Specialist personality disorder services in England: a case for managed clinical networks?

Norton, Kingsley; Lousada, Julian; Healy, Kevin

doi:10.1192/pb.29.10.365

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…As a member of the Expert Advisory Group who 'wrote' the document and leader of its training subgroup, I can confirm that it was quite the opposite. Perhaps a failing of the policy guidance was that it had not prescribed a precise role for such units, in relation to relevant secondary tier and forensic services (Norton, Lousada, & Healy, 2005).…”

Section: Unanticipated Effects Of Past Policies On Service Deliverymentioning

confidence: 99%

Understanding failures of NHS policy implementation in relation to borderline personality disorder: Learning lessons and moving towards an authentic person-centred service

Norton

2009

Psychodynamic Practice

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Despite an increasing number of policies and guidelines relating to psychological therapies within the NHS, there is little clear evidence of many of the intended benefits actually accruing from their implementation. Drawing on the work of Tom Main and others, this paper examines some of the emotional and unconscious factors, in both staff and patients, which determine the fate of policies and specifically the extent to which they become authentically embedded within a hospital system. Unanticipated or unintended effects of past policy implementation in relation to borderline personality disorder are discussed in the context of secondary and tertiary level NHS psychotherapy services. These effects include the risk that the latter services become sidelined by cheaper initiatives and interventions at primary care level, irrespective of the evidence base in relation to borderline personality disorder. Given the financial and human costs of policy failure, the paper proposes a significant and active role for psychodynamic psychotherapists in promoting a more thoughtful approach to local policy implementation so as to lead toward a service that is genuinely patient-centred.

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Section: Unanticipated Effects Of Past Policies On Service Deliverymentioning

confidence: 99%

Understanding failures of NHS policy implementation in relation to borderline personality disorder: Learning lessons and moving towards an authentic person-centred service

Norton

2009

Psychodynamic Practice

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“…41 In England and Wales, multiple-agency public protection panels have been introduced by legislation to further the aim of managing the risk to the general public from convicted sexual and violent offenders. 42 The arrangements also encompass those convicted of certain offences who are subject to hospital orders or guardianship, either under the Mental Health Act 1983 or after being found to be under disability.…”

Section: Multi-disciplinary Agency Co-operationmentioning

confidence: 99%

“…In 2003, the National Institute for Mental Health in England published a paper entitled ''Personality Disorder: No Longer a Diagnosis of Exclusion'', which recommended establishing specialist multidisciplinary teams linked within the local multi-agency services to meet the needs of patients with personality disorders. 41 In England and Wales, multiple-agency public protection panels have been introduced by legislation to further the aim of managing the risk to the general public from convicted sexual and violent offenders. 42 The arrangements also encompass those convicted of certain offences who are subject to hospital orders or guardianship, either under the Mental Health Act 1983 or after being found to be under disability.…”

Section: Multi-disciplinary Agency Co-operationmentioning

confidence: 99%

Interventions to Address Violence Associated with Mental Illness

Scott

2008

Australas Psychiatry

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The necessary elements of intervention to reduce violence by the mentally ill are holistic care, access to services and, where necessary, legal leverage. In the custodial setting, this includes screening, early intervention and treatment in prison, and assertive post-release case management to divert mentally ill offenders away from substance use and to support their return to the community. In the community setting, active case management, including access to inpatient beds and co-ordination between mental health services and other agencies, is crucial to providing continuity of care for patients at risk of violence in the community.

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Personality disorder service provision: a review of the recent literature

Evans

Sethi²,

Dale

et al. 2017

MHRJ

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Purpose The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003. Design/methodology/approach A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken. Findings The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population. Research limitations/implications The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour. Originality/value This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

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Specialist personality disorder services in England: a case for managed clinical networks?

Cited by 3 publications

References 23 publications

Understanding failures of NHS policy implementation in relation to borderline personality disorder: Learning lessons and moving towards an authentic person-centred service

Understanding failures of NHS policy implementation in relation to borderline personality disorder: Learning lessons and moving towards an authentic person-centred service

Interventions to Address Violence Associated with Mental Illness

Personality disorder service provision: a review of the recent literature

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