A two-model integrated personality disorder service: effect on bed use

Abstract

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.

A two-model integrated personality disorder service: two-year follow up of effect upon psychiatric bed use

“…The overall figures show that black and ethnic minority groups were under-represented compared to local demographic data and in line with our earlier study (Jones et al, 2012). There is a greater representation of mixed race or other minority group service-users attending SUN than in the MBT-TC sample.…”

“…In all, 44 (60.3 per cent) SUN members returned the SAPAS questionnaire and this return rate is again broadly similar to that reported in our earlier study (Jones et al, 2012). All but one of the respondents (97.7 per cent) scored "3 or more", meeting the SAPAS threshold for likely presence of a personality disorder.…”

“…Given that all patients presenting to the MBT-TC arm of the service routinely undertake a full SCID-II interview, we considered it to be nonsensical to also administer a SAPAS screening questionnaire for the sake of sample comparisons between SUN and MBT-TC groups, which nonetheless contradicts our stated intention within the earlier study (Jones et al, 2012). Analysis of resulting diagnostic data showed that 39 (97.5 per cent) patients in the MBT-TC arm of the service fulfiled diagnostic criteria for "personality disorder" while 38 (95 per cent) met diagnostic criteria for "borderline personality disorder", according to the SCID-II.…”

“…The process of our own service development and of our attempt to deliver a service, in recognition of these aspects, has been described fully elsewhere (Jones and Miller, 2011;Jones et al, 2012). The model is informed by therapeutic community principles and comprises of two arms.…”

Surviving as a personality disorder service

“…The fact remains, though, that for three years of service delivery, the staff group had been largely left to 'play' with the patients in the manner described, surpassing commissioners' expectations about performance in the process. The service had enjoyed some objective successes in terms of outcomes, with high patient satisfaction ratings and a significant reduction in the use of inpatient psychiatric beds (over 60% at 18 months of contact) in the absence of any fatality, through the creative integration of the two service models (MBT and SUN) and the modification of MBT to include a therapeutic community ethos (MBT-tc) (Jones et al, 2012(Jones et al, , 2013a(Jones et al, , 2013b. The service was short-listed by the Royal College of Psychiatrists for psychiatric team of the year and team members received the collective accolade of 'NHS heroes, awarded by the local NHS Trust following nomination by the patient group.…”