Structured clinical management (SCM)

What is structured clinical management?

Structured Clinical Management (SCM) is a treatment that helps people with emotional challenges. It is especially useful for those diagnosed with emotionally unstable personality disorder (EUPD). This treatment is available through our Doncaster complex emotional needs pathway.

Personality means how we think, feel, and behave. Life experiences can sometimes cause problems in these areas. If these problems are very upsetting, last a long time, and affect many parts of your life, you might need help from mental health services.

Structured clinical management is as helpful as other treatments like dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). It is available to people of all backgrounds, ages, genders, and ethnicities. The materials can also be adapted for people with different learning needs. Structured clinical management focuses on solving problems, planning for crises, reviewing medications, and following up if appointments are missed.

Is structured clinical management right for me?

Structured clinical management may be right for you if you have issues with:

acting without thinking (impulsivity)
managing relationships
solving problems and coping with emotions
handling emotions and mood
managing self harm and suicidal thoughts
meeting criteria for emotionally unstable personality disorder (EUPD) diagnosis (may have other diagnoses too)
wanting a life outside mental health services

There are no major risks with SCM, but like all therapies, it involves thinking and talking about your problems, which can be tough. You can discuss any worries with your SCM worker. If you decide not to join SCM, other options will be discussed with you, but SCM is the main treatment offered by Doncaster Community Mental Health teams.

What help can I expect?

Structured clinical management has three phases:

introductory and assessment phase
intervention phase
ending phase

Introductory and assessment phase

Understand your problems and how they developed.
See how your needs affect you now.
Identify problem areas.
Set your short and long-term goals.
Advocate for you.
Develop a safety and crisis plan.
Agree on treatment contracts and care plans.
Complete outcome measures.

Intervention phase

Work on problem-solving.
Understand and manage strong emotions.
Understand others and manage relationships.
Understand and manage risky behaviours like self-harm and suicidality.
Attend group sessions for 2 hours per week and one-on-one sessions up to 1 hour per week, usually in community settings.

Ending phase

Review the skills you’ve learned.
Plan how to keep using these skills.
Explore any resources you might need.
Most people will have their care transferred back to their GP after successful treatment.

Medication

There is no specific medication for emotionally unstable personality disorder (EUPD) or personality difficulties, but you might be on medication for related issues. It is important to review these medications with a psychiatrist or GP to discuss their purpose, effectiveness, and any side effects. You might need to stop or reduce any unhelpful medications.

What is the commitment for?

You will be in the structured clinical management (SCM) program for up to 6 months, plus the induction and ending phases. You will need to complete brief questionnaires to help monitor progress.

What about hospital treatment?

The best treatments for complex emotional needs happen in the community. If hospitalisation is needed, it should be short and focused on a clear goal, like understanding the cause of current problems or stabilising a crisis with a new plan.

Questions and answers

What happens in the first session?

The first group session helps you understand how the group works. You will talk about your goals, the problems you want to work on, and the rules that keep everyone safe. You will get handouts to help you with this.

What if I don’t like it?

You might not like someone in the group or find others too talkative or critical. This is normal and happens in everyday life too. You will be encouraged to solve any problems during your one-on-one sessions. If you think the treatment isn’t helping, discuss it in your one-on-ones.
Many people feel nervous about group sessions and prefer one-on-one treatment, but studies show that group treatment works best for shared learning and support. If you need help joining the group, we have occupational therapists and support workers who can assist you.

What is good about a group?

Everyone in the group is trying their best to learn and deal with life problems in a better, healthier way. You all share similar experiences and get to practice new skills in a safe environment. Then, you can try these skills in the outside world to improve your life there too.

Do I have to tell everything about myself and my experiences in the group?

No, many people worry about this. You are not expected to talk about childhood experiences, past traumas, or anything you are uncomfortable with. We also encourage everyone to be mindful of how much they share, as it can affect others. The group focuses on skills and problem-solving, so you only need to share what you are comfortable with.

Useful websites

Page last reviewed: December 12, 2024
Next review due: December 12, 2025

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