Self-harm, capacity, and refusal of treatment: implications for emergency medical practice. A prospective observational study

Advance Statements for Borderline Personality Disorder: A Qualitative Study of Future Crisis Treatment Preferences

“…Participants included clear statements in their joint crisis plans relating to a desire to recover from the crisis and to establish a more optimal level of social functioning. This finding challenges misconceptions held by many clinicians that people with borderline personality disorder either consistently make self-destructive life choices (39) or lack the requisite capacity to make sensible life choices (7, 40,41). We think this highlights the fallacy whereby clinicians may make unfavorable assumptions about the level of functioning of people with borderline personality disorder during their daily lives based on their presentation during a crisis.…”

Mentally disordered or lacking capacity? Lessons for management of serious deliberate self harm

“…Case studies show that for patients with a personality disorder, the process of assessing decision making capacity concerning the treatment of the disorder may become a therapeutic intervention. [13][14][15] The information that must be offered to patients to enable them to understand the nature of the "illness," and the treatment, is complex. For example, it usually includes a detailed history of past maladaptive responses to a range of challenging circumstances; the treatment options for personality disorder, together with their differing rationales, might be extensive, as might a discussion about how they could best suit the patient's difficulties.…”

Are emergency department staffs' perceptions about the inappropriate use of ambulances, alcohol intoxication, verbal abuse and violence accurate?

“…Patients who commit deliberate self-harm (DSH) are known to be at increased risk of further self-harm and suicide 25. This is concerning as many are recorded as leaving before their treatment is completed,26 despite 40% lacking the capacity to make this decision 27…”