Search results for ‘Subject term:"personality disorders"’ Sort:
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Personality disorder service provision: a review of the recent literature
- Authors:
- EVANS Sacha, et al
- Journal article citation:
- Mental Health Review Journal, 22(2), 2017, pp.65-82.
- Publisher:
- Emerald
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. (Publisher abstract)
Is contact with adult mental health services helpful for individuals with a diagnosable BPD? A study of service users views in the UK
- Authors:
- MORRIS Charlotte, SMITH Ian, ALWIN Nic
- Journal article citation:
- Journal of Mental Health, 23(5), 2014, pp.251-255.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Aims: This study explores the experiences of individuals with a diagnosis of BPD in accessing adult mental health services and aims to better understand which aspects of contact with services can be helpful or unhelpful. Methods: Nine service users with a diagnosable BPD were recruited through voluntary sector services in England. Semi-structured interviews were used and interview data was analysed using an inductive thematic analysis. Results: Three themes were generated including “The diagnostic process influences how service users feel about BPD”, “Non-caring care” and “It’s all about the relationship”. Conclusion: The participants’ accounts identify a number of practical points which services could implement to improve the experiences of service users. (Edited publisher abstract)
Dedicated community-based services for adults with personality disorder: Delphi study
- Authors:
- CRAWFORD Mike J., et al
- Journal article citation:
- British Journal of Psychiatry, 193(10), October 2008, pp.342-343.
- Publisher:
- Cambridge University Press
Dedicated community-based services have been recommended for people with personality disorder, but little is known about how such services should be configured. Delphi survey assesses opinions about this. A panel of expert authors, service providers and service users agreed on only 21 (39%) of 54 statements on the organisation and delivery of care. Consensus was not reached on important issues such as working with people with a history of violent offending, the role of community outreach and the use of compulsory treatment. Further work needs to be undertaken before the optimal organisation of dedicated personality disorder services can be agreed.
A pilot personality disorder outreach service: development, findings and lessons learnt
- Authors:
- LEE Tennyson, et al
- Journal article citation:
- Psychiatric Bulletin, 32(4), April 2008, pp.127-130.
- Publisher:
- Royal College of Psychiatrists
This describes the development of a pilot personality disorder outreach service. A case series of 13 patients was studied. Data were collected using pro forma, semi-structured interviews and a structured assessment of personality disorder. All personality disorder clusters were represented among the 13 patients. Treatment recommendations usually supported the existing approach – the ‘added value’ of the outreach service was that difficult interpersonal dynamics could be considered and thought through with an objective observer. Opinions differed on whether the service was more useful for the assessment and brief treatment or continuing care teams. Personality disorder services need to develop expertise in all clusters. There is a need to moderate the harsh self-critical attitudes of the care coordinators. The national framework for personality disorder is useful for service development, but the services need to be tailored to the individual needs of specific teams.
An agitation of contrary opinions
- Author:
- TYRER Peter
- Journal article citation:
- British Journal of Psychiatry, 190(Supplement 49), May 2007, pp.s1-s2.
- Publisher:
- Cambridge University Press
Those people who are dangerous often have personality disorders. Should these individuals be dealt with by criminal justice or mental health services? England (note not Scotland) has taken the mental health route with the Dangerous and Severe Personality Disorder Programme. Is this bold move wise or foolish? To answer this question we have both evidence and opinion – neither is conclusive.
Dangerous and severe personality disorder: antecedents and origins
- Author:
- MADEN Anthony
- Journal article citation:
- British Journal of Psychiatry, 190(Supplement 49), May 2007, pp.s8-s11.
- Publisher:
- Cambridge University Press
The origins of the Dangerous and Severe Personality Disorder (DSPD) Programme can be traced to developments in structured assessment and services for the cognitive–behavioural treatment of sexual and violent offenders in other countries. A comparison with these other services highlights the strengths and weaknesses of DSPD. The decision to use a medical model raises ethical and financial questions that may jeopardise the Programme's future.
Specialist personality disorder services in England: a case for managed clinical networks?
- Authors:
- NORTON Kingsley, LOUSANA Julian, HEALY Kevin
- Journal article citation:
- Psychiatric Bulletin, 29(10), October 2005, pp.365-368.
- Publisher:
- Royal College of Psychiatrists
Managed clinical networks are rare among mental health services, although there have been strong advocates of their use, including in relation to personality disorder. Of themselves, these networks would not be a panacea for personality disorder; however, they could have a role (particularly in complex cases) where treatment involves primary, secondary and tertiary services or where multiprofessional or multi-agency services are involved, as, for example, with much antisocial personality disorder. Managed clinical networks ‘provide the opportunity for professional collaboration across existing boundaries, real or imagined.
A two-model integrated personality disorder service: effect on bed use
- Authors:
- JONES Barry, JUETT Georgia, HILL Nathan
- Journal article citation:
- Psychiatrist (The), 36(8), August 2012, pp.293-298.
- Publisher:
- Royal College of Psychiatrists
A study assessed the impact on psychiatric inpatient bed use of a new personality disorder service in South London using 2 psychoanalytical models: mentalisation-based treatment and the provision of service user network groups (using therapeutic community principles with coping process and psychoanalytical theories). The number of psychiatric bed days used by patients attending the open-access service user groups or 2 or 3 day mentalisation-based treatment programmes was collated using the electronic patient record system, and bed use in the 6 months and 12 months before starting treatment was compared with bed use in the same periods after starting treatment. Statistical analysis showed bed use to be significantly reduced by treatment, with the reduction maintained at 12 months. There was no significant difference in bed use between patients attending the mentalisation-based treatment and those attending the service user network project at 6 months. The authors present detailed findings and discuss their implications.
Innovations in user involvement: the development and evaluation of a preparatory training package for service user representatives
- Author:
- BALLS Makala
- Journal article citation:
- Mental Health and Learning Disabilities Research and Practice, 7(1), Spring 2010, pp.77-91.
- Publisher:
- South West Yorkshire Mental Health NHS Trust and University of Huddersfield
The role that service users can play in improving health care delivery has been a key aspect of policy making since the 1990s. However, research has highlighted that poor preparation and lack of appropriate skills may be a barrier to effective and credible implementation of user involvement in mental health services. The aim of this paper is to describe the development and evaluation of a training package delivered to members of a service user reference group to enable them to contribute to staff training aimed at improving attitudes towards borderline personality disorder. The training comprised eight 3 hour sessions over a period of approximately 5 months and was focused around topics such as presentation skills and self-disclosure. The training was evaluated by means of semi-structured individual interviews conducted with 6 participants who had received the training package. An analysis of the participants’ comments revealed 6 key themes: personal and professional gains; importance of team work; satisfaction with teaching; lack of organisation; difficulties with communication; and recruitment issues. All the participants rated the training package very highly, but inappropriate recruitment of user representatives and a lack of funding and subsequent consistent practical support were cited as barriers to effective user involvement. The article concludes that careful selection and training of user representatives is vital to maximise the efficacy of user involvement. Further robust comparative research is required to demonstrate the usefulness of user involvement.
Recognising complexity: commissioning guidance for personality disorder services
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2009
- Pagination:
- 64p., bibliog.
- Place of publication:
- London
Practice guidance for commissioners in the NHS, criminal justice system, local authorities and others, to help them improve outcomes for people with personality disorders. The document provides information and suggestions on best practice drawn from pilot services and from service users. The document is organised in four sections which provide information on: an overview of the broad context; key areas for effective commissioning; commissioning dedicated personality disorder services; and commissioning for groups with particular needs.