Matched care

The concept of matched (or stepped) care is based on the understanding that for most health conditions, there will be a larger number of people with less severe forms of the disorder, with numbers of those affected by the disorder becoming progressively smaller as severity increases. Treatment is organised in tiers to best match intensity of service with complexity and severity of need. This has benefits for patients and services but does require appropriate assessment and signposting of patients to the most appropriate intervention for them at that time. For example, STEPPS is the most appropriate stabilisation intervention for moderate severity borderline personality difficulties but DBT is more appropriate for treating patients with more severe forms of the disorder, given its more intensive approach.

Figure 2.2. Tiers of service provision for people with personality disorder

In NHS Highland, services fall within the first 3 tiers of this model. Primary care, social care, third sector and specialist outreach from the PDS (primarily in terms of education/awareness interventions) comprise the first tier. Tier 2 includes inpatient and community mental health services (including STEPPS), and PDS outreach interventions to these services. These outreach interventions include education/awareness, and consultation/liaison interventions. The PDS represents the third tier of service in NHS Highland incorporating DBT and the CAS Day Service.

Table 2.2 shows some examples of interventions for each phase of treatment available within the different tiers of service provision. This table is illustrative only and is by no means exhaustive.