Personality disorder services in England: findings from a national survey

Dale, Oliver; Sethi, Faisil; Stanton, Clive; Evans, Sacha; Barnicot, Kirsten; Sedgwick, Rosemary; Goldsack, Steve; Doran, Monica; Shoolbred, Lucinda; Samele, Chiara; Urquía, Norman; Haigh, Rex; Moran, Paul

doi:10.1192/pb.bp.116.055251

Cited by 53 publications

(74 citation statements)

References 11 publications

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“…Improving access to services and delivering better outcomes for people with personality disorder were central to the policy document ‘Personality Disorder: No Longer a Diagnosis of Exclusion’, which reiterated findings that those with personality disorder often faced a revolving door within services, and owing to insufficient training, resources and skills clinicians were reluctant to work with those with personality disorder. Since this publication, access to care and dedicated personality disorder services in England has significantly improved . However, just under half of the National Health Service (NHS) mental health trusts and independent organizations stated that patients did not have equal access to dedicated personality disorder services owing to their area of residence .…”

Section: Introductionmentioning

confidence: 99%

The personality disorder patient pathway: Service user and clinical perspectives

Flynn

Raphael

Graney

et al. 2019

Personality & Mental Health

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Aims There have been recent policy developments and research into care provision for service users with personality disorder. However, few studies have focused on service user and staff perspectives on how services could be improved. Methods A qualitative study was undertaken in the UK between 2016 and 2017. We conducted six focus groups with clinicians in mental health services with experience of working with people with personality disorder. Using an online survey, we asked current and past service users with personality disorder to describe their experiences of mental health services and make recommendations for improvements. A thematic analysis was conducted. Results Forty‐five clinicians participated in the focus group and 131 service users contributed to the online survey. The main areas of concern identified by both staff and patients were the diagnosis of personality disorder, the absence of a coherent care pathway, access to psychological treatment and staff training. Conclusions The care pathway for individuals with personality disorder is unclear to clinicians and service users, and elements of the pathway are disjointed and not working as effectively as they could. Guidelines recommended by National Institute for Health and Care Excellence are not being followed. Specialist psychological interventions should be available to ensure consistent and stable care provision. © 2019 John Wiley & Sons, Ltd.

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Section: Introductionmentioning

confidence: 99%

The personality disorder patient pathway: Service user and clinical perspectives

Flynn

Raphael

Graney

et al. 2019

Personality & Mental Health

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“…Through our role of gate keeper, we were aware that previously, our Trust referred the most complex service users out of area. The national pattern across the UK is likely similar, despite most Trusts declaring some level of specialized PD services . However, NHS England's Five Year Forward Plan is to eliminate inappropriate OATs by 2021, through promoting accessible high‐quality care in the least restrictive setting as close to home as possible .…”

Section: Discussionmentioning

confidence: 99%

“…This growing evidence has spurred the development of specialist community services for PD. A survey within the English NHS found that there had been a fivefold increase in organizations with dedicated PD services between 2002 and 2015, but despite 84% of organizations having a PD service, it remained unclear if the quality of care had improved . Similarly, Tulloch et al .…”

Section: Introductionmentioning

confidence: 99%

“…A survey within the English NHS found that there had been a fivefold increase in organizations with dedicated PD services between 2002 and 2015, but despite 84% of organizations having a PD service, it remained unclear if the quality of care had improved. 21 Similarly, Tulloch et al reported little evidence of benefit (effectiveness, safety, patient centeredness and the costs) when community services were reorganized to focus on care pathways for PD. 22 This paper is an interim study, 12 months after establishing a local specialist community-based PD team, to examine the impact in terms of people being sent out of area (OATs), use of local psychiatric bed days and crisis contacts.…”

Section: Introductionmentioning

confidence: 99%

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A preliminary service evaluation of a personality disorder case management service

Graham

Sullivan

Briggs

et al. 2019

Personality & Mental Health

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Aims The aim of this study is to assess the impact of establishing a specialized community personality disorder team on out of area placements, local hospital admissions and out of hours crisis contacts for service users with borderline personality disorder. Method This is a before–after interim evaluation of a new service. We tested, through a paired t‐test, whether the intervention generated statistically significant differences over a range of measures of service usage, including out of area placements, local hospital admissions and out of hours crisis contacts. Data from 12 months after the intervention started were compared with the previous 12 months of routine care, to determine the effect on crisis contacts, days in hospital and those returning from/or sent out of area for care. Finally, we have assessed the likelihood to generate cost savings. Results All service users in out of area placements were repatriated to live in the community locally (100%), and there was a statistically significant decrease in inpatient admissions (80%). This was counterbalanced by a smaller but statistically significant increase in out of hours community crisis contacts (30%), although these reduced over time. Conclusion Reorganizing local care pathways can lead to less out of area placements and less hospital admissions. © 2019 John Wiley & Sons, Ltd.

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“…This has included negative attitudes from some healthcare workers (Dickens, Lamont, & Gray, ), and reports that some people with this diagnosis have had their distress dismissed (Bonnington & Rose, ) have been treated disrespectfully (Lawn & McMahon, ) and treated as a label rather than an individual (Veysey, ). In the UK, this has meant that despite expansion in the provision of specialist services over the last 15 years (Dale et al., ), and the lack of consistent high quality care has recently prompted a government sponsored consensus statement to improve treatment experiences (Lamb, Sibbald, & Stirzaker, ).…”

Section: Introductionmentioning

confidence: 99%

Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008–2017

Bowen

2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? People with a diagnosis of personality disorder often experience stigma both outside of, and within, mental health services. The media contribute to people's understanding of mental health issues, and negative portrayals appear to lead to increased negative attitudes in readers. Relatively little is known about how the press represent personality disorder, and the types of messages that people with this disorder may be receiving, which may impact on their understanding of themselves and emotional well‐being. What the paper adds to existing knowledge? The key findings indicate that in a 10‐year period, the representation of personality disorder in the popular tabloid press in the UK was characterized by the frequent use of language of violence. The research approach enabled the study to identify significant patterns in the language used, rather than only using a checklist of words that the press are directed to avoid. This adds to our understanding about the images repeatedly presented that may affect how readers treat people with a diagnosis of personality disorder and affect the self‐esteem of those with the diagnosis. What are the implications for practice? Mental health nurses are well placed to address issues of stigma both in terms of the general public's beliefs and the impact it has on those who use mental health services. A greater understanding of the messages in the press can help nurses to support service users who are vulnerable to believing that their lives will start to reflect the negative messages they have read. Abstract IntroductionMany people with a diagnosis of personality disorder experience stigma, and the press’ representations may contribute to those processes. To date, little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid.AimThe aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatization.MethodCorpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n = 260).ResultsThe findings identified a range of words that constructed narratives of violence.DiscussionThe method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self‐stigma.Implications for practiceGreater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho‐social interventions to address the impact of self‐stigma on self‐esteem.

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Personality disorder services in England: findings from a national survey

Cited by 53 publications

References 11 publications

The personality disorder patient pathway: Service user and clinical perspectives

The personality disorder patient pathway: Service user and clinical perspectives

A preliminary service evaluation of a personality disorder case management service

Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008–2017

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