I am writing this update as an 18-year-old patient diagnosed with Emotionally Unstable Personality Disorder (EUPD) after another deeply disappointing meeting with the Deccrau Newydd DBT Team to discuss the reasons behind the neglient letter sent to me last week with a decision to deny me the essential treatment I need. Unfortunately, this meeting was a complete failure and did not give me any further clarity. 

❌️ Professional conduct expected as per HCPC regulations neglected 

❌️ NICE guidelines dismissed 

❌️ Royal College of Psychiatrists guidelines dismissed 

❌️ EUPD diagnosis backed up by several psychiatrists dismissed 

❌️ Sixth months worth of psychiatric assessment and two psychologist reports dismissed

❌️ 800+ pages worth of medical records since Feburary dismissed 

❌️ DBT recommendations by multiple psychiatrists dismissed 

❌️ My opinions on my care needs and preference for DBT treatment dismissed 

❌️ My concerns surronding bias and age discrimination by the service in breach of the Equalities act 2010 dismissed 

❌️ Risks associated with failure to provide treatment including further suicide attempts and pronlonged hospitalised dismissed 

❌️ My distress and suicide attempts caused directly by their own decisions to deny DBT, anxieties around getting 'help', and their poor conduct dismissed

❌️ Own healthboard policy for access to DBT as per recent prevention of Future deaths reports dismissed 

Despite multiple clear professional diagnoses and the urgent need for Dialectical Behaviour Therapy (DBT), I am still being denied appropriate treatment. The ongoing failures I face are not only personally devastating but also demonstrate serious breaches of national clinical guidelines and the policies of Swansea Bay University Health Board (SBUHB).

Personal Impact and Denial of Evidence-Based Treatment

At 18 years old, legally an adult, I fully meet the diagnostic criteria for EUPD. Yet, my age continues to be used as an excuse to withhold or delay treatment, contrary to every established guideline and policy. The latest excuse I have been told is that I need “more assessment” despite multiple thorough psychiatric evaluations recommending DBT. I was shocked when the psychologist who had offered further assessment later refused it, stating it was because "I complained” — a clear retaliation and breach of NHS and Health Board complaints policies. She also could not give me any rationale behind this reason cited.

Despite being formally diagnosed, I am being directed to the inadquete Local Primary Mental Health Support Service (LPMHSS) for a “short-term intervention” that does not provide any DBT, the only evidence-based treatment recommended by NICE for EUPD. I have also been offered a diluted course that contradicts the NICE mandate for at least 12 months of structured, comprehensive DBT including individual therapy, group skills sessions, and telephone coaching.

This inadequate “treatment” blatantly fails to meet the NICE Guideline CG78 standards:

“Do not offer brief psychological interventions to people with borderline personality disorder.”

“Do not offer generic counselling or unstructured therapy that does not specifically address borderline personality disorder.”

I am formally diagnosed with EUPD - a diagnosis agreed with by multiple qualified professionals across settings, including psychiatrists Dr. Pr, Dr. Ro, Dr. Si, Dr. Me, Dr. Sh, Dr. Co, and Dr. Ma (initials used in this instance as no need to name) A private psychologist and neuroscientist have all also supported my diagnosis. All agree I meet SCID-II criteria for EUPD/BPD. I’ve had clear recommendations for long term DBT with Dr Provan stating I need at least 1 year worth of treatment and Dr Robertson stating a year and a half worth is needed.

I have undergone extensive psychological formulation, including a detailed written formulation report during my inpatient admission on Ward F and an independent private psychologist’s report. Dr. Shree’s assessment under the latest ICD-11 criteria confirmed a personality disorder diagnosis with significant impairment in negative affectivity and disinhibition.

Yet I remain denied access.

Shocking Age Discrimination and Bias

I was also told dismissive things such as “it’s just hormones” or my "brain development" indicating I cannot have my diagnosis taken seriously at this age. The clinician psychologist explicitly stated herself that she “wouldn’t diagnose at such a young age,” which strongly indicates age-based bias. This is not only insulting but unlawful discrimination based on age, violating key guidelines:

NICE Guideline CG78 states:

“Age alone should not be a barrier to the diagnosis or treatment of borderline personality disorder.”

“A diagnosis of borderline personality disorder should be considered for young people aged 18 or over if they meet the criteria.”

“Care should not be withheld or delayed because of assumptions about the individual’s age, appearance, or diagnosis.”

Royal College of Psychiatrists’ Position Statement PS04/2010 mandates:

“Services must be accessible and appropriate for people of all age groups, including young adults, and should not exclude people based on age.”

“People with personality disorders should not be denied access to treatment because of stigma, their age, or because they are deemed difficult to treat.”

Under the Equality Act 2010, such refusal based on age and perceived “difficulty” constitutes unlawful discrimination.

This age bias not only breaches legal protections but puts me at greater risk of worsening symptoms, repeated hospitalisation, and suicide attempts. I have already missed crucial life events including my prom, family holidays, and social milestones — my future career and wellbeing are at stake.

Swansea Bay University Health Board’s Response to the Prevention of Future Deaths (PFD) Report for Amy Padley

Following the tragic death of Amy Padley, the Coroner issued a Prevention of Future Deaths report calling for urgent improvements in care for patients with EUPD. Swansea Bay University Health Board’s own formal response to this PFD report (https://www.judiciary.uk/wp-content/uploads/2025/02/2025-0105-Response-from-SWANSEA-BAY-UNIVERSITY-HEALTH-BOARD-.pdf) explicitly states that patients diagnosed with EUPD and eligible for secondary mental health care should receive full DBT from the SBUHB community personality disorder service (Dechrau Newydd), including:

• Weekly 1:1 DBT therapy
• Weekly 2.5-hour group skills sessions
• Weekday telephone coaching to support crises

This is Swansea Bay University Health Board’s own policy commitment outlining how they will act to prevent future deaths.

Yet, despite this clear mandate, it being suggested I attend the inadquete LPMHSS service, which the Health Board itself confirms:

“The LPMHSS does not currently offer specific treatment approaches for EUPD, such as DBT as outlined by NICE guidance.”

This means I am being denied the specialist treatment I require, in direct contradiction to both the Health Board’s stated prevention policy and the evidence-based standards.

Disturbing Comments and Lack of Empathy

When I raised these concerns and cited Amy Padley’s case, the DBT team responded with:

“They would have said the same to her as they have to me.”

This comment was shocking, dismissive, and deeply insensitive. It implies that the same substandard care and excuses given to me would’ve been given to a patient who later died, normalising failures that can lead to death.

They followed with:

“Not you tho, different person.”

While I understand individuals differ, this response dangerously dismisses systemic issues highlighted by the PFD report and ignores the real risk that other patients—including me—may be similarly harmed by denial of care.

Breaches of NICE and Other National Standards

NICE Guideline CG78 (Borderline Personality Disorder: Recognition and Management, 2009, updated 2015) is explicit in recommending DBT as a first-line treatment for EUPD, with minimum treatment of 12 months including weekly individual therapy, group skills training, and telephone coaching:

“Consider offering dialectical behaviour therapy (DBT) to those with borderline personality disorder who self‑harm frequently.” — CG78 1.3.1.3

“Structured psychological interventions include dialectical behaviour therapy (DBT). These should be delivered over an extended period (usually at least 12 months) by trained therapists.” — CG78 1.3.1.5

“When providing psychological treatment for borderline personality disorder, consider twice-weekly sessions and a duration of more than 12 months.” — CG78 1.3.1.4

NICE Quality Standard QS88 supports this, stating:

“Full DBT is recommended to last 12 months or more.”

The NICE Quality Standard QS34 (2013) further emphasises the importance of timely, structured psychological interventions for EUPD, and clearly states treatment should not be delayed due to age or subjective judgments.

The Royal College of Psychiatrists’ Position Statement PS04/2010 mandates:

“Effective treatments for people with personality disorder are available and should be offered, including evidence-based psychological therapies such as DBT and mentalisation-based therapy (MBT).”

 “Services should provide access to these therapies through specialist teams with appropriate training and expertise.”

Legal and Ethical Violations

These failures and dismissive attitudes breach multiple guidelines and legal protections including:

• NICE Guideline CG78: requires evidence-based treatment without age discrimination.
• Royal College of Psychiatrists PS04/2010: mandates accessible, appropriate care for all ages.
• NHS Constitution & Mental Health Act Code of Practice (2015): guarantee right to timely, effective treatment without discrimination or retaliation for complaints.
• All Wales Mental Health Measure (2010) supports access to secondary mental health services and specialist personality disorder services.
• Equality Act 2010: prohibits discrimination on age or disability grounds.
• SBUHB Complaints Policy: protects patients from punitive responses when raising concerns.

The Human Cost — My Life on Hold

It is deeply concerning that my age is being used against me as a reason to delay treatment. Why should I be forced to suffer for years before receiving the care I need? Denying me early access to appropriate interventions significantly increases the risk of further suicide attempts, greater emotional distress, worsening of my condition, and repeated hospitalisations. This preventable harm continues unchecked.

The lack of timely, effective care is the reason I remain held in hospital at present, with my future—including my ambitions for a pharmacy career—on indefinite hold. I have already missed important milestones: my prom, lads' holidays, my final year of sixth form, much of my eighteenth year with its ‘adult’ milestones, family holidays, and countless opportunities with friends and loved ones. Moreover, due to the absence of treatment and my difficulties managing emotions, I have lost valuable relationships that I wished to preserve, compounding my trauma. 

NICE guidelines explicitly state the importance of early intervention to mitigate risks and improve outcomes: “Consider early intervention to reduce the risk of further deterioration and improve long-term outcomes for people with borderline personality disorder.” (NICE CG78, 1.3.1.2). They further emphasise that “Early intervention in borderline personality disorder is important to reduce long-term morbidity, risk, and poor social and occupational functioning.” (NICE CG78, section 1.3.1.2). This guidance underscores the urgent need for me to receive DBT now—not after unnecessary delay or not at all.

The denial of care is not just clinical negligence—it is deeply harmful, discriminatory, and unacceptable.

Concerns About Resource-Based Denial of Treatment

During a previous assessment, I raised concern about comments made by the psychologist suggesting the decision to deny me DBT was based on resource constraints rather than my individual clinical need. These included references to a “six-month waiting list,” “ten people ahead of you,” and the statement “we don’t like to take people on for DBT” These remarks strongly imply a blanket approach or quota system rather than a personalised, clinical needs-based decision. It should be noted I've been waiting six months to get a referral sorted and handled due to severe failures in basic communication yet alone getting treatment.

When I questioned this again during the recent meeting, no clear explanation or justification was given.

If this is the case, as has been implied, NICE CG78, section 1.3.4.5 has been breached, which states:

“Do not use exclusion from treatment as a way of... reducing demand on services.”

Repeated Assessments Used as an Excuse — Against NICE Guidelines

Despite multiple formal diagnoses agreed by several psychiatrists and detailed psychologist reports—including one during inpatient admission on Ward F and an independent private psychologist’s report—the excuse that I need “more assessment” is being cited for denial. This also dismisses the fact I've been under ongoing psychiatric asessement since February and the fact that the service has around 800+ pages worth of records regarding my symptoms and difficulties (* based on MH1 - MH8 record files)

This is a clear misuse of clinical process and resources, delaying and denying urgent care without valid justification.

NICE Guideline CG78 states:

“Healthcare professionals should aim to maintain continuity of care and minimise repeated assessments by ensuring clear information is passed between services.”

“Do not use repeated assessments as a substitute for offering treatment. Ensure continuity of care and timely access to structured psychological interventions.”

This excuse citing further assessment is a delaying tactic that breaches clinical guidelines and puts me at increased risk.

The Medical Reality of My Diagnosis

I was also dismissively told that “EUPD is just a label”. This is both medically incorrect and inherently discriminatory. EUPD (Emotionally Unstable Personality Disorder) is a recognised clinical diagnosis formally listed in both the DSM-5 and ICD-10/11. Reducing it to “just a label” significantly undermines its clinical significance, disregards years of mental health research and treatment protocols, and contributes to ongoing stigma and prejudice around personality disorders.

This kind of invalidating language fosters an environment in which service users feel dismissed, disbelieved, and dehumanised.

NICE CG78 explicitly states: “Staff should maintain a consistent and calm approach, and avoid negative or rejecting attitudes.”

The continual conflicting reasons given to deny me therapy, along with outright dismissal of my diagnosis, violate these mandates and exacerbate the trauma caused by my difficulties. Instead of helping me, the very people meant to be helping me are contributing to my distress by dismissing me and rejecting me for treatment- which is the very trigger I suffer with as part of my condition. This has already contributed to further suicide attempts and is escalating my distress.

Urgent Call for Action

This is not just about my individual experience; it reflects a wider pattern of poor consideration within the DBT service that puts patients at serious risk. The tragic death of Amy Marie Padley, as highlighted in the Coroner’s Prevention of Future Deaths report, was directly linked to the failure to provide timely and appropriate psychological intervention. Shockingly, during my recent interactions with the personality disorder service, I was told by the service manager that “they would’ve said the same thing to her as they said to me.” This statement not only callously dismisses Amy’s death but also exposes the very same harmful attitudes and neglect I have faced—being denied access to DBT despite clear clinical need, repeatedly labelled dismissively as “just a hormonal teenager,” and subjected to ongoing delays and invalidation of my diagnosis and risks. Such a comparison minimises the seriousness of Amy’s death and reflects a dangerous culture within the service, where vulnerable individuals are denied evidence-based care. Additionally, I am aware of at least one other patient who was initially accepted for DBT but later denied access—raising concerns about inconsistent application of criteria and fairness. Despite clear NICE guidelines, misconceptions and arbitrary barriers continue to limit access to vital, evidence-based care. 

Meanwhile, individuals like the service forensics psychologist have dismissed my well established diagnosis, misrepresented standards, and taken retaliatory hostile stances toward myself for advocating for treatment. 

These actions breach multiple Health and Care Professions Council standards, including respect for service users, honesty, effective communication, and risk management. If those charged with leading specialist services cannot uphold these basic essential responsibilities, how can vulnerable individuals trust that their safety and wellbeing will be protected? The DBT service’s current approach demands urgent review and reform to prevent further harm and uphold the principles of compassionate, evidence-based mental health care.

I demand:

• Immediate access to the full, evidence-based DBT program recommended by NICE and the Swansea Bay University Health Board’s own Prevention of Future Deaths policy response.
• Proper adherence to all relevant guidelines and policies without delay or age-based excuses.
• An end to the retaliatory and dismissive treatment myself and others have endured.
• A review of current DBT service eligibility processes, assessment criteria and operation, to ensure they are: aligned with NICE guidance and the Equality Act 2010, They are not applied inconsistently, subjectively, or discriminatorily.
• Patients are treated equitably, with decisions based on need — not age, stigma, or resource pressures.
• A thorough view of systemic failures highlighted by Amy Padley’s death, my case and those of others ensuring no other patient suffers similarly.

This is a matter of life and death.

Thank you for reading and to everyone for your continued support. It means so much to me and my family in what continues to be an incredibly difficult time which is unfortunately being extrabated further by the neglect of Swansea Bay Mental Health Services. I will be in touch with more updates soon.

Many thanks,

Jacob Robertson