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Structured Clinical Management

This leaflet includes information about Structured Clinical Management (SCM). SCM is a treatment for people who have personality difficulties. SCM has been found to be as effective as other treatments such as Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Treatment (MBT) in helping people address their personality difficulties.

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  • What is Structured Clinical Management?

    Structured Clinical Management (SCM), is a treatment for people who have personality difficulties.

    “Personality” refers to the way we think, feel and behave. Due to life experiences, difficulties can arise in these areas.

    If the difficulties are causing you great distress, are long-lasting and impact on many aspects of your life, then help may be needed from mental health services.

    SCM has been found to be as effective as other treatments such as Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Treatment (MBT) in helping people address their personality difficulties.

    SCM can be accessed by people from diverse backgrounds, ages, gender and ethnicity.

    Please see page seven of this leaflet for references which can provide further information about the development of SCM and its effectiveness.

  • Benefits and risks of SCM

    The benefits of engaging in SCM are described in this leaflet.

    There are no significant risks associated with SCM however as with all therapies, it requires participants to think and talk about their difficulties. This can be challenging, but you will have the opportunity to discuss any concerns you may have with your SCM worker. If you choose not to engage in SCM, your options will be discussed with you.

  • Is SCM right for me?

    SCM may be helpful if you have difficulties with:
    • Managing your emotions and mood
    • Managing urges to act quickly (acting without thinking)
    • Self-harm and suicidal thoughts
    • Making and keeping healthy relationships
    • Problem solving in relationships and coping with emotions.

  • What can I expect from SCM?

    Your SCM worker (in some cases this will be your care coordinator) will work with you through three SCM phases and offer you regular planned sessions so that you can learn skills to help you manage difficulties.

  • The three phases of SCM

    In the introductory phase you and your SCM practitioner will work on:
    • Understanding your difficulties and how they have developed
    • Setting short term and long term goals
    • Agreeing treatment contracts so you know what to expect and what is asked of you
    • Developing a safety plan to help you in difficult times

    In the active intervention phase your SCM practitioner will help you to develop skills to address your problems and meet your goals by focusing on four key areas:
    • Understanding and managing emotions and moods
    • Understanding and managing relationships
    • Problem solving
    • Understanding and managing behaviours that put you at risk, including self-harm and suicidality

    In this phase, you may be offered weekly group sessions as well as weekly individual sessions, if a full programme is available in your area.

    If a full programme is available, you will be given more information about this by your SCM worker in the introductory phase.

    In the ending or next steps stage, you and your SCM practitioner will review the skills you have developed, plan how you can maintain these in the future and explore the resources you will need.

  • How long will SCM last?

    The three phases of SCM typically last between 18 to 24 months, depending on your needs and the services available in your area.

    We recommend that you attend SCM twice weekly (including one group and one individual session). However this may vary according to your needs, local resources or your stage of recovery.

    The length of time and commitment needed will be discussed with you individually as part of your goal setting and treatment contract.

  • Where does SCM take place?

    SCM is usually delivered within community mental health settings, as this is where you will learn skills and strategies for solving life problems. Recovery happens best in the community.

    If hospital admission is necessary at any point, it is recommended that this is relatively brief and with a clear goal and timescale in mind.

    Contact with your SCM worker should continue during the admission wherever possible.

  • Medication

    No medications have been found effective for the longer term treatment of personality difficulties.

    As part of SCM you will be offered psychiatric reviews to discuss the medications you are using, the function and effectiveness of these, and any potential side effects. It may be necessary to reduce or stop any unhelpful medications. The frequency of psychiatric review will depend on your needs and will be discussed with you as part of your treatment planning.

  • Useful websites

    • National Institute for Health and Care Excellence

    • The NHS website

    • Mind

    • Rethink

  • References

    • Bateman, A., & Fonagy, P. (2006). Mentalization-based treatment for borderline personality disorder: A practical guide. Oxford University Press.

    • Bateman, A. W., & Krawitz, R. (2013). Borderline personality disorder: an evidence-based guide for generalist mental health professionals. Oxford University Press.

    • Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American journal of psychiatry, 164(6), 922-928.

    • McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1365-1374.

  • Other formats, references and review

    Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

    This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

    Published by the Patient Information Centre
    2019 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
    Ref, PIC/806/0119 V1 Tel: 0191 246 7288
    Review date 2022