An introduction to the Nottinghamshire Mentalization Based Treatment Service

Nottinghamshire Mentalization Based Treatment service (Notts MBT)

Who are we?

Notts MBT is a community service that provides individual assessment, individual and group therapy and treatment to adults who are felt to be experiencing difficulties with aspects of their personality. Difficulties include, longstanding problems in relationships, early experiences of trauma, poor early attachments, and a pronounced difficulty in managing overwhelming emotions. These difficulties will often have led the service users to have made frequent presentations to services for help and support. Service users do not necessarily need to have a diagnosis of Personality Disorder, but they will experience personality difficulties which are persistent, problematic and impact on multiple areas of their lives.

What services do we offer?

The service offers Mentalization Based Treatment groups for people of all ages. MBT is a type of psychological therapy that aims to improve a person's ability to mentalize in close relationships. MBT is a structured programme of therapy. It starts with an introductory educational group (MBTi) lasting for 12 weeks where you learn more about mentalization, attachment and personality disorder. This is followed by 18 months of weekly therapy that takes place both one-to-one and in a group. We also have the capacity to offer a group focusing on males aged-25-and-over with difficulties which are perhaps more antisocial in nature.

We offer Cognitive Analytic Therapy (CAT) which is provided as a group for young adults aged between 18-25 with emerging personality disorder/difficulties (called InsPiRE). The group is run in a rolling format. Service users are offered 24 weekly therapy sessions and five individual sessions. There is also a small offer of individual CAT therapy for clients meeting the service criteria whose difficulties may not be driven by mentalizing deficits.

We lastly offer Personality Disorder awareness training, and work alongside the Personality Disorder hub in delivering carers work for family, friends and carers of service users. The latter offer comprises of nine fortnightly sessions including topics such as looking after yourself, developing your own wellness plan, information about Personality Disorder and available treatment and advice on the support available to service users. Queries for more information/details about carers support can be made here or for training requests.

Service criteria

Service users assessed as appropriate for the Notts MBT Service will ideally have established some stability (i.e. stable housing, and drug and alcohol use not at a level where it will interfere with therapy engagement) and have some skills to tolerate distress in order to withstand an exploratory group therapy. While service users are not expected to have become masterful in managing their distress, they are expected to have some skills to tolerate overwhelming distress that would inhibit their ability to engage in an exploratory therapy. There is also an expectation that the individual has some sense of personal responsibility for their difficulties, is motivated to make changes and ready to commit to regular attendance and engage in group-based therapy.

How to refer

We accept referrals from Secondary Mental Health Services I.e. Local Mental Health Teams and other Mental Health Services, following assessment (and completion of the RiO CORE and risk assessment). Professional referrals or case discussions/queries can be made directly by emailing the Notts MBT Service with the following information: 

• Confirmation that the CORE and risk assessments are up to date
• A brief summary of the service users presentation/difficulties and why these are considered personality trait or difficulties
• Some sense of their goals and, whether the  service user is motivated and happy to be referred/open to considering group work.

Contacts details:

General enquiries – Tel: 0115 876 0162

• Simone Beason – Clinical Lead/Forensic Psychologist: Email: [email protected]
• Amy Dokic - Operational Team Leader: Email: [email protected]
• Jane McDonald-Loseby - Senior Clinical Therapist: Email: [email protected]
• Clare Lloyd - Clinical Team Leader: Email: [email protected]

Avoidant Restrictive Food Intake Disorder (ARFID) Service for Adults in Nottinghamshire

A three-year adult ARFID scoping project has been commissioned by Nottinghamshire Healthcare NHS to scope the clinical need for an Avoidant Restrictive Food Intake Disorder (ARFID) service for adults in Nottinghamshire.

ARFID is a condition characterised by someone avoiding certain foods or types of food or having restricted intake in terms of overall amount eaten, or both. This is typically caused by issues such as sensory difficulties, traumatic experiences such as choking or fear of becoming unwell, or lack of interest in eating. Body image and weight concerns are not drivers for ARFID, unlike with other eating disorders such as Anorexia Nervosa or Bulimia Nervosa. ARFID has significant impacts on someone's life, such as malnutrition, sometimes weight loss, and impaired social functioning.

The diagnostic criteria for ARFID identifies that the restriction and avoidance is associated with at least one of the following: 

• Substantial weight loss or failure to gain weight
• Severe nutritional deficiency
• Dependence on supplements
• Significant interference with social functioning

The disturbance cannot be better explained by factors such as lack of food, other mental health or medical condition, or other eating disorder with body disturbance concerns.

Four members of staff were initially seconded to deliver this scoping project namely, Simone Beason (Clinical Lead/ psychologist), Esther Dark (Specialist Occupational Therapist), Ben Havercroft (Highly Specialist Dietitian) and Anna Kalyta-Spawton (Trainee Advanced Clinical Practitioner). All professionals are currently based in the Nottingham Eating Disorder Service.

The first year of the project has focused on us understanding the prevalence and characterisations of the adult ARFID population nationally and locally within Nottinghamshire to inform the pathway. As well as completing an in-depth literature review, we designed and distributed a survey to help capture the opinions of professionals in primary, secondary and voluntary services who work with individuals living in Nottingham/Nottinghamshire. 

The survey sought to gain further information about the professional's knowledge/understanding of ARFID and their experiences of working with such clientele. It also allowed us to gain a better understanding of the local population and identify any good practice and/or gaps in current service provision. We then conducted patient interviews to understand how the adult ARFID population are currently accessing and experiencing mental health care services in Nottingham and Nottinghamshire.

The ARFID scoping team have also designed a one-hour training package which can be delivered upon request to increase professionals' knowledge about ARFID. We also offer a fortnightly professional only consultation. This is a supportive forum for professionals to recognize, explore and discuss the challenges linked with working with adults with ARFID or suspected ARFID in Nottinghamshire.

It is also a space for professionals to gain greater clinical understanding, share best practice and resources, and help to improve patient safety, care, and reduce treatment related costs and delays.

The team are currently in the process of writing up the phase one findings in a comprehensive report, which will be shared with key stakeholders. This report will highlight various options for service delivery for how an adult ARFID pathway could be developed in Nottingham and Nottinghamshire. To obtain high quality outcomes, ensure excellence, clinician confidence and patient safety, phase two of the project seeks to pilot the service to a small group of individual ARFID patients. The outcomes of this pilot will be evaluated and assist in any further planning or modifications to the potential service delivery options.

To make a request for consultation, training or find more about the adult ARFID scoping project, please email the team.