Crisis interventions for adults with borderline personality disorder

Monk-Cunliffe, Jonathan; Borschmann, Rohan; Monk, Alice; O'Mahoney, Joanna; Henderson, Claire; Phillips, Rachel; Gibb, Jonathan; Moran, Paul

doi:10.1002/14651858.cd009353.pub3

Cited by 6 publications

(7 citation statements)

References 87 publications

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Section: Discussionmentioning

confidence: 99%

“…Advance statements, joint crisis plans, and self-referred brief admissions are all interventions that have been tried for patients with BPD. [71][72][73][74] Theoretically, these measures may sound palatable, since they intend to increase the patient's agency, increase therapeutical alliance, decrease self-harm behaviour, and decrease the need for compulsory care. So far, however, such interventions have not been shown to decrease the amount of inpatient care, self-harm episodes, suicide attempts, deaths, or compulsory care.…”

Section: Resistance To Changementioning

confidence: 99%

“…So far, however, such interventions have not been shown to decrease the amount of inpatient care, self-harm episodes, suicide attempts, deaths, or compulsory care. 71,72 On the other hand, patients have felt validated and content with such interventions. 73,74 There is always a risk, when working with BPD patients, that interventions done with the best intentions do not entail the expected consequences.…”

Section: Resistance To Changementioning

confidence: 99%

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Is compulsory care ethically justified for patients with borderline personality disorder?

Lundahl,

Helgesson,

Juth

2023

Clinical Ethics

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Patients with borderline personality disorder (BPD) are overrepresented in compulsory inpatient care for suicide-protective reasons. Still, much evidence indicates negative effects of such care, including increased suicide risk. Clinical guidelines are contradictory, leaving clinicians with difficult ethical dilemmas when deciding on compulsory care. In this study, we analyse the arguments most commonly used in favour of compulsory care of BPD patients, to find out in what situations such care is ethically justified. The aim is to guide clinicians when deciding on compulsory care for BPD patients and reduce the use of potentially harmful care. The arguments analysed are (a) the patients lack decision competence, (b) the patients lack authenticity, (c) compulsory care saves the patient from suicide, (d) compulsory care safeguards against litigation, complaints, or doctor's anxiety, (e) compulsory care is a practical solution in emergencies, and (f) it is better for the caregiver to ‘err on the safe side’. We conclude that compulsory care is not ethically justified in most cases unless the clinician has probable reason to believe that the patient lacks decision capacity by suffering from a severe mental co-morbidity and stands to benefit from such care.

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Section: Discussionmentioning

confidence: 99%

Section: Resistance To Changementioning

confidence: 99%

Section: Resistance To Changementioning

confidence: 99%

See 1 more Smart Citation

Is compulsory care ethically justified for patients with borderline personality disorder?

Lundahl,

Helgesson,

Juth

2023

Clinical Ethics

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“…The literature for acute care is smaller than for community care for people with this diagnosis, which is also under researched [ 67 ]. The review included studies that were found in the previous more focused reviews [ 10 , 12 ], but also included a wider range of literature.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reviews examining crisis interventions and services for people with a ‘personality disorder’ diagnosis have limited inclusion criteria to randomised controlled trials (RCTs) or have not included studies reporting outcomes from commonly used crisis service models. A Cochrane review performed in 2022 of crisis interventions designed for people with a ‘personality disorder’ diagnosis found only two studies: a RCT of a brief admission intervention [ 9 ] and a pilot RCT of crisis planning [ 10 , 11 ], both reporting no effect of the study intervention compared to treatment as usual. A systematic review conducted in May 2022 searched for randomised and observational studies of crisis-focused psychosocial interventions for ‘borderline personality disorder’ that can be delivered within acute care and found five studies [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Crisis and acute mental health care for people who have been given a diagnosis of a ‘personality disorder’: a systematic review

Maconick,

Ikhtabi,

Broeckelmann

et al. 2023

BMC Psychiatry

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Background People who have been given a diagnosis of a ‘personality disorder’ need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a ‘personality disorder’ diagnosis using crisis and acute mental health services. Methods We searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a ‘personality disorder’ diagnosis. We performed a narrative synthesis of evidence for each model of care found. Results We screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987–2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty. Conclusion The literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.

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Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial

Lindkvist,

Steen Carlsson,

Daukantaitė

et al. 2024

Nordic Journal of Psychiatry

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Crisis interventions for adults with borderline personality disorder

Abstract: Analysis 1.2. Comparison 1: Joint crisis plan (JCP) plus treatment as usual (TAU) versus TAU alone, Outcome 2: Death: number of deaths during study period (worst-case scenario; sensitivity analysis

Cited by 6 publications

References 87 publications

Is compulsory care ethically justified for patients with borderline personality disorder?

Is compulsory care ethically justified for patients with borderline personality disorder?

Crisis and acute mental health care for people who have been given a diagnosis of a ‘personality disorder’: a systematic review

Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial

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