DBT in the UK (Part 1)

March 15, 2023

This feature by Michaela Swales, PhD and Christine Dunkley, DClinP is Part 1 of 2 in a series about DBT in the UK. In this first part, Michaela and Christine share the journey so far. DBT is a worldwide community, and we are excited to shine a light on how DBT has developed in different regions and countries.

Last year the British Isles DBT training team (biDBT) celebrated 25 years of delivering training to mental health professionals in the UK and beyond. The only UK providers affiliated with Behavioral Tech Institute, the team has grown from Michaela Swales and Heidi Heard booking their own venues and stapling binders to an office of 10 staff and 14 trainers.

DBT in the UK is mostly delivered by mental health professionals under our National Health Service (NHS), and from the start biDBT held the standard that training would only be provided to teams. The early trainings were just two Intensive Trainings a year in spring and autumn as well as some two-day skills workshops.

Despite being a fledgling service, the training team held the highest standard. To do an intensive, the delegates had to provide no fewer than four people who could meet together weekly with a clinical psychologist on the team. Skills workshops were more open access, and the reputation of the trainings grew.

Being a DBT trainer in the early 2000s meant being on the road a lot. In comparison with the USA, we may have a small geographical area, but we are densely populated. Demand was springing up in each of the nations in the UK: England, Northern Ireland, Scotland and Wales. The Republic of Ireland invited us to train the teams for their national implementation of DBT as a means of reducing suicide, with excellent results (Flynn et al, 2020).

A DBT patient in the UK will most likely receive their care from one of 5 places:

  1. Through the NHS, paid for out of taxation and free to the patient at the point of delivery.
  2. In a private hospital. Although these are profit-making entities, many will have beds commissioned by the NHS and paid for out of government funding. This makes sense if the local NHS hospitals are approaching capacity, as it is cheaper than building new hospitals to meet demand.
  3. The charitable or voluntary sector. These are not-for profit organisations that plough the money received back into patient care.
  4. Prison and forensic services. These may be private or government-funded.
  5. Educational establishments. Universities, like Bangor in North Wales, provide some aspects of DBT, and skills training groups are being seeded in some schools or colleges.

The UK government has long had a campaign against what they call a “post-code lottery.” This refers to the fragmented availability of DBT (and other treatments) across the UK. To even up accessibility, the government announced a project in 2020 to fund DBT training across the land. NHS mental health practitioners could sign up for a two-year postgraduate diploma free of charge, providing they could convene or join a consultation team. biDBT, in partnership with Bangor University, was delighted to be awarded the contract, due in no small part to our tremendous reputation for training quality.

The post-graduate diploma in DBT is open to professionals with a core professional training in mental health, such as psychologists, nurses, occupational therapists, social workers, and psychiatrists. Over the course of the two-year programme, students complete the following modules: Theories and Principles of DBT (which covers material akin to Part I of the Intensive Training), Clinical Applications of DBT (which covers material similar to a Part II of the Intensive), Advanced Clinical Skills in DBT, Mindfulness in DBT, Principles of Learning and Behaviour Change.  In addition, all students must be delivering DBT for up to three days per week. As part of their Advanced module, they all receive 20 hours of specialist supervision, as they must submit a clinical session that meets the standard of an adherent session to pass the programme. On successful completion of the programme, all graduates are eligible to become an accredited – the UK equivalent of certified – DBT therapist. To meet the demand of this new programme (over 100 professionals graduated this year for the first time from the programme), we have heavily invested in supervision infrastructure, developing and providing a five-day specialist supervision programme for all supervisors (who must be accredited DBT therapists) who all also participate in bimonthly supervision mentorship group meetings. Each year, we admit over 100 potential therapists to the programme, so we have over 200 therapists in training at any one time.  This is all in addition to our open-enrolment trainings!

Read here for part two of this blog, in which Michaela and Christine discuss the continued journey of DBT in the UK into recent years.

Michaela Swales, PhD, is a Consultant Clinical Psychologist and Professor in Clinical Psychology on the North Wales Clinical Psychology Programme, Bangor University. Professor Swales is the Director of the British Isles Training Team, an International Affiliate of the Linehan Institute. She has trained more than a thousand professionals in DBT, seeding over 400 programmes, in both the UK and further afield. Read her full bio here.

Christine Dunkley, DClinP has a doctorate in Clinical Practice from the school of health sciences at the University of Southampton, and a certificate of qualification in Social work. She practiced as a medical social worker prior to working in psychological therapies, and is a senior accredited practitioner with BACP. She is a Vice President of the Society for DBT. Read her full bio here.


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