A Qualitative Study on the Use of the Care Programme Approach with Individuals with Borderline Personality Disorder: A Service User Perspective

Abstract

A newly developed specialist personality disorder service in the United Kingdom arranged a focus group with seven service users with a diagnosis of borderline personality disorder (BPD) to explore their experiences of the Care Programme Approach (CPA) while under the care of a community mental health team. A thematic analysis generated seven themes. Understanding Borderline Personality Disorder and Understanding Recovery were highlighted as difficulties service users face, with a lack of staff understanding. They also spoke about the struggle of having a voice in their CPA meetings and the lack of information they received in the CPA process. They discussed the deliberation between progression versus consistency and moving on from services. Service users discussed the challenges of accessing treatment and lack of follow up in the CPA process. Greater service user involvement in the process would help address the dissatisfaction and disempowerment in care planning experienced by individuals diagnosed with BPD. [Journal of Psychosocial Nursing and Mental Health Services, 51(10), 38-45.].

Systematic synthesis of barriers and facilitators to service user-led care planning

“…An update to our original search was performed in May 2014, which identified a further five papers meeting our inclusion criteria. 134 – 138 Although all were small studies focused on specific clinical populations, 134 , 136 , 138 or on variants of care planning, 135 , 137 their data corroborated our synthesis, highlighting the following ongoing barriers to service user involvement: ritualised practices; 136 , 138 insufficient information provision; 134 , 135 , 138 lack of service user confidence, 138 or competence; 135 and professional scepticism. 137 Effective involvement will aIways depend on the skills and competencies of the parties involved, and it is arguable whether all service users and carers possess the necessary skills and confidence to work collaboratively with mental health professionals.…”

Recovery from Borderline Personality Disorder: A Systematic Review of the Perspectives of Consumers, Clinicians, Family and Carers

“…Similarly the perspectives of mental health clinicians on the recovery journey in BPD were also absent. Misunderstandings surrounding what constitutes as recovery has also been identified as a barrier to clinicians promoting recovery[ 69 ]. Differences in understanding may have detrimental effects on therapeutic alliance.…”

Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives

“…Our study is somewhat unusual in identifying user‐centred limitations to care planning alongside deficits in the care planning process. We have seen that users are looking to professionals and services to help them navigate well‐known issues around perceived capacity and insight (Rogers & Dunne , Shields et al . ), which have been used to suppress people's involvement previously (Chinman et al .…”

“…Where users' views have been explored these have tended to be via small scale, qualitative studies focused on a single facet of the decision‐making process (Goss et al . , Rogers & Dunne ). There thus persists an important knowledge gap between the more nebulous ‘top‐down’ concepts advocated by mental health policy and the power and influence of individual stakeholders in determining exactly what user‐involved care planning should entail.…”