Sequoia is an NHS contracted service for people with mild, moderate or emerging difficulties associated with Personality Disorders inclusive of Complex Emotional Needs (CEN/PD). The service is co-delivered by AWP and Rethink. Sequoia’s core purpose is:

Empowering people with CEN/PD to have hope for better lives

In order to do that; Sequoia provide holistic support for people with CEN/PD across BNSSG. The service promotes wellness and safety and will continue to grow to meet the needs of those within our community. 

Sequoia offers evidence‑based group interventions for people with complex emotional needs (CEN) or personality difficulties (PD). All interventions are delivered in group settings, either in person or online. Research consistently shows that group‑based approaches improve outcomes for people with CEN/PD.

Groups provide:

• Opportunities to connect with others who share similar experiences

• A sense of belonging and reassurance that people are not alone

• A supportive environment to learn and practice new skills

• The ability for Sequoia to reach and support more people at once

Groups Available

Peer Support Group

• Led by Peer Support staff with lived experience of mental health difficulties

• Semi‑structured, with topics and activities chosen by the group itself

• No pressure to speak — attendance is the only expectation

• Encourages shared learning and mutual support

Education Group

• Led by Wellbeing Practitioners

• Focused on teaching and learning about topics linked to CEN/PD

• Participants are encouraged to engage with the material and reflect between sessions

• Builds understanding and practical strategies for everyday life

Dialectical Behaviour Therapy (DBT)‑Informed Group

• Based on DBT principles, covering a selection of core topics

• Designed to help people:

  • Manage emotions more effectively

  • Cope better with distress

  • Improve relationships and communication

• Includes practice tasks (“homework”) between sessions to reinforce skills

Mentalisation Based Treatment (MBT)‑Informed Group

• Based on MBT principles, covering a concepts

• Designed to support people:

  • Reflect on relationships and communication

  • Understand their own thoughts and feelings, as well as those of others

• Includes discussing scenarios in the group with an emphasis on everyone participating

Everyone who is referred to Sequoia is first invited to a Welcome Session.

• This session provides clear information about the service and what to expect.

• The person can then decide whether they wish to continue with Sequoia support.

If they choose to continue:

1. Initial 1‑to‑1 conversation – offered to help the person decide which group best meets their needs.

2. Waiting period – there may be several months wait until the next available group begins.

3. Pre‑group 1‑to‑1 – just before the group starts, the person is offered another individual session to prepare, think about their goals and feel confident about joining.

4. Group attendance – the person attends the chosen group, either in person or online.

5. Post‑group 1‑to‑1 review – after completing the group, the person is offered a review session to reflect on progress and plan next steps.

Future support:

• People are welcome to return for more support from Sequoia in the future.

• A period of consolidation is encouraged after completing an intervention, so that learning and skills can be embedded before starting something new.

Opportunities beyond groups:

• Sequoia also offers opportunities to volunteer, contribute to service design, and in some cases progress to employment within the service to support others.

Sequoia is committed to creating safe spaces where everyone feels respected. We ask professionals to encourage the person being referred to:

• Treat others with respect in groups and sessions

• Communicate with the Sequoia team if they cannot attend an appointment or if they are struggling and need extra support

• Attend the sessions they are offered, as participation is central to how Sequoia provides help

We also recognise that timing matters.

• If it isn’t the right time for the person to engage, Sequoia can be accessed again in the future.

• This ensures that support is available when the person feels ready, without pressure or judgement

“Complex emotional needs” (CEN) is a broad umbrella term describing a range of emotional and relational difficulties. Sequoia is commissioned to support people with CEN who show symptoms associated with a personality disorder (CEN/PD).

• A formal diagnosis is not required to access Sequoia.

• The person does need to show symptoms consistent with CEN/PD.

• These symptoms are often described using the “three Ps”: Persistent, Pervasive, and Problematic.

• The criteria below are adapted from ICD‑11 guidance.

The “Three Ps” Criteria

1. Longstanding / Persistent

• The person experiences enduring difficulties in how they see themselves (e.g., identity, self‑worth, accuracy of self‑view, self‑direction).

• They may also have ongoing difficulties in relationships (e.g., forming and maintaining close, mutually satisfying connections, understanding others’ perspectives, managing conflict).

• These difficulties have lasted for an extended period of time (typically 2 years or more).

2. Affecting many areas of life / Pervasive

• The difficulties appear across a wide range of personal and social situations.

• They are not limited to one specific relationship or role, though they may be more noticeable in certain circumstances.

3. Causing difficulty for the person or others / Problematic

• The difficulties show up in patterns of thinking, feeling, expressing emotions, and behaviour that are maladaptive (e.g., inflexible or poorly regulated).

• They are linked to substantial distress or significant impairment in important areas of life, such as family, social relationships, education, work, or other daily functioning.

Once it has been established that someone has complex emotional needs/personality difficulties (CEN/PD), the next step is to consider the severity of their difficulties. This is an individual judgement, but as a referrer you should reflect on:

• Impact on life overall – how much of the person’s life is affected

• Day‑to‑day functioning – how their difficulties affect daily activities and responsibilities

• Relationships – how their connections with family, friends, or colleagues are impacted

• Coping strategies – whether the ways they cope are harmful to themselves or others

Tools to Support Assessment

• The SASPD (Standardised Assessment of Severity of Personality Disorder) is a brief questionnaire that can help guide this decision.

• As with all dilemmas, if you would like to discuss the situation please get in touch with the team.

Eating difficulties

If the person has eating difficulties or an eating disorder, this should be carefully discussed between the referrer and Sequoia staff.

• If the eating difficulties are causing significant weight change, affecting cognition, or having other concerning effects, Sequoia will usually recommend that the person receives specific support for these difficulties.

• This support may be offered alongside Sequoia or before starting Sequoia, depending on the person’s needs.

Drug and alcohol use

If the person’s drug or alcohol use is:

• Newly emerging,

• Has significantly changed, or

• Is at a level that prevents them from benefiting from Sequoia interventions,

then Sequoia will likely recommend that the person accesses specialist support for substance use, either alongside or before engaging with Sequoia.

Psychosis or other serious mental illness (SMI)

If the person is experiencing what is often referred to as a serious mental illness (SMI) — including but not limited to psychosis, bipolar disorder, clinical depression, or obsessive‑compulsive disorder — please consider the following:

• If the presentation is new or has recently changed: Sequoia will recommend that the person has an assessment from a relevant service before Sequoia offers support.

• If the diagnosis is historical and stable: If the person has a stable history of SMI and also shows symptoms of CEN/PD, Sequoia may be able to support them. In these cases, please discuss with the Sequoia team to ensure the right pathway is chosen.

This is a common question, and the answer depends on the type of support. Below we break it down into typical situations:

Therapy

• Sequoia asks that people take part in one intervention at a time.

• If someone chooses a group intervention with Sequoia and also wants therapy, we ask that therapy is paused while they attend the Sequoia group.

• However, because there is often a wait between referral and starting a group, people who want therapy can usually coordinate it around the group start date.

• If someone is already in therapy, we encourage them to reflect on why they are seeking something additional. Helpful questions include:

  • Is the current therapy effective?

  • Has there been a rupture in the relationship with the therapist?

• We recommend that the person discusses these questions directly with their therapist before deciding what else they might need.

Drug and alcohol support

• Sequoia often works with people who also need support around drug or alcohol use.

• We encourage people to seek out this support.

• Sequoia is open to people receiving drug and alcohol support alongside Sequoia interventions, if this feels most helpful.

• In these cases, the approach will be discussed with the person during their support conversation, so that care is coordinated.

Other types of support 

• Examples include:

  • Social care support around parenting

  • Community groups or “talk clubs”

  • Telephone helplines

  • Support around relationships

• Each situation is individual. Sequoia will work with the person to decide what feels most helpful.

• These discussions also take place during the support conversation, ensuring the person’s preferences and needs are central.

As mentioned above, complex emotional needs (CEN) is a broad umbrella term that covers many different difficulties and symptoms. Within Sequoia, we focus on the core symptoms of personality disorder (PD).

Many people we support also live with additional diagnoses or difficulties. These do not prevent access to Sequoia, as long as the person also has symptoms associated with a personality disorder. Below are the main examples, with notes for referrers:

Complex Post‑Traumatic Stress Disorder (CPTSD)

• CPTSD and personality disorder share many overlapping features, with some subtle differences.

• Sequoia can support people with CPTSD who also have difficulties linked to personality disorder.

• Please note: Sequoia’s interventions are focused on CEN/PD.

• Sequoia does not provide trauma‑processing interventions.

Autism / Autism Spectrum Condition (ASC)

• There is significant overlap in symptoms between ASC and CEN/PD, though the underlying reasons are thought to be different.

• Sequoia can support people who have both ASC and CEN/PD.

Attention Deficit Hyperactivity Disorder (ADHD)

• ADHD and CEN/PD also share overlapping symptoms, again with different underlying causes.

• Sequoia can support people who have both ADHD and CEN/PD.

Overall approach

At Sequoia, our focus is always on whether our interventions will be helpful for the person.

• If you are unsure whether Sequoia is the right fit, please contact the team to discuss.

• We will work with you to ensure the person is directed to the most appropriate support.

Mental health services have often struggled to engage with every part of our communities. There is now a growing understanding that people from different cultures, backgrounds, ethnicities, and communities may present with a different set of symptoms or difficulties than those that services have traditionally supported.

At Sequoia, we are committed to increasing access to support for people with complex emotional needs/personality difficulties (CEN/PD) across all communities.

We encourage professionals making referrals to:

• Hold these cultural and community differences in mind

• Act positively and refer someone even if they do not fit neatly into the criteria described above

• Recognise that inclusion and equity are central to Sequoia’s approach

As with any dilemmas, if you are unsure whether Sequoia is the right fit, please get in touch with the team. We are always happy to have a conversation and ensure the person is directed to the most appropriate support.

Safety and Risk

Predicting someone’s safety – whether they are at risk to themselves, to others, or from others – is complex. When Sequoia considers a referral, the key question is: Is the person, and those around them, safe within their current level of support?

This is assessed individually. Each person’s situation is different:

• Some people maintain their own safety most of the time
• Others need regular support from their community or other services

Sequoia staff review the information provided in the referral form to understand this. Our aim is to decide whether the person has enough safety in place to benefit from Sequoia’s support.

What Sequoia Offers

Sequoia provides brief, low-intensity, group-based interventions. These usually involve:

• A weekly group session for between six week to three months
• Skills and strategies to help people make positive changes, including improving safety

However:

• These groups are not designed as stabilisation or risk-reduction interventions
• Sequoia does not offer regular one-to-one support or care coordination
• We cannot respond to urgent or dynamic safety concerns

Understanding Safety and Risk

The table below explains different areas of safety and risk, and when Sequoia is likely to support someone, when we need to consider carefully, and when we cannot offer support.

Safety can change over time. If we decide that now is not the right time, this is only about the current situation. A future referral is always welcome and encouraged.

Area of Safety / Risk

Safeguarding concerns

If the person is vulnerable or presents a safeguarding risk, please include full details in the referral form. Where possible, include names of others involved. This helps us avoid situations where both a perpetrator and a victim are placed in the same group.

Eligibility for Sequoia Support

Once it is established that a person has Complex Emotional Needs (CEN) or a Personality Disorder (PD) and can maintain their own safety and the safety of others within their current support network, they may be eligible for support from Sequoia.

The next step is to consider any barriers that might make it harder for the person to access or benefit from Sequoia’s support. These barriers vary from person to person and can change over time. This section outlines common barriers and what referrers should consider.

Sequoia will always aim to work with the person to overcome these barriers wherever possible. In some cases, Sequoia may recommend additional support either before starting Sequoia interventions or alongside them.

Drug and Alcohol Use

• If drug or alcohol use does not significantly affect the person’s ability to benefit from Sequoia interventions, Sequoia can be offered as the main support.
• If drug or alcohol use is new, has changed significantly, or is at a level that prevents meaningful engagement, Sequoia will usually recommend the person accesses specialist support for this—either before starting Sequoia or alongside it.

Unstable Housing

• If housing is unstable (for example, the person is about to move, facing eviction, or currently homeless), Sequoia can still offer support if it is considered the right time.
• Referrers should work with the person to decide whether engaging with Sequoia now would be helpful or whether it might add extra pressure.
• If it is not the right time, Sequoia will reassure the person that they are welcome to return in the future.

Education, Employment, or Financial Difficulties

• If these issues are causing significant stress, referrers should consider whether the person needs additional support first or alongside Sequoia.
• Timing is important—sometimes addressing these challenges before starting Sequoia can make engagement more effective.

Access and Practical Barriers

Travel, Technology, Disability, or Neurodiversity

• Sequoia delivers sessions in community venues chosen for good public transport links, parking, and accessibility.
• Online sessions are available via Microsoft Teams video calls.
• Sessions can be adapted for people with disabilities or neurodiverse needs.
• If the person may struggle to attend sessions or needs information in an alternative format, please contact Sequoia. We will work with the person to make reasonable adjustments.

Once Sequoia receives a referral, one of our practitioners will review the information provided on the referral form and check relevant details on electronic record systems. There are three possible outcomes:

1. If Sequoia is the Right Service

• Our admin team will contact the person.
• The standard approach is to send an email, unless the referral form specifies a different method.
• After receiving the email, it is the person’s responsibility to get in touch with the team.
• The person will then be invited to attend a Welcome Session (more information is available on this page).
• If we do not hear back, we will assume it is not the right time for support. In this case, we will step down the referral, usually with an offer for the person to re-access the service via self-referral within a set timeframe.

2. If We Are Unsure Whether Sequoia Is the Right Service

• We may request additional information from the referrer.
• This will usually involve a discussion with one of the Sequoia team members.

3. If Sequoia Is Not the Best Service at This Time

• We will write back to the referrer explaining our decision.
• We will ask the referrer to inform the person about this outcome and if appropriate think about other sources of support for them. 

For more information, the person can visit the Sequoia website: www.awpsequoia.nhs.uk