Services for personality disorder: organisation for inclusion

Abstract

Mental health services are not yet organised to allow patients with personality disorders easy access, and practitioners lack the necessary skills to implement effective treatment. A number of service models have developed, albeit without a clear evidence-base. These include sole-practitioner, divided-functions and specialist-team models. In general, a divided-functions or specialist-team model is probably best for reducing risk and improving outcomes. Both models present difficulties with integrating treatment, but these can be overcome by good communication. Good management of patients requires careful assessment of need and risk, a consistent approach, constancy of staff, team coherence and adequate inpatient support. Not all practitioners can treat patients with personality disorders and the interpersonal skills of the mental health professional may be crucial in maintaining a patient in treatment.

Working with adults with personality disorder in the community: a multi-agency interview study

“…It has been suggested that one reason why clients with personality disorder create so many problems in treatment is that they evoke inconsistency (Bateman & Tyrer, 2004). Although this is to some extent supported by the apparent ability of the Cluster B presentation in particular to cause disagreement within a team, our findings suggest that certain personality disorder presentations were relatively consistent in their impact on staff irrespective of the agency in which they worked.…”

Community mental healthcare for people with severe personality disorder: narrative review

“…A meta-analysis of psychotherapy outcomes for personality disorders and a recent Cochrane systematic review of psychotherapies for borderline personality disorder were analysed to detect studies that possibly described CMHC as the control condition. 1,2 No other more recent meta-analyses or Cochrane reviews of this field were available at the time this search took place.…”

“…1 Many may go unnoticed owing to limited detection by health providers, 2 resulting in patients not receiving specialised therapy. [3][4][5] Even when such increasingly effective therapies are indicated, [6][7] not all patients profit from them because of limited availability or suitability.…”

Olive Tree community treatment centre for individuals with personality disorder: naturalistic service evaluation

“…6 The National Service Framework for Mental Health refers to service user 48 times, patient 12 times and client twice. 7 The Royal College of Psychiatrists, in its report Mental Illness: Stigmatisation and Discrimination within the Medical Profession, refers to patient 77 times, service user 7 times and user (independently of service user) twice. 8 Of national mental health charities, SANE refers to 'people affected by mental illness' (www.sane.org.uk/ AboutSANE), whereas MIND variously refers to user, service user or user/survivor.…”

“…The Coventry Community Specialist Personality Disorder Service is a tertiary specialist team 7 with the aim of using the structure of a clinical psychiatric service, designed around the assertive outreach recovery model, to deliver therapy in a variety of settings to individuals with a primary diagnosis of personality disorder. The service came into being towards the start of 2005, but owing to staff recruitment problems became fully operational only towards the end of the year.…”