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Specialist services for personality disorders

Our research has helped put personality disorders firmly on policy-makers’ agendas and has helped make specialist services available within the NHS.

5 Specialist services for personality disorders
People with a personality disorder are more likely to develop other serious mental health problems, more likely to take their own life, and more likely to experience physical health problems.

About four in every 100 people have a personality disorder. Until recently most mental health trusts didn’t run services specifically for people with a personality disorder and many health professionals did not have the necessary skills to offer appropriate support.

Research carried out by Dr Paul Moran in our Department of Health Service and Population Research has helped put the diagnosis firmly on policy-makers’ agendas and contributed to a programme of work that has resulted in specialist personality disorder services becoming routinely available within the NHS.

Our researchers carried out a series of studies to find out more about personality disorders, demonstrating the large number of people with the disorder. The research included a survey of GP patients that showed nearly a quarter of them (24 per cent) had a personality disorder and visited the surgery more frequently and more spontaneously than other patients.

Their work was cited in Personality disorder: no longer a diagnosis of exclusion, published in 2003 by the then National Institute for Mental Health in England and the springboard for the National Personality Disorder Development Programme, which ran until 2011.

Thereafter, services for personality disorders were developed and various training initiatives for health professionals were launched. Dr Moran was involved in the evaluation of government-funded pilot services for men with a personality disorder who had a history of, or were at high risk of, offending. He was also part of a research team that evaluated the effectiveness of 11 pilot specialist community-based services for people with a personality disorder.

Evidence from this work was used in National Institute for Health and Care Excellence (NICE) guidelines about antisocial personality disorder and borderline personality disorder, published in 2009.

Dr Moran has also developed a short screening questionnaire that allows health professionals to identify people who potentially have a personality disorder and refer them on to specialist services where a detailed assessment can be undertaken. The Standard Assessment of Personality Abbreviated Scale (SAPAS) has just eight questions, takes five minutes to complete and has been translated into Danish, French, Spanish and Japanese.

Dr Moran continues to evaluate the success of new treatments for personality disorders, including investigating whether forward planning in the shape of ‘joint crisis plans’ could help people with borderline personality disorder stop self-harming. He is also part of a Nottingham-led team evaluating the success of giving people information about their personality disorder alongside therapy to help them solve everyday problems.

Research led by Dr Paul Moran

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References

• Coid J et al. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry, 2006; 188: 423-31

• Moran P et al. The prevalence of personality disorder among UK primary care attenders. Acata Psychiatr Scand, 2000; 102(1): 52-57

• Moran P et al. The impact of personality disorder in UK primary care: a 1-year follow-up of attenders. Psychol Med 2001; 31(8): 1447-1454

• Rendu A et al. Economic impact of personality disorders in UK primary care attenders. Br J Psychiatry, 2002; 181: 62-66

• Moran P et al. Does co-morbid personality disorder increase the risk of suicidal behaviour in psychosis? Acta Psychiatrica Scandinavica, 2003; 107(6): 441-448

• Moran P et al. Personality disorder and cardiovascular disease: results from a national household survey. Journal of Clinical Psychiatry, 2007; 68 1: 69-74

• Hesse M et al. Screening for personality disorder with the Standardised Assessment of Personality; Abbreviated Scale (SAPAS): further evidence of concurrent validity. BMC Psychiatry, 2010 Jan 28; 10: 10

• Fortune Z et al. An evaluation of new services for personality disordered offenders: staff and service user perspectives. Int J Soc Psychiatry, 2010 Mar; 56(2): 186-95

• Borschmann R, Barrett B, Hellier J, Byford S, Henderson C, Rose D, Slade M, Sutherby K, Szmukler G, Thornicroft G, Hogg J, Moran P. Randomised controlled trial of joint crisis plans for people with borderline personality disorder: feasibility and outcomes. British Journal of Psychiatry, 2013; 202, 357-364, doi: 10.1192/bjp.bp.112.117762

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