The personality disorder patient pathway: Service user and clinical perspectives

Abstract

Aims There have been recent policy developments and research into care provision for service users with personality disorder. However, few studies have focused on service user and staff perspectives on how services could be improved. Methods A qualitative study was undertaken in the UK between 2016 and 2017. We conducted six focus groups with clinicians in mental health services with experience of working with people with personality disorder. Using an online survey, we asked current and past service users with personality disorder to describe their experiences of mental health services and make recommendations for improvements. A thematic analysis was conducted. Results Forty‐five clinicians participated in the focus group and 131 service users contributed to the online survey. The main areas of concern identified by both staff and patients were the diagnosis of personality disorder, the absence of a coherent care pathway, access to psychological treatment and staff training. Conclusions The care pathway for individuals with personality disorder is unclear to clinicians and service users, and elements of the pathway are disjointed and not working as effectively as they could. Guidelines recommended by National Institute for Health and Care Excellence are not being followed. Specialist psychological interventions should be available to ensure consistent and stable care provision. © 2019 John Wiley & Sons, Ltd.

Clinical characteristics and care pathways of patients with personality disorder who died by suicide

“…Patients felt that if they had regular contact with services, they would less likely be at risk of self-harm. 13 This finding is consistent with previous research that found that those with no community care had an elevated risk of suicide. 14 Although it may not be feasible in the current economic climate to redesign a service for personality disorder, consideration should be given to offering regular appointments and increasing NHS day care services, which have been shown to have improved outcomes.…”

“…Patients felt that if they had regular contact with services, they would less likely be at risk of self-harm. 13 This finding is consistent with previous research that found that those with no community Criminal justice mental health service Fig. 1 The pattern of referral the year before the patient's death.…”

Effects of diagnostic disclosure and varying diagnostic terminology on social attitudes to personality disorder: An experimental vignette study.

“…People with PD diagnoses frequently report experiences of stigmatization in qualitative and quantitative studies (Bonnington & Rose, 2014; Catthoor, Feenstra, Hutsebaut, Schrijvers, & Sabbe, 2015; Sheehan, Nieweglowski, & Corrigan, 2016; Stalker, Ferguson, & Barclay, 2005). Research with health professionals confirms stigmatizing attitudes and treatment pessimism are common in mental health services (Black et al, 2011; Chartonas, Kyratsous, Dracass, Lee, & Bhui, 2017; Flynn et al, 2019; Lam, Poplavskaya, Salkovskis, Hogg, & Panting, 2016; Lam, Salkovskis, & Hogg, 2016). Negative attitudes to PDs have also been identified in criminal justice contexts (Martin & Thomas, 2015; Smith, Edens, Clark, & Rulseh, 2014).…”

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

“…Internationally, service user activists, professional bodies and policy makers have advocated for better quality services for people with CEN [15][16][17]. Ideally, service improvement should be rooted in evidencebased practice [21,22]. A number of systematic reviews have reported on the trial literature on psychological interventions for people with a borderline personality disorder, including Dialectal Behaviour Therapy (DBT), Mentalisation Based Therapy (MBT), Cognitive Behavioural Therapy (CBT), and psychodynamic therapies, amongst others [23][24][25].…”