Reviewing and embedding changes
Reviewing your changes is an important step towards full implementation and can help you decide if your changes need further development. The resources provide examples of how different services across Scotland have made their changes to pathways business as usual.
NHS Dumfries and Galloway Structured Clinical Management pathway
This is a useful resource if you would like to know more about how an NHS board has reviewed a pathway of care and made changes based on these outcomes business as usual.
NHS Greater Glasgow and Clyde Dialectical Behaviour Therapy service development
A visual diagram to illustrate the 10-year implementation process of the DBT service in NHS Greater Glasgow and Clyde. The narrative contains six key stages from exploration to sustainability. This resource will be beneficial to areas that are scoping development of a new service or seeking to approach full implementation of an existing service.
NHS Greater Glasgow and Clyde – Borderline and beyond: Coping skills
Example from the BPD dialogues group. The resource highlights how people with lived and living experience can meaningfully be involved creating peer support resources.
Diagnosis and formulation
It is essential for services to have agreed terminology around diagnosis, to have robust staff training relating to changes with diagnostic classifications (such as the ICD11), and for diagnosis to be recorded robustly in systems. This will simplify data collection and evaluation. It is also crucial to know what diagnosis means to the individual and to understand that this is a process between patient and clinician.
Whilst diagnoses can guide evidence‑based interventions, services need to also understand the limitations that come with a diagnostic label describing complex presentations.. Good practice always guides towards diagnosis and psychological formulation being used in tandem. Psychological formulation is widely used by mental health services to understand presenting difficulties on different levels.
Teaching slides about ICD11 and diagnostic considerations used in staff training within NHS Greater Glasgow and Clyde BPD service.
The teaching slides contain an example of training materials that are currently being used to support staff around the changes in the ICD-11 and how these relate to personality disorder. While challenges around diagnosis are framed here in the context of personality disorder, they are also relevant to other complex mental health conditions.
This is a useful resource that assists in capturing some of the main considerations around moving from ICD-10 to ICD-11.
British Psychological Society guidance on the use of psychological formulation
1 January 2011
Guidelines that were developed to promote best practice in psychological formulation, a core competency for clinical psychologists. Shorter versions for other stakeholders, such as commissioners, service users, and carers are currently in development.
British Psychological Society patient information leaflet for understanding formulation
Patient information leaflet that describes the process and purpose of psychological formulation along with an example patient formulation
Association of Clinical Psychologists: Team Formulation Key Considerations in Mental Health Services
June 2022
This resource focuses on team formulation, where multidisciplinary teams work collaboratively with the person. It explains how team formulation differs from individual formulation, summarises the evidence, explores benefits and challenges, includes service user perspectives, and outlines key principles for good practice.
NHS Greater Glasgow and Clyde – Borderline Personality Disorder Guidance for Staff: Part of CCC (Co-ordinated Clinical Care) for working with people with a diagnosis of BPD
This guidance document outlines good practice for the assessment, diagnosis, and formulation of BPD. It addresses key issues such as underdiagnosis and the importance of considering BPD early in the assessment process.
The document provides step by step guidance across four areas: meeting diagnostic criteria; embedding diagnosis within the MDT formulation; developing collaborative recovery focused plans; and ongoing review and re formulation. It also emphasises the active involvement of individuals, and families or carers where appropriate, in the formulation process.
Five Ps formulation
May 2021
The 5 Ps of formulation is a biopsychosocial framework that helps professionals understand mental health difficulties by identifying key influences, risks, triggers, and supports. This tailored approach enables clearer formulation and more effective, sustainable interventions. This resource from Nottinghamshire Healthcare NHS Foundation Trust provides a useful overview of the 5 Ps of formulation and a template for case formulation.
Approaches to data, measurement and evaluation
A clear data and measurement plan is essential for understanding the effectiveness of services for the people they support. Data and measurement plans should be reviewed regularly to ensure they are capturing what is needed. Earlier resources highlight commonly used outcome measures in personality disorder services and those recommended by the ICHOM.
A range of people can support data and evaluation work, depending on local roles and data expertise. You should also consider what local data support may be available to you. When using or sharing confidential information, the Caldicott Principles should guide the appropriate use of patient‑level data.
Examples of data collection and evaluation in services supporting complex patients
Across Scotland, some areas are using effective approaches to data and evaluation to inform services, understand staff capacity, and demonstrate improved outcomes for people. Boards have adopted different data collection methods, including manual collection where business intelligence systems have limitations. Audit and evaluation can also help to understand how interventions work in practice, support flexibility where needed and recognise the role of clinical judgement.
Inpatient data from your area can provide strong evidence of the wider impact of your service across the system, including reduced service pressures, improved patient outcomes, and cost effectiveness.
The resource list provides examples of how some areas in Scotland have approached data and evaluation.
Document on importance/impact of evaluation
This is a useful resource that summarises how evaluation can support service improvement across a range of areas, such as planning capacity, empowering staff and recognising where improvement can be made
Tools and resources to support evaluation in mental health services
This resource provides a practical set of tools and guidance from reliable sources to help strengthen evaluation work, with a focus on supporting planning, capacity building, involving staff and service users more effectively, and improving the overall service quality and impact.
Data systems in action: approaches to data within NHS Grampian CMHT
This is a useful example of how service redesign work in NHS Grampian provided opportunity for a new approach to collecting, analysing, and visualising data in CMHTs.
The aim of this work was to create systems which would provide up to date and accurate information about caseloads, demands, and outputs, and assist with decision making around service design and staffing. This should be viewed in conjunction with the recording below.