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Community mental healthcare for people with severe personality disorder: narrative review

  • Bauke Koekkoek (a1), Berno van Meijel (a2) and Giel Hutschemaekers (a3)
Abstract
Aims and method

To assess the contents and the theoretical and empirical base of community mental healthcare (CMHC) for people with severe personality disorder. Medline and PsycINFO databases and handbooks were searched from 1980, as well as a recent meta-analysis and systematic review of trials in which CMHC served as the control condition.

Results

Community mental healthcare is a long-term community-based treatment within a supportive atmosphere, aimed at stability rather than change. Mostly offered by community psychiatric nurses, occupational therapists and social workers, it lacks a formal structure, as well as theoretical underpinnings that guide interventions.

Clinical implications

Community mental healthcare might profit from a more systematic application of effective ingredients from other treatments.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Bauke Koekkoek (b.koekkoek@altrecht.nl)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Bateman, AW, Tyrer, P. Services for personality disorder: organisation for inclusion. Adv Psychiatr Treat 2004; 10: 425–33.
2 Links, PS, Boiago, I, Allnut, S. Understanding and recognizing personality disorders. In Clinical Assessment and Management of Severe Personality Disorders (ed Links, PS): 120. American Psychiatric Publishing, 1996.
3 Andrews, G. The essential psychotherapies. Br J Psychiatry 1993; 162: 447–51.
4 Stone, MH. Personality-disordered Patients. Treatable and Untreatable. American Psychiatric Publishing, 2005.
5 Adshead, G. Murmurs of discontent: treatment and treatability of personality disorder. Adv Psychiatr Treat 2001; 7: 407–15.
6 Leichsenring, F, Leibing, E. The effectiveness of psychodynamic therapy and cognitive behaviour therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003; 160: 1223–32.
7 Binks, CA, Fenton, M, McCarthy, L, Lee, T, Adams, CE, Duggan, C. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2006; issue 1: CD005652.
8 Zanarini, MC, Frankenburg, FR, Hennen, J, Silk, KR. Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years. J Clin Psychiatry 2004; 65: 2836.
9 Dowson, JH, Grounds, A. Personality Disorder: Recognition and Clinical Management. Cambridge University Press, 1995.
10 Craddock, N, Antebi, D, Attenburrow, MJ, Bailey, A, Carson, A, Cowen, P, et al. Wake-up call for British psychiatry. Br J Psychiatry 2008; 193: 69.
11 Lewis, G, Appleby, L. Personality disorder: the patients psychiatrists dislike. Br J Psychiatry 1988; 153: 44–9.
12 Deans, C, Meocevic, E. Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder. Contemp Nurse 2006; 21: 43–9.
13 Newton-Howes, G, Weaver, T, Tyrer, P. Attitudes of staff towards patients with personality disorder in community mental health teams. Aust N Z J Psychiatry 2008; 42: 572–7.
14 Woody, GE, McLellan, AT, Luborsky, L, O'Brien, CP. Sociopathy and psychotherapy outcome. Arch Gen Psychiatry 1985; 42: 1081–6.
15 Linehan, MM, Armstrong, HE, Suarez, A, Allmon, D, Heard, HL. Cognitive-behavioural treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 1991; 48: 1060–4.
16 Stevenson, J, Meares, R. An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry 1992; 149: 358–62.
17 Bateman, A, Fonagy, P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999; 156: 1563–9.
18 Linehan, MM, Schmidt, H, Dimeff, LA, Craft, JC, Kanter, J, Comtois, KA. Dialectical behaviour therapy for patients with borderline personality disorder and drug-dependence. Am J Addict 1999; 8: 279–92.
19 Koons, CR, Robins, CJ, Tweed, JL, Lynch, TR, Gonzalez, AM, Morse, JQ, et al. Efficacy of dialectical behaviour therapy in women veterans with borderline personality disorder. Behav Ther 2001; 32: 371–90.
20 van den Bosch, LM, Verheul, R, Schippers, GM, van den Brink, W. Dialectical Behaviour Therapy of borderline patients with and without substance use problems. Implementation and long-term effects. Addict Behav 2002; 27: 911–23.
21 Chiesa, M, Fonagy, P, Holmes, J, Drahorad, C. Residential versus community treatment of personality disorders: a comparative study of three treatment programs. Am J Psychiatry 2004; 161: 1463–70.
22 Burns, T. An introduction to community mental health teams (CMHTs): how do they relate to patients with personality disorders? In Personality Disorder and Community Mental Health Teams: A Practitioner's Guide (eds Sampson, M, McCubbin, R, Tyrer, P). Wiley, 2006.
23 Keown, P, Holloway, F, Kuipers, E. The prevalence of personality disorders, psychotic disorders and affective disorders amongst the patients seen by a community mental health team in London. Soc Psychiatry Psychiatr Epidemiol 2002; 37: 225–9.
24 Greenwood, N, Chisholm, B, Burns, T, Harvey, K. Community mental health team case-loads and diagnostic case-mix. Psychiatr Bull 2000; 24: 290–3.
25 Sampson, M, McCubbin, R, Tyrer, P (eds). Personality Disorder and Community Mental Health Teams: A Practitioner's Guide. Wiley, 2006.
26 American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry 2001; 158 (suppl): 152.
27 Giesen-Bloo, J, van Dyck, R, Spinhoven, P, van Tilburg, W, Dirksen, C, van Asselt, T, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006; 63: 649–58.
28 Clarkin, JF, Levy, KN, Lenzenweger, MF, Kernberg, OF. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007; 164: 922–8.
29 Gunderson, JG, Gratz, KL, Neuhaus, EC, Smith, GW. Levels of care in treatment. In Textbook of Personality Disorders (eds Oldham, JM, Skodol, AE, Bender, DS): 239–48. American Psychiatric Publishing, 2005.
30 Livesley, WJ. Changing ideas about the treatment of borderline personality disorder. J Contemp Psychother 2004; 34: 185–92.
31 Paris, J. Personality disorders over time: precursors, course and outcome. J Personal Disord 2003; 17: 479–88.
32 Links, PS. Psychiatric rehabilitation model for borderline personality disorder. Can J Psychiatry 1993; 38 (suppl 1): S358.
33 Krawitz, R, Watson, C. Borderline Personality Disorder: A Practical Guide to Treatment. Oxford University Press, 2003.
34 Nehls, N. Being a case manager for persons with borderline personality disorder: perspectives of community mental health center clinicians. Arch Psychiatr Nurs 2000; 14: 12–8.
35 Barton, R. Psychosocial rehabilitation services in community support systems: a review of outcomes and policy recommendations. Psychiatr Serv 1999; 50: 525–34.
36 Twamley, EW, Jeste, DV, Lehman, AF. Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials. J Nerv Ment Dis 2003; 191: 515–23.
37 Ranger, M, Methuen, C, Rutter, D, Rao, B, Tyrer, P. Prevalence of personality disorder in the case-load of an inner-city assertive outreach team. Psychiatr Bull 2004; 28: 441–3.
38 Cohen, K, Edstrom, K, Smith-Papke, L. Identifying early dropouts from a rehabilitation program for psychiatric outpatients. Psychiatr Serv 1995; 46: 1076–8.
39 Ruiz-Sancho, AM, Smith, GW, Gunderson, JG. Psychoeducational approaches. In Handbook of Personality Disorders: Theory, Research and Treatment (ed Livesley, WJ): 460–74. Guilford, 2001.
40 Hoffman, PD, Fruzetti, AE. Psychoeducation. In Textbook of Personality Disorders (eds Oldham, JM, Skodol, AE, Bender, DS): 375–86. American Psychiatric Publishing, 2005.
41 Winston, A, Rosenthal, RN, Muran, JC. Supportive psychotherapy. In Handbook of Personality Disorders: Theory, Research and Treatment (ed Livesley, WJ): 344–58. Guilford, 2001.
42 Appelbaum, A. Supportive psychotherapy. In Textbook of Personality Disorders (eds Oldham, JM, Skodol, AE, Bender, DS): 335–46. American Psychiatric Publishing, 2005.
43 Livesley, WJ. A framework for an integrated approach to treatment. In Handbook of Personality Disorders: Theory, Research and Treatment: 570600. Guilford, 2001.
44 Dawson, D. The therapeutic relationship. In Clinical Assessment and Management of Severe Personality Disorders (ed Links, PS): 161–74. American Psychiatric Publishing, 1996.
45 Aviram, RB, Hellerstein, DJ, Gerson, J, Stanley, B. Adapting supportive psychotherapy for individuals with borderline personality disorder who self-injure or attempt suicide. J Psychiatr Pract 2004; 10: 145–55.
46 Hellerstein, DJ, Rosenthal, RN, Pinsker, H, Samstag, LW, Muran, JC, Winston, A. A randomized prospective study comparing supportive and dynamic therapies. Outcome and alliance. J Psychother Pract Res 1998; 7: 261–71.
47 Piper, WE, Joyce, AS, McCallum, M, Azim, HF. Interpretive and supportive forms of psychotherapy and patient personality variables. J Consult Clin Psychol 1998; 66: 558–67.
48 Rockland, LH. A review of supportive psychotherapy, 1986–1992. Hosp Community Psychiatry 1993; 44: 1053–60.
49 Holmes, J. Supportive psychotherapy. The search for positive meanings. Br J Psychiatry 1995; 167: 439–45.
50 Tyrer, P. Nidotherapy: a new approach to the treatment of personality disorder. Acta Psychiatr Scand 2002; 105: 469–71.
51 Tyrer, P, Sensky, T, Mitchard, S. Principles of nidotherapy in the treatment of persistent mental and personality disorders. Psychother Psychosom 2003; 72: 350–6.
52 Hennessey, M, McReynolds, CJ. Borderline personality disorder: psychosocial considerations and rehabilitation implications. Work 2001; 17: 97103.
53 Appelbaum, AH, Munich, RL. Reinventing moral treatment: the effects upon patients and staff members of a program of psychosocial rehabilitation. Psychiatr Hosp 1986; 17: 11–9.
54 Zanarini, MC, Frankenburg, FR, Hennen, J, Reich, DB, Silk, KR. Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry 2006; 163: 827–32.
55 Gunderson, JG, Bender, D, Sanislow, C, Yen, S, Rettew, JB, Dolan-Sewell, R, et al. Plausibility and possible determinants of sudden ‘remissions’ in borderline patients. Psychiatry 2003; 66: 111–9.
56 Fonagy, P, Bateman, A. Progress in the treatment of borderline personality disorder. Br J Psychiatry 2006; 188: 13.
57 Dawson, D, Macmillan, H. Relationship Management of the Borderline Patient. Brunner Mazel, 1993.
58 Gunderson, JG. Borderline Personality Disorder: A Clinical Guide. American Psychiatric Publishing, 2001.
59 Paris, J. Personality Disorders Over Time. American Psychiatric Publishing, 2003.
60 Lieb, K, Zanarini, MC, Schmahl, C, Linehan, MM, Bohus, M. Borderline personality disorder. Lancet 2004; 364: 453–61.
61 Prosser, D, Johnson, S, Kuipers, E, Szmukler, G, Bebbington, P, Thornicroft, G. Mental health, ‘burnout’ and job satisfaction among hospital and community-based mental health staff. Br J Psychiatry 1996; 169: 334–7.
62 Onyett, S, Pillinger, T, Muijen, M. Job satisfaction and burnout among members of community mental health teams. J Ment Health 1997; 6: 5566.
63 Tyrer, P, Al Muderis, O, Gulbrandsen, D. Distribution of case-load in community mental health teams. Psychiatr Bull 2001; 25: 10–2.
64 Bateman, AW, Fonagy, P. Effectiveness of psychotherapeutic treatment of personality disorder. Br J Psychiatry 2000; 177: 138–43.
65 Gallop, R, O'Brien, L. Re-establishing psychodynamic theory as foundational knowledge for psychiatric/mental health nursing. Issues Ment Health Nurs 2003; 24: 213–27.
66 Sampson, MJ. The challenges community mental health teams face in their work with patients with personality disorders. In Personality Disorder and Community Mental Health Teams: A Practitioner's Guide (eds Sampson, M, McCubbin, R, Tyrer, P): 221–40. Wiley, 2006.
67 Krawitz, R. Borderline personality disorder: attitudinal change following training. Aust N Z J Psychiatry 2004; 38: 554–9.
68 Hazelton, M, Rossiter, R, Milner, J. Managing the ‘unmanageable’: training staff in the use of dialectical behaviour therapy for borderline personality disorder. Contemp Nurse 2006; 21: 120–30.
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Community mental healthcare for people with severe personality disorder: narrative review

  • Bauke Koekkoek (a1), Berno van Meijel (a2) and Giel Hutschemaekers (a3)
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