Initial outcomes of a therapeutic community‐based outpatient programme in the management of personality disorder

Abstract

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.

Outcomes of therapeutic community treatment for personality disorder

“…Nine of the studies subjected to quality assessment achieved between 12-16 points out of a possible score of 30 (Barr et al, 2010;Birtchnell et al, 2009;Jones, Juett & Hill, 2013;McFetridge & Coakes, 2010;Morrissey & Taylor, 2014;Pearce & Haigh, 2008;Rawlinson & Bennett, 2010;Shuker & Newton, 2008;Wilson et al, 2014). The low range of these scores suggests a high risk of bias within the majority of included studies for review.…”

“…Some studies harboured increased risk of sample bias. Morrissey & Taylor (2014) Further risk of bias existed within some studies due to small sample size (Barr et al, 2010;Jones et al, 2013;Morrissey & Taylor, 2014;Pearce & Haigh, 2008;Rawlinson & Bennett, 2010) and subjective (screening) assessments of PD (IPDE, PDQ - Barr et al, 2010;Morrissey & Taylor, 2014;Rawlinson & Bennett, 2010;Shuker & Newton, 2008). In four studies, retested participants were more likely to have been in treatment longer (Barr et al, 2010;McFetridge & Coakes, 2010;Shuker & Newton, 2008;Wilson et al, 2014).…”

“…Five studies incurred a drop out rate of ≥50% (59-72%) (Birtchnell et al, 2009;Jones et al, 2013;McFetridge & Coakes, 2010;Pearce & Haigh, 2008) or attrition rates were not reported . Two studies retained data from lost participants pre-discharge via intention to treat (ITT) analysis (Chiesa et al, 2004;Wilson et al, 2014).…”

“…Two studies retained data from lost participants pre-discharge via intention to treat (ITT) analysis (Chiesa et al, 2004;Wilson et al, 2014). Two studies excluded data from lost participants from pre-post comparisons of treatment effect (Barr et al, 2010;Jones et al, 2013). Shuker & Newton (2008) included participants who did not complete treatment but were re-tested prior to leaving the prison TC.…”

“…No studies based within mini, day or forensic TCs employed follow up measures for the treatment group (Barr et al, 2010;Birtchnell et al, 2009;Jones et al, 2013;Residential TCs: The two studies based in residential TCs utilized follow up measures, although time of administration was asymmetrical, increasing risk of bias (Chiesa et al, 2004;McFetridge & Coakes, 2010).…”