A preliminary service evaluation of a personality disorder case management service

Abstract

Aims The aim of this study is to assess the impact of establishing a specialized community personality disorder team on out of area placements, local hospital admissions and out of hours crisis contacts for service users with borderline personality disorder. Method This is a before–after interim evaluation of a new service. We tested, through a paired t‐test, whether the intervention generated statistically significant differences over a range of measures of service usage, including out of area placements, local hospital admissions and out of hours crisis contacts. Data from 12 months after the intervention started were compared with the previous 12 months of routine care, to determine the effect on crisis contacts, days in hospital and those returning from/or sent out of area for care. Finally, we have assessed the likelihood to generate cost savings. Results All service users in out of area placements were repatriated to live in the community locally (100%), and there was a statistically significant decrease in inpatient admissions (80%). This was counterbalanced by a smaller but statistically significant increase in out of hours community crisis contacts (30%), although these reduced over time. Conclusion Reorganizing local care pathways can lead to less out of area placements and less hospital admissions. © 2019 John Wiley & Sons, Ltd.

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

“…In non-primary outcomes , compared to TAU, participants receiving Joint Crisis planning did not differ in outcomes. Compared to Structured Goal-Focused Pre-Treatment Intervention (GFPTI), participants receiving therapeutic assessment showed improvements in more than half of non-primary outcomes Self-management and care planning vs established generic or specialist mental health services RCT ( n = 1) [ 242 ] Sample size: 20–100 ( n = 1) Date: 2000–2010 ( n = 1) Country: UK ( n = 1) Diagnoses: Severe mental illness and comorbid personality disorder or difficulty ( n = 1) In 1 RCT with primary outcomes , there were no differences between Nidotherapy enhanced assertive outreach and standard assertive outreach in primary outcomes (number of admissions: 0/1; duration of bed use: 0/1) or non-primary outcomes Non-randomised experiments, observational studies, quasi experiment, and natural experiment with pre-post comparison ( n = 3) [ 243 – 245 ] Sample size: 20–100 ( n = 2); > 100 ( n = 1) Date: 2010–2019 ( n = 3) Country: Europe ( n = 1); North America ( n = 1); UK ( n = 1) Diagnoses: “Personality disorder” diagnosis ( n = 2); major depressive disorder with or without a “personality disorder” diagnosis ( n = 1) Demographics: not reported Non-randomised experiments: In 1 study, compared to TAU, participants receiving collaborative care management showed improvement on the primary outcome (remission of depression: 1/1). In 1 study, compared to TAU, participants in the Collaborative Care Programme (CCP) improved on one of two non-primary outcomes In 1 study with comparisons over time , participants improved on outcomes Novel mental health service model vs day hospital RCT ( n = 5) [ 246 – 250 ] Sample size: 20–100 ( n = 1); > 100 ( n = 4) Date: 2000–2009 ( n = 1); 2010–2019 ( n = 4) Country: Europe ( n = 5) Diagnoses: “Personality disorder” ( n = 4) or “BPD” diagnosis ( n = 1) Demographics: not reported RCTs with primary outcomes: Four RCTs reported results for the same sample at different time points.…”