Complex emotional and relational needs pathway

We have developed a number of evidence-based psychological treatments for people with complex emotional and relational needs (CERN).

Previously if you had these needs you may have been diagnosed with 'personality disorder', but you don't need a diagnosis to make use of these services.

The pathway is here if you have significant difficulties in emotional regulation and interpersonal relationships, and you are open to secondary care services.

Some of these psychological services have a team or base in each of Pennine Care's five boroughs, while some have one team covering them all.

Please see each service webpage for details on how to be referred.

This service covers the whole of Pennine Care. 

You can be referred to the dialectical behaviour therapy service by the community mental health, secondary care psychology therapy and structured clinical management teams in your borough.

We provide an evidence-based intervention and treatment to help if you are experiencing recurrent suicide and self-harm attempts, high impulsivity, and unstable and intense interpersonal relationships, to the extent that your life or those around you are at risk of harm. 

We can also offer consultation and supervision if you are a health professional working with someone with these behaviours.

This service is currently in development and will cover the whole of Pennine Care. It is not yet open to referrals.

Mentalizing is something we do imaginatively with our minds to work out what we or others are feeling, thinking, or believing, and how this affects our behaviour. We can mentalize about ourselves, others and our relationships.

Mentalizing is important because it helps us make sense of ourselves and other people, it helps us cope with painful feelings and thoughts, it reduces the risk of doing things impulsively which might be harmful, and it helps us to have more fulfilling relationships.

Mentalization-based therapy may be a helpful treatment if you want to better understand your own and other peoples’ minds and what causes you to act and feel as you do. It can help you to develop and maintain more satisfying relationships, and find new ways of understanding and coping with your emotions so you feel more resilient.

Mentalization-based therapy treatment involves:

  • Introductory group - An 8–10 week group focused on developing an understanding of what mentalizing is, why mentalizing matters, and problems associated with poor mentalizing. The group can also help assess whether the full therapy programme is suitable.
  • Individual review – After you attend the introductory group, you will be offered an individual review to consider if full mentalization-based treatment is the most appropriate therapy. If you and your therapist are in agreement, this will be offered.
  • Mentalization-based treatment – This involves attending weekly individual and group therapy sessions for 12 months. The therapy aims to establish secure relationships, where you can bring your mentalizing experiences and difficulties to explore in the group, in order to develop your mentalizing abilities through practice with others.
  • Follow up - to support ongoing mentalizing and promote resilience and recovery.


This service covers the whole of Pennine Care.

The democratic therapeutic community is a one-day-a-week group therapy approach. We offer a structured environment where you will come together with other people with a range of complex psychological conditions, to interact and take part in therapy.

It is designed to help if you have long-standing emotional problems and a history of self-harming, by teaching you skills needed to interact socially with others. As part of this you will develop an understanding of yourself. 

As well as taking part in group therapy, you would be expected to do other activities designed to improve your skills and self-confidence through peer interactions, communal experiences and shared group responsibility. This encourages a sense of belonging, personal empowerment and self-agency.

Visit our democratic therapeutic community webpage for more information.

Structured clinical management is an evidence-based intervention which may be helpful if you have difficulties with: ​​​​​​

  • Making and keeping healthy relationships
  • Managing emotions and mood
  • Impulsivity (managing urges to act quickly)
  • Self-harm and suicidal thoughts

We offer one to one sessions to get to know you and understand your difficulties, called an assessment.

Our team will work with you and help identify the most useful treatment option for you. If you continue with the structured clinical management full program, this consists of weekly group and one to one sessions, teaching you skills in:

  • Problem solving
  • Understanding and managing emotions and mood
  • Understanding and managing behaviours that put you at risk
  • Understanding and managing relationships.

Each borough has it’s own structured clinical management team. Visit our structured clinical management webpage for more information.

Each borough has a secondary care psychology service.

These services offer individual assessment and treatment options, such as cognitive behavioural therapy, eye movement desensitization therapy, clinical psychology, and cognitive analytical therapy.

Click on your borough to read more and see what support is available:

We are also working on developing services specially for people with complex emotional and relational needs in older person's psychological services. These are still in the early stages of development.