Aim The study examined concurrent mental and physical healthcare received by patients diagnosed with a personality disorder on acute general hospital wards. The specific objectives were (i) to conduct a web based cross sectional survey and (ii) to explore experiences and perspectives with a subsection of the survey sample, using telephone interviews. Design A convergent parallel mixed methods design, which comprised a web‐based cross sectional survey (n = 65) with embedded qualitative telephone interviews (n = 12). Participants were social media users, with a self‐reported diagnosis of personality disorder, admitted to an acute general hospital in the UK in the previous 2 years. Methods Participants were recruited on social media between May 2017 and August 2017 by snowballing. Mixed data were integrated at the stage of analysis using a framework approach. Findings are reported thematically. Results Most of the participants surveyed (94%, n = 61) reported distress during admission to the acute general hospital. However, the findings indicated the hospital environment was not conducive to mental health. Four interrelated themes were identified and related to: patient distress; the workforce; service delivery; and service design. Conclusion Findings indicated that patients with a personality disorder diagnosis received disadvantaged healthcare, might be at considerable risk of treatment noncompletion, and were languishing in the gaps between mental and physical health services. Impact This is one of the first studies to collect primary data on the concurrent mental and physical healthcare received by patients diagnosed with a personality disorder on acute general hospital wards. Ad hoc training and education focused on raising awareness of ‘personality disorder’ would not seem sufficient to address the deficits. This research may be of interest to people who use mental health services, acute general hospital and liaison clinicians, hospital managers and researchers.
What is known on the subject?:• People diagnosed with a personality disorder might be more likely to have physical health problems and be admitted to the hospital. Treatment in hospitals might be complicated by mental health crises or self-injury, and barriers to NHS care may increase the risk of developing further illness with serious consequences.• Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Thirteen clinicians working in mental health liaison in the general hospital were interviewed as part of a sequence of research studies. What this paper adds to existing knowledge:• This study identified unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in general hospitals.People with a "personality disorder" diagnosis were discriminated against and over-and under-medicated.• Mental health liaison clinicians reported limited understanding and skills among general hospital clinicians. People working in general hospitals were fearful of the "personality disorder" diagnosis. Poor care was accepted because general hospital clinicians did not consider themselves to be "mental health trained."What are the implications for practice?:• Clinicians working in mental health liaison need credible knowledge of mental and physical health and medicines.• Capability, influence, and high-level interpersonal skills are needed to successfully work across mental health services and the general hospital.• More advanced and consultant-level nursing roles in more mental health liaison teams are needed to strengthen this specialist workforce.
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