Barriers to and facilitators of treatment engagement for clients with personality disorder: a Delphi survey

Abstract

Clients with personality disorder (PD) can encounter difficulties engaging in psychosocial therapy. One way to address this is to identify the factors that contribute to their low engagement. The Multifactor Offender Readiness Model (MORM), a model developed to explain poor treatment engagement in offenders, might guide the identification of engagement difficulties in clients with PD. In this study, we sought to validate and extend the MORM for clients with PD by identifying the perceived barriers to and facilitators of their engagement. A two-round Delphi Survey was employed to identify clients' and clinicians' levels of agreement on the factors that impair and promote engagement. Seventy-six clients and 55 clinicians were recruited from English specialist forensic and non-forensic personality disorder services. Our findings reveal that the perceived barriers to engagement for those with PD are in the most part congruent with the impediments outlined in the MORM. However, we do find some additional barriers relevant specifically to people with PD. A Treatment Readiness Model for Personality Disorder (TReMoPeD), which is an augmented version of the MORM, is presented. This model provides guidance for ways of taking action to improve a client's chance of engaging with services. Copyright

A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

“…Analysing data of the long-stay patients in more detail confirmed that -in line with studies on general forensic populations 29,105 -patients initially primarily entered the forensic psychiatric system via prison. In our study we were able to compare entry to secure care with admission to current unit, which revealed a significant shift from prison to other secure settings as admission source.…”

“…in terms of population studied or national coverage). The only recent study in the UK describing characteristics of a national medium secure sample 105 is also of relevance, although it describes a discharge sample. These latter studies do not differentiate between long-stay patients and non-long-stay patients but inform about characteristics of patients in secure care more generally.…”

“…These data on admission source additionally reflect potential challenges in the smooth transfer of this patient group along a pathway from more to less secure settings as identified by others (e.g. Tetley et al 105 for PD patients).…”

“…In line with previous research, our findings suggest that our long-stay sample shares characteristics with general forensic samples that are suggestive of early disruptive lives with patients not having achieved stable relationships or employment. Others 29,42,105 have described an over-representation of those from BME groups in general forensic samples, both high and medium secure. The percentage of patients from BME groups in our sample, in line with other long-stay studies, 42,88 does not indicate over-representation, suggesting, maybe, that patients from BME groups are less likely to become long-stay patients, although longitudinal studies would be required to investigate differences in the pathways of patients from different ethnic backgrounds.…”

Long-stay in forensic-psychiatric care in the UK

“…The data on admission source additionally reflects potential challenges in the smooth transfer of this patient group along a pathway from more to less secure settings as identified by others (e.g. Tetley et al for PD patients [27]). Such pathways typically identify the journey of a patient from more to less secure units, and ideally back into the community.…”