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Personality disorder: challenges in service development in the light of the new NICE guidelines

  • Christopher Garrett (a1), Tennyson Lee (a2), Samantha Blackburn (a2), Leanne Priestly (a1) and Kamaldeep Bhui (a3) (a4)...
Abstract
Aims and method

Using the National Institute for Health and Clinical Excellence (NICE) guidelines on borderline personality disorder as a framework, we describe the profile of the first 100 individuals referred to a personality disorder service in London, captured through the use of record review and case study.

Results

The referral population ethnic profile does not match the wider population of the borough; a third of the borough is Bangladeshi, but only 9% of those referred to the service are. Of those diagnosed with borderline personality disorder and on psychotropic medications, only one person had a clear current indication based on NICE guidelines. Of the 100 individuals who were referred to the service, a quarter were accepted to the programme; a third either did not want to proceed with the assessment or were unprepared for an intensive programme.

Clinical implications

The under-representation of Black and minority ethnic individuals in referrals in the peresonality disorder service needs to be actively addressed. Interventions are required to support psychiatrists in reviewing their prescribing practice regarding individuals with borderline personality disorder. Access to the service needs to be improved.

Copyright
Corresponding author
Tennyson Lee (tennyson.lee@eastlondon.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 National Institute for Health and Clinical Excellence. Borderline Personality Disorder: Treatment and Management (CG78). NICE, 2009.
2 Bateman, A, Fonagy, P. Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford University Press, 2004.
3 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.
4 Bateman, A, Fonagy, P. Treatment of borderline personality disorder with psychoanalytically orientated partial hospitalisation: an 18 month follow up. Am J Psychiatry 2001; 158: 3642.
5 Bateman, A, Fonagy, P. Health service utilisation costs for borderline personality disorder with psychoanalytically orientated partial hospitalisation versus general psychiatric care. Am J Psychiatry 2003; 160: 169–71.
6 Bateman, A, Fonagy, P. 8-year follow-up of patients treated for borderline personality disorder: mentalisation-based treatment versus treatment as usual. Am J Psychiatry 2008; 165: 631–8.
7 Bateman, A, Fonagy, P. Mentalization-Based Treatment for Borderline Personality Disorder A Practical Guide. Oxford University Press, 2006.
8 Morant, N, King, J. A multi-perspective evaluation of a specialist outpatient service for people with personality disorders. J Forens Psychiatry Psychol 2003; 14: 4466.
9 Pretorius, JL, Albeniz, A. Learning experience from the Coventry Community Personality Service. Br J Forens Practice 2006; 8: 3440.
10 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization, 1992.
11 Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766–71.
12 Office for National Statistics. 2001 Census. ONS (http://www.statistics.gov.uk/census2001/access_results.asp).
13 Bhui, K, Bhugra, D, Goldberg, D, Dunn, G, Desai, M. Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner. Psychol Med 2001; 31: 815–25.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Personality disorder: challenges in service development in the light of the new NICE guidelines

  • Christopher Garrett (a1), Tennyson Lee (a2), Samantha Blackburn (a2), Leanne Priestly (a1) and Kamaldeep Bhui (a3) (a4)...
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