Structured Clinical Management

Structured Clinical Management (SCM), is a generalist treatment for people who have personality and relational difficulties. This may include problems with managing emotions, moods, triggers of distress, urge to deal with feelings and thoughts quickly and interpersonal situations that make you feel vulnerable or sensitive, such as feeling rejected being alone.

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

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

SCM has been found to be as effective as other specialist treatments such as Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Treatment (MBT) in helping people address their personality and relational difficulties that are long lasting. Emotion and mood regulation, managing urges and interpersonal problems and quality of life all improve with SCM treatment, and are usually maintained over time. So, the outcomes aimed for are hopeful and good!

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.

The benefits of engaging and working in SCM treatment programme 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 in a collaborative way with their practitioner. This can be challenging, but you will have the opportunity to discuss any concerns you may have with your SCM practitioner. If you choose not to engage and work an SCM programme, other options will be discussed with you.

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

Your SCM practitioner (who may currently also be your care coordinator) will work with you through three SCM phases and offer you regular planned sessions so that you can learn skills in problem solving, managing emotions and urges to help you manage difficulties more effectively.

Phase 1 – Introduction
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 and what role your practioner and their team plays in your care plan
• Developing a safety plan to help you in difficult times when you feel there is a crisis or ugent situation developing

Phase 2 – Intervention
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 three key areas:
• Understanding and managing emotions and moods
• Understanding and managing relationships
• Understanding and managing urges and behaviours that may be unsafe, including self-harm and suicidality

In this phase, you may be offered weekly group sessions as well as weekly( or less frequently as discussed with your practitioner) 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 practitioner in the introductory phase.

Phase 3 – Moving on
In the moving on phase you and your SCM practitioner will review the skills you have developed, plan how you can maintain these in the future and explore any further resources you will need to maintain the changes. You may also consider exploring further therapy, gaining voluntary or paid work experience, returning to study, or developing links with different support groups in the community. Your practitioner will usually offer you some follow-up sessions to see how your are progressing within a period of around 6 months.

The three phases of SCM typically last between 12-18 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) if at all possible, as most people do best with a combined treatment of group plus individual sessions. However this may be changed to match 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.

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 rather than in hospital or a residential unit.

If hospital admission is necessary at any point, it is recommended that this is usually quite brief (from a few days to a couple of weeks), although at times may be longer if needed, and with a clear goal and timescales in mind.

Contact with your SCM practitioner will continue during the admission as far as possible.

No medications have been found effective for the longer term treatment of personality difficulties. If you have been prescribed medication in the past or currently, it is best if this is reviewed with you on a regular basis by your psychiatrist or pharmacist.

As part of SCM you will be offered psychiatric reviews to discuss the medications you are using, the function purpose 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.

We hope you have found this leaflet helpful in getting to know some basic information about what is involved when you consider an SCM approach to care and treatment. Please discuss the leaflet and any question you may have with your SCM practitioner. We wish you well in your SCM journey!

• National Institute for Health and Care Excellence
www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/personality-disorders

• The NHS website
www.nhs.uk/conditions/personality-disorder

• Mind
www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/

• Rethink
www.rethink.org/diagnosis-treatment/conditions/personality-disorders

• 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.

• Mitchell, S., Sampson, M. & Bateman, A. (2021). Structured Clinical Managment (SCM) for Personality Disorder: An Implementation Guide. Oxford: Oxford University Press

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.

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Published by the Patient Information Centre
2022 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Ref, PIC/806/0122 V2
www.cntw.nhs.uk Tel: 0191 246 7288
Review date 2025