In 2017 Michelle and Carol trained more than 500 staff from NHS Highland. Each service and department from the whole of NHS Highland were represented. The aim was to implement The Decider Skills throughout all services and departments across the whole organisation. In order for NHS Highland to become self-sufficient in maintaining The Decider Skills training, Michelle and Carol trained identified skilled and experienced clinicians to become Authorised Trainers.


The Decider has become embedded across NHS Highland as the default common language for communicating about difficulties in emotion regulation and self-management, and as the default psychosocial skill set used to support the management of such difficulties.

The Decider is used wherever possible to add value to patient care. Applications involve the Decider as a “stand-alone” intervention and integrated into broader treatment packages, in both individual and group settings. In addition the Decider package is used to inform care and recovery planning, clinical communication and clinical documentation.

The process of supporting these aims included:

  • Offering further training to the entire current and future workforce, including local provision of training for trainers to support sustainability
  • The Decider Skills are delivered by Authorised Trainers from a wide range of backgrounds, who work across teams and services where necessary
  • Using The Decider to enhance the well-being of staff
  • Set up effective ways of sharing information, including sharing of learning and experience, and updates on progress across Highland
  • Provide ongoing supervision, coaching, consultation and education as necessary, including guidance in the establishment of groups
  • Develop effective processes to measure the benefits of The Decider, including improvements in patient outcomes, better joined-up working, and enhancement of staff skills, morale and well-being
  • Work towards provision of the Decider as a population intervention
  • Overcome obstacles to the realisation of the vision

The Decider Skills have proved to be an effective and adaptable model, able to be upscaled across a large geographical area and organisation.

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