Crisis resolution home treatment team Clinicians' perceptions of using a recovery approach with people with a diagnosis of borderline personality disorder

Abstract

Accessible Summary What is known on the subject? It is known that people with a diagnosis of borderline personality disorder often experience crises in their mental wellbeing. There is little evidence about the approaches of mental health nurses in community‐based crisis teams when working with people with a diagnosis of BPD. What the paper adds to the existing knowledge? This paper highlights that limited resources, work‐patterns and issues of stigma present challenges to delivering recovery‐oriented care. The paper highlights that nurses typically try to navigate the challenges to continue to provide individualized care, though their self‐assessment is that this is with mixed success. What are the implications for practice? The findings suggest that support is needed to develop brief interventions specific to teams working with people with a diagnosis of BPD who are at a point of crisis. Abstract IntroductionPeople with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis, and in the UK, this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated; however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research AimTo understand the perceptions held by CRHTT clinicians about their provision of recovery‐orientated acute care, for people with a diagnosis of BPD. MethodFrom a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. ResultsFive themes emerged: person‐centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. DiscussionThe results demonstrate tensions between a drive to deliver person‐centred care and a range of challenges that inhibit this, with the possibility of reframing a recovery approach as “recovery‐ready”. Implications for PracticeA whole‐system approach is required to enable a consistent recovery‐oriented approach, but research is also needed for brief interventions specific to this context.

Accompanying mental health problems at home: Preliminary data from a crisis resolution and home treatment team in Catalonia

“…The responsibility has been shared between the person, the family, and the professionals, helping to contain the crisis and fostering a greater coping capacity. Previous research has highlighted that risk management in a crisis is an understandable source of stress for clinicians in CRHTTs (Lombardo et al, 2019), and teamwork is essential to tolerate it (Taylor et al, 2022). Teamwork and joint home visits where two professionals were always present, one of them being the mental health nurse, implied a more flexible professional role.…”

“…Continuity of care with the same professionals also may have played a notable role in the results. As a study on home care for people with BPD points out, the therapeutic relationship can be hard to build when the person must see different professionals (Taylor et al, 2022). The CRHTT staff was very reduced, so the same professionals cared for the person in crisis during the home treatment duration, facilitating the therapeutic alliance.…”

Peer support for borderline personality disorder: A critical review of its feasibility, acceptability, and alignment with concepts of recovery.

“…Five articles provided practice recommendations for promoting BPD recovery (Bowen, 2013; Bradbury, 2016; Langley & Klopper, 2005; Nehls, 2000; Taylor et al, 2023). Four included empirical data, namely interviews with clinicians (Bowen, 2013; Taylor et al, 2023), people with BPD (Bradbury, 2016), or a combined clinician and patient sample (Langley & Klopper, 2005), and one was theoretical (Nehls, 2000). Recovery-oriented care was consistently described as built on genuine understanding and acceptance of the patient’s circumstances, lived experiences, strengths, and capabilities; elevating self-determination and autonomy; and being built on mutual trust.…”

“…Defining "Recovery-Oriented Practice." Five articles provided practice recommendations for promoting BPD recovery (Bowen, 2013;Bradbury, 2016;Langley & Klopper, 2005;Nehls, 2000;Taylor et al, 2023). Four included empirical data, namely interviews with clinicians (Bowen, 2013;Taylor et al, 2023), people with BPD (Bradbury, 2016), or a combined clinician and patient sample (Langley & Klopper, 2005), and one was theoretical (Nehls, 2000).…”

A qualitative investigation of crisis cafés in England: their role, implementation, and accessibility

“…In England, the principal type of crisis service supported by policy over the past 20 years has been the crisis resolution and home treatment team, providing assessment and intensive treatment mainly in patients’ homes [13]. Even though many service users value the option of treatment at home, it is clear that these teams do not meet a full range of service user needs in crisis: they are intended to be narrowly focused on crises of a severity close to the threshold for hospital admission, and service users, especially those with a “personality disorder” diagnosis, often report that their needs for a readily accessible service in which they are able to form good therapeutic relationships with staff who have time to talk are not met [11, 14]. Crisis care improvement is currently a key policy target in England, with an aim that people should have access to good quality mental health crisis care ‘around the clock, 365 days a year’ [15, 16].…”