tools such as personas and patient experience maps can also be used to enhance staff training
National Trauma Transformation Programme: Tools and Resources
This resource aims to increase service and staff understanding of trauma and trauma informed approaches as well as resources to support the well-being of staff who work with complex patient groups.
Reform webinar: Developing staff to work confidently with complex mental health needs
September 2025
This is a useful resource if you would like to know more about how staff development has been approached in NHS Highland Personality Disorder Service, NHS Dumfries and Galloway SCM pathway and how emotional coping skills training was delivered in inpatient settings in NHS Greater Glasgow and Clyde.
Evaluation of one day PD training Coordinated Clinical Care rolled out across large board area in GG&C
This poster illustrates the outcomes of an evaluation into the CCC training in NHS Greater Glasgow and Clyde. People with lived and living experience had active involvement in the CCC training delivered. Poster should be viewed alongside further information in the resource below.
NHS Highland Personality Disorder Service Awareness, Education and Training Platform
The NHS Highland Personality Disorder Service Awareness, Education & Training Platform is an online learning resource that provides education, training and psychoeducation materials for people with lived experience of personality disorder, family members, friends and staff.
It aims to increase understanding, build skills and support self-management through accessible learning resources, while also providing access to the NHS Highland Personality Disorder Integrated Care Pathway.
Considerations around ethical approaches to risk in personality disorder services
Supporting people with complex mental health needs can be challenging, especially when balancing safety with autonomy. When designing or improving care pathways and considering what is needed for staff development, it’s important to consider ethical approaches to risk management. The resources include materials on the Action/Consequences Model, an ethical, person‑centred framework for considerations around risk management in personality disorder.
Borderline personality disorder and the ethics of risk management: The action/consequence model
This is a useful resource for furthering considerations around ethical approaches and decision making around risk in personality disorder diagnosis
The Action/Consequences Model: a tool to prompt thinking and ethical decision making around risk
January 2017
This is a useful resource for furthering considerations around ethical approaches and decision making around risk in personality disorder diagnosis
Reform webinar – Thoughtful and ethical approaches to risk for people with a diagnosis of personality disorder
29 January 2025
This resource will help add further context to the development and utility of the action/consequences model