Personality disorder services in England: findings from a national survey

Abstract

Aims and method We aimed to evaluate the availability and nature of services for people affected by personality disorder in England by conducting a survey of English National Health Service (NHS) mental health trusts and independent organisations.Results In England, 84% of organisations reported having at least one dedicated personality disorder service. This represents a fivefold increase compared with a 2002 survey. However, only 55% of organisations reported that patients had equal access across localities to these dedicated services. Dedicated services commonly had good levels of service use and carer involvement, and engagement in education, research and training. However, a wider multidisciplinary team and a greater number of biopsychosocial interventions were available through generic services.Clinical implications There has been a substantial increase in service provision for people affected by personality disorder, but continued variability in the availability of services is apparent and it remains unclear whether quality of care has improved.

The personality disorder patient pathway: Service user and clinical perspectives

“…Improving access to services and delivering better outcomes for people with personality disorder were central to the policy document ‘Personality Disorder: No Longer a Diagnosis of Exclusion’, which reiterated findings that those with personality disorder often faced a revolving door within services, and owing to insufficient training, resources and skills clinicians were reluctant to work with those with personality disorder. Since this publication, access to care and dedicated personality disorder services in England has significantly improved . However, just under half of the National Health Service (NHS) mental health trusts and independent organizations stated that patients did not have equal access to dedicated personality disorder services owing to their area of residence .…”

A preliminary service evaluation of a personality disorder case management service

“…Through our role of gate keeper, we were aware that previously, our Trust referred the most complex service users out of area. The national pattern across the UK is likely similar, despite most Trusts declaring some level of specialized PD services . However, NHS England's Five Year Forward Plan is to eliminate inappropriate OATs by 2021, through promoting accessible high‐quality care in the least restrictive setting as close to home as possible .…”

“…This growing evidence has spurred the development of specialist community services for PD. A survey within the English NHS found that there had been a fivefold increase in organizations with dedicated PD services between 2002 and 2015, but despite 84% of organizations having a PD service, it remained unclear if the quality of care had improved . Similarly, Tulloch et al .…”

“…A survey within the English NHS found that there had been a fivefold increase in organizations with dedicated PD services between 2002 and 2015, but despite 84% of organizations having a PD service, it remained unclear if the quality of care had improved. 21 Similarly, Tulloch et al reported little evidence of benefit (effectiveness, safety, patient centeredness and the costs) when community services were reorganized to focus on care pathways for PD. 22 This paper is an interim study, 12 months after establishing a local specialist community-based PD team, to examine the impact in terms of people being sent out of area (OATs), use of local psychiatric bed days and crisis contacts.…”

Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008–2017

“…This has included negative attitudes from some healthcare workers (Dickens, Lamont, & Gray, ), and reports that some people with this diagnosis have had their distress dismissed (Bonnington & Rose, ) have been treated disrespectfully (Lawn & McMahon, ) and treated as a label rather than an individual (Veysey, ). In the UK, this has meant that despite expansion in the provision of specialist services over the last 15 years (Dale et al., ), and the lack of consistent high quality care has recently prompted a government sponsored consensus statement to improve treatment experiences (Lamb, Sibbald, & Stirzaker, ).…”