There is a dearth of high quality evidence about the attitudes of mental health nurses towards people with a diagnosis of borderline personality disorder. This is an important gap since nurses hold the poorest attitudes of professional disciplines involved in the care of this group. Further work is needed to ascertain the most effective elements of training programmes; this should involve trials of interventions in samples that are compared against adequately matched control groups.

Aims and objectives To evaluate and explore mental health nurses’ responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of borderline personality disorder (BPD). Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ). Background Attitudes towards people with a diagnosis of BPD are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of BPD. No previous intervention has been co‐produced with an expert by experience. We developed and delivered a 1‐day intervention comprising these elements. Design A mixed‐methods design was used comprising prospective within‐subjects cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK. Methods Measurement of cognitive and emotional attitudes to people with a diagnosis of BPD at pre‐ and postintervention (N = 28) and at 4‐month follow‐up. Focus groups were used to explore participants’ experiences of the intervention (N = 11). Results Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience. Conclusions Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful. Relevance to clinical practice The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert by experience co‐production. Mental health nurses, however, believe that more well‐resourced services are the key to improving care.

Efforts to increase physical activity levels in people with serious mental health conditions are viewed as desirable but little is known about how best to support this group to engage in exercise over extended periods. From a personal recovery perspective, the dominant paradigm in current mental health service delivery, one promising route involves participation with, rather than administration to or supervision of, mental health service users in team sports, usually football, in order to foster sharing of common interests and experiences. We aimed to explore the factors underlying the success of four collaborative mental health football (soccer) projects and the role played by football in mental health care delivery and in personal recovery. We held semi-structured focus groups with service user (n=18) and staff (n=7) participants from four football groups (two 'walking' football and two regular football) in two geographical National Health Service Boards in Scotland. Thematic analysis revealed that, central to success, were perceived relational, and personal and physical recovery-related benefits; competition and collaboration-related aspects were important drivers of interest in and commitment to the groups. Further, participants identified barriers to and concerns for continued success; specifically, they expressed that they need more explicit support from senior management. The clear emerging message was that collaborative football groups were perceived by participants as a conduit for recovery and an important aspect of mental healthcare delivery. Playing football was associated with a sense of wellbeing, and enhanced relationships between service users and staff.

There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder.

Background: Mental health professionals' attitudes to people with Borderline Personality Disorder can be negative. No systematic review to date has examined how service-users and their families experience professional care. Aims: To critically synthesise evidence of service-users' and families' subjective experience of mental health care for borderline personality disorder. Methods: Multiple computerised databases were searched using comprehensive terms. All relevant, English language empirical studies were included. We read and critically assessed all papers independently. Study findings were subject to a meta-synthesis. Results: N=38 studies were included. Analysis revealed four themes for service-users: assessment and diagnosis; approach of professionals; therapeutic interventions, and service provision; two broad themes for family / carers: support, burden, and information; and experience of professional and therapeutic approaches. Both groups expected to receive professional healthcare, and were clear they valued professionalism, respect, compassion and the therapeutic nature of positive relationships with professionals. Expectations were jeopardised where difficulties with knowledge, communication, information sharing, and support were perceived.. Conclusions Service-users and families /carers should expect to receive high quality, fair and equal care. In light of current evidence, a cultural shift towards more relational, person centred and recovery-focused care could improve experiences.