5 Boroughs Partnership NHS Foundation Trust, in the Northwest of England, has trained over 500 staff in the Knowledge and Understanding Framework, level 1 personality disorder awareness training. This is a 3-day nationally devised training programme delivered via an innovative co-production model (i.e. co-delivery and partnership working with service users who have lived experience). This paper provides quantitative and qualitative information on the effectiveness of training delivery and also serves to provide some insight into the impact of service-user involvement via such a co-production model. Information on 162 participants using the Knowledge and Understanding Framework bespoke questionnaire (Personality Disorder Knowledge, Attitudes and Skills Questionnaire) suggests that the training can be effectively delivered by and within a local NHS Mental Health Trust. Results immediately post-training suggest an improvement in levels of understanding and capability efficacy and a reduction in negative emotional reactions. Indications from a 3-month follow-up suggest that while understanding and emotional reaction remain improved, capability efficacy regresses back to pre-training levels, suggesting the need for ongoing supervision and/or support to consolidate skills. Discussion includes guidelines for the implementation of a truly integrated co-production model of training provision, as well as advice relating to the maximization of long-term benefits.

Findings Multidisciplinary teams working with people with borderline personality disorder should use team formulations to create a shared understanding of individual patient's needs and goals for recovery, so they can deliver a consistent approach to care. Recovery questionnaires should be used to develop an understanding of a patient's individual recovery goals. Limitations Opportunity sampling was utilized in recruitment, and the sample was not representative of the general population of staff working with borderline personality disorder. Although views from a wide range of professions were sampled in this research, the views of psychiatrists were not represented.

Theory and existing research suggest that emotion regulation capabilities develop during the formative years. Emotion dysregulation is associated with psychological distress and may contribute towards difficulties such as personality disorder and self-harm. This study aimed to explore the contexts in which individuals' narratives of emotional experience and self-harm developed. Eight participants who cut themselves and were seen by a personality disorder service were recruited. Semi-structured interviews were carried out, and interview transcripts were analysed using a narrative approach. Five temporal themes were generated: 'Seen and not heard', 'A big release … to get rid of all the pain and hurt', 'A vicious circle', 'A different world' and 'Trying to turn my life around'. The findings highlight how early experiences may have led participants to perceive emotions as unacceptable and subsequently suppress emotion in adulthood. Suppression of emotions appeared to be related to appraisals of emotions and to secondary emotional distress. Furthermore, cutting was linked to suppression of emotions as well as negative self-beliefs formed during childhood and reinforced through subsequent experiences. The study emphasizes the need for therapeutic approaches to focus on emotions when working with individuals who self-cut. Furthermore, the findings indicate the need for compassionate and validating health services that may help service users develop more optimistic future narratives.

When working with individuals who self-harm it may be beneficial for practitioners to consider clients' experiences of positive emotions, and how to cultivate these, in addition to targeting the negative emotions which tend to underpin self-harming behaviours.

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