PurposeThis study aims to describe the effectiveness of two arms of a personality disorder service: a modified mentalization based therapy (MBT) day programme and an open access service‐user network (SUN) support. Both arms utilised therapeutic community principles in service delivery.Design/methodology/approachPersonality disorder subtypes for all patients entering the modified MBT programme were diagnosed at a clinical assessment interview and corroborated through use of a standardized semi‐structured interview (SCID II). All patients were also allowed open access to a service user network community support group (SUN Project). Outcome measures were applied at baseline, mid‐therapy and end of therapy and included self‐report measures of depression, anxiety, general symptom distress, interpersonal function, social adjustment and patient satisfaction. Clinician‐rated measures of general health and functioning were also used. Data analysis used paired sample T‐tests and Wilcoxon Rank Sum tests, depending upon the assessment of parametric or nonparametric tests of trend. The open access nature of the SUN Project demanded a different data collection method. All members received a Standardized Assessment of Personality – abbreviated scale (SAPAS). Two validated empowerment questionnaires were sent to all SUN members that had achieved six months of membership: the first relating to the six‐month period before joining the SUN and the second to the six‐month period after joining the SUN Project. Paired sample T‐tests were used to compare sets of empowerment scores.FindingsPatients who completed 18 months of MBT‐tc treatment showed a statistically significant improvement on the clinician‐administered measures relating to psychological, social and occupational functioning, compared to baseline. Patients also reported statistically significant improvement in using the brief symptom inventory. All SUN members perceived significant increases in empowerment across the five score subscales. No completed suicidal acts were recorded within the period of analysis within either arm of the service.Originality/valueAn integrated therapeutic community day service appears to afford improvements in perceived empowerment and symptom severity for patients. Further data collection with a larger sample is needed to clarify whether these outcomes support the development of a wider integration of the relatively low cost SUN Project model and MBT within therapeutic communities.
Aims and methodTo assess the impact on psychiatric in-patient bed use of a new personality disorder service that uses two psychoanalytical models: mentalisation-based treatment (MBT) and the service user network (SUN). The number of psychiatric bed days used by patients attending each of the three arms of the service model (SUN, 3-day MBT, 2-day MBT) was collated using the electronic patient records system. Bed use in the 6 months and 12 months before each patient started treatment was compared with bed use in the same periods after starting treatment.ResultsOverall, statistical analysis revealed bed use to be significantly reduced by 6 months of treatment, and the reduction continued to prove significant at 12 months. Comparison between subgroups found no significant difference in bed use between patients attending the MBT programme and patients attending the SUN project at 6 months, but patients on the 3-day MBT programme exhibited a significantly greater reduction in bed use at 6 months compared with patients on the 2-day MBT programme.Clinical implicationsIntervention had a statistically significant effect overall on reducing bed use, which we suggest is linked to an improvement in patients' functioning, and is maintained at 6 months and 12 months of treatment. The lacking difference between the SUN and MBT components of the model raises questions regarding the best allocation of resources and the longer-term effects on bed use, to be answered by further study.
Purpose – Following on from an earlier published study, the purpose of this paper is to further clarify with a larger sample and over a longer timescale of two years the effect of a therapeutic-community informed personality disorder service intervention upon psychiatric in-patient bed use. The service integrates two psychoanalytical models; a mentalization-based treatment (MBT) and a service user network (SUN) model. Design/methodology/approach – The number of psychiatric bed days used by patients attending each arm of the service model (SUN and MBT) was collated using the electronic patient records system. Bed use in the six-12-18-and 24-month period before each patient started treatment was compared with bed use in the same periods after starting treatment. Findings – There appeared no significant increase after intervention in the group of patients using no psychiatric beds prior to intervention. Bed use in the second group (those using beds prior to intervention) appeared significantly reduced by six months and the reduction continued to prove significant at 12 and 18 months post-intervention. In relation to the component arms of the service, a significant reduction in bed use was seen in each of the MBT and SUN interventions at six, 12, 18 and 24 months after commencement. However, due to the small sample sizes, these results lacked sufficient power to afford a meaningful comment upon the effect of component arms. Research limitations/implications – Intervention by the TC informed two-model integrated personality disorder service had a statistically significant effect overall on reducing bed use, which was maintained at six and 12 months. Practical implications – The paper supports the finding of the authors’ previous study; a therapeutic model of care that significantly reduces psychiatric bed use. That the reduction in psychiatric bed use continues to further appear highly significant at 18 months suggest that our service has an enduring effect upon inpatient psychiatric resources. Originality/value – The paper describes a unique model of care currently successfully employed in the therapeutic management of people with personality disorder. The model is replicable and effective and offers some possibilities for the development of therapeutic-community informed practice.
Evaluation of treatment outcomes in personality disorder services is frequently a requirement of service commissioners and there is a need to safely and reliably monitor treatment effectiveness. The selection of appropriate measures is discussed along with other related issues of methodology.
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