An important distinguishing feature of one group of personality disorders is the wish of the sufferer to seek treatment. For another group this wish is rarely entertained. Although there is some variation between different types of personality disorder the wish to change is not confined to any one diagnostic category. A useful subclassification of personality disorders is therefore into Type R (treatment rejecting) and Type S (treatment seeking) personality disorders, and these are defined operationally. The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others. It is suggested that this typology is useful for those contemplating treatment with those who have personality disorders.

Screening for suicidal ideation in primary care among people who have signs of depression does not appear to induce feelings that life is not worth living.

Aims and MethodThe aim was to record the prevalence, type and severity of personality disorder dealt with by an inner-city outreach team. Patients on the register of an assertive outreach team were approached and asked to give informed consent for an informant interview with their principal worker to determine their personality status, using the informant-based ICD–10 version of the Personality Assessment Schedule.ResultsOf the 73 patients, 62 (85%) of whom had a psychotic diagnosis, 67 (92%) had at least one personality disorder, with 37 (51%) having complex or severe personality disorders.Clinical ImplicationsThe findings suggest that the National Service Framework requirements for assertive outreach teams tend to select many patients with comorbid personality disorder in addition to other severe psychiatric disorders.

As a result of rapid globalization the Gross Domestic product of countries may have changed, but the gap between the very rich countries and poor countries has changed too, along with a change in social and economic strata within each society; although the rates of psychiatric disorders are affected by industrialization and urbanization, the financial pressures add yet another layer of burden. Global burden of disease due to mental illness is tremendously high and yet, in spite of pressures, there is no equity and increased discrimination related to mental illness. This paper presents some of the issues related to the economic state of the countries. In order to ensure that citizens receive the best treatments available it is important that socio-economic causes and gaps in treatment are identified and dealt with at national levels.