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- PublicationThe Waterford mental health surveyThe primary objective of the Waterford Mental Health Survey was to document the prevalence of co-morbid personality disorders in a sample of inpatients and outpatients attending the HSE mental health service in Waterford and outline the implications of this for service development. Between July 2011 and June 2014, 100 inpatients and 99 outpatients were evaluated with the Structured Clinical Interviews for DSM-IV axis I and II disorders, the Childhood Trauma Questionnaire, the Global Assessment of Functioning rating scale, the SCORE family assessment instrument, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Participants were consenting, consecutive referrals who were not too unwell to engage with the study. The sample interviewed was probably slightly higher functioning than all cases attending the service. With regard to the primary objective of the study, we found that 98.4% of cases had DSM-IV axis I psychiatric disorders and 39.3% of these had comorbid axis II personality disorders. Between approximately a half and three-quarters of cases with personality disorders had comorbid anxiety, depressive or alcohol and substance use disorders. Compared to those without personality disorders, cases with personality disorders had experienced more child maltreatment; had poorer personal and family functioning and more severe presenting problems; and reported greater unmet service needs and motivation for psychotherapy. In terms of service development, approximately 2 out of 5 patients attending the public mental health services in Waterford require specialist psychological therapy for personality disorders which addresses low levels of personal and family functioning and past history ofchild maltreatment. Specialist psychological therapies include dialectical behaviour therapy (Linehan, 1993. 2014), schema therapy (Young et al., 2007), cognitive behaviour therapy (Beck et al., 2004) and brief psychodynamic psychotherapy such as mentalization-based treatment (Bateman & Fonagy, 2006; Clarkin et al., 2010). A review of psychology staffing levels is required to determine the number of psychologists required to provide this type of service in line with recommendations in the national mental health policy - Vision for Change (Department of Health & Children, 2006) - and the HPSI Psychology briefing paper for the HSE mental health division (Heads of Psychology Services Ireland, 2014). Intensive initial staff training and ongoing supervision are required for psychologists to provide these specialist evidence-based interventions.
- PublicationChild maltreatment and adult psychopathology in an Irish contextOne-hundred-ninety-nine adult mental health service users were interviewed with a protocol that included the Childhood Trauma Questionnaire, the Structured Clinical Interviews for Axis I and II DSM-IV disorders, the Global Assessment of Functioning scale, the SCORE family assessment measure, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Compared to a U.S. normative sample, Irish clinical cases had higher levels of maltreatment. Cases with comorbid axis I and II disorders reported more child maltreatment than those with axis I disorders only. There was no association between types of CM and types of psychopathology. Current family adjustment and service needs (but not global functioning and motivation for psychotherapy) were correlated with a CM history. It was concluded that child maltreatment may contribute to the development of adult psychopathology, and higher levels of trauma are associated with co-morbid personality disorder, greater service needs and poorer family adjustment. A history of child maltreatment should routinely be determined when assessing adult mental health service users, especially those with personality disorders and where appropriate evidence-based psychotherapy which addresses childhood trauma should be offered.
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