Priorities for service improvement in personality disorder in Australia: Perspectives of consumers, carers and clinicians

Ng, Fiona; Townsend, Michelle L.; Jewell, Mahlie; Marceau, Ely M.; Grenyer, Brin F. S.

doi:10.1002/pmh.1485

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Given the high levels of need within community services (defined in this study as publicly-funded primary care services, non-specialist secondary mental health services, specialist community 'personality disorder' services and non-profit community organisations and networks that work with people with CEN, and excluding community forensic mental health services) and the considerable variability in service quality, a growing number of international policy guidelines are intended to improve and enhance community care for people with CEN [20,21]. Yet, the data sources used to develop many of these guidelines fail to incorporate the views and perspectives of service users and the family and friends who support them [20,22]. In addition, most research on care models for people with CEN focus on psychological interventions, especially those intended to reduce self-harm [23].…”

Section: Introductionmentioning

confidence: 99%

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

et al. 2022

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Background There is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users’ views and co-production initiatives have had little impact on the development of interventions and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs. Methods A co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data. Results Participants reported some experiences of good practice but also of experiences of severely stigmatising interventions, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised and compassionate way and care that is trauma-informed. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs. Conclusions Relational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with people with relevant lived experience, their carers and the professionals who support them.

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Section: Introductionmentioning

confidence: 99%

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

et al. 2022

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“…Peer support may be beneficial for consumers with BPD and their carers to help enhance recovery. Peer support has been recommended for consumers with BPD to improve relationships and sense of self [10], and to improve personality disorder services [11,12].…”

Section: Introductionmentioning

confidence: 99%

Using peer workers with lived experience to support the treatment of borderline personality disorder: a qualitative study of consumer, carer and clinician perspectives

Barr

Townsend

Grenyer

2020

bord personal disord emot dysregul

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Background: Peer support is a recovery oriented approach where consumers and carers are introduced to people with lived experience of the disorder who have recovered. Paid roles within health services for such consumer peer workers and carer peer workers (or 'specialists') are increasingly common. To date specific studies on such peer support for consumers with borderline personality disorder (BPD) and their carers has not been conducted. Methods: This qualitative study used interviews to explore perceptions and models of peer support for BPD from the perspectives of 12 consumers, 12 carers, and 12 mental health professionals. Participant responses were analyzed using reflexive thematic analysis within a phenomenological methodology. Results: All groups described how consumer peer workers may provide hope, connection, and validation to a consumer's lived experience. Offering both traditional mental health treatment plus peer support, and giving consumers choice regarding a consumer peer worker was welcomed. Differences in opinion were found regarding the consumer peer worker's role in relation to the mental health team, including whether consumer peer workers should access medical records. Perspectives differed regarding the consumer peer worker and carer peer worker positions, highlighting potential role confusion. Carers discussed the value of receiving support from carer peer workers and consumer peer workers. Mental health professionals described how consumer peer workers can experience workplace stigma and problems with boundary setting, and acknowledged a need for peer workers to be valued by having a duty of care and confidentiality code to follow and be offered supervision. Conclusions: Two models of peer support for BPD emerged: an integrated model where consumer peer workers work within the mental health team, and a complementary model where consumer peer workers are separate from the mental health team. Based on these findings we provide recommendations for services to help support such peer work for consumers with BPD and their carers.

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“…With the increasing interest in recovery, the study of the lived experience of BPD is critical to progressing the field. To date, the small body of qualitative literature exploring the experiences and perspectives of people with BPD have focused on life histories and trauma (Holm et al, 2009 ), daily life (Spodenkiewicz et al, 2013 ) experience of the BPD diagnosis (Courtney & Makinen, 2016 ; Horn et al, 2007 ; Sulzer et al, 2016 ), service user perspectives (Fallon, 2003 ; Morris et al, 2014 ; Ng et al, 2020 ; Redding et al, 2017 ; Rogers & Acton, 2012 ; Rogers & Dunne, 2011 ; Stapleton & Wright, 2017 ) and more recently the emerging area of recovery (Gillard et al, 2015 ; Holm & Severinsson, 2011 ; Katsakou & Pistrang, 2017 ; Lariviere et al, 2015 ; Ng et al, 2016 ; Ng, Carter, et al, 2019 ; Ng, Townsend, et al, 2019 ). However, few studies have explored the lived experiences and perspectives of individuals with who are at different stages of recovery to understand some of factors that may contribute to outcomes.…”

Section: Introductionmentioning

confidence: 99%

To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder

Grenyer

Townsend

Lewis

et al. 2022

Personality & Mental Health

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Although recovery from borderline personality disorder (BPD) is common, not all individuals improve over time. This study sought to examine the features that contribute to response or non-response for individuals at different stages of recovery from BPD over a longitudinal follow-up. Participants were individuals with a diagnosis of BPD that were followed up after 1 year of receiving psychological treatment. There were no significant differences between participants at intake across key indices; however, at 1-year follow-up, two groups were distinguishable as either 'functioning well' (n = 23) or 'functioning poorly' (n = 25) based on symptomatology and functional impairment. Participant qualitative responses were analysed thematically and via Leximancer content analysis. Thematic analysis indicated three key themes: (1) love of self and others, (2) making a contribution through work and study and (3) stability in daily life. Participants who were 'functioning well' described meaningful relationships with others, enjoyment in vocation, and described less frequent or manageable life crises. The 'functioning poorly' group described relationship conflicts, vocational challenges, feelings of aimlessness and purposelessness, instability in daily living and frequent crises. Leximancer content analysis visually depicted these divergent thematic nomological networks. Corroborating quantitative analyses indicated significant differences between these groups for social, occupational and symptom profiles. These findings highlight the centrality of achieving the capacity to 'love and work' in fostering a sense of personal recovery. Treatments may need specific focus on these factors, as they appeared to reinforce symptomatic trajectories of either improvement or poor non-response to therapy.

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Priorities for service improvement in personality disorder in Australia: Perspectives of consumers, carers and clinicians

Cited by 11 publications

References 24 publications

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Using peer workers with lived experience to support the treatment of borderline personality disorder: a qualitative study of consumer, carer and clinician perspectives

To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder

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