Mental health services, care provision, and professional support for people diagnosed with borderline personality disorder: systematic review of service-user, family, and carer perspectives

Background: Mental health professionals’ attitudes to people with Borderline Personality Disorder can be negative. No systematic review to date has examined how service-users and their families experience professional care. Aims: To critically synthesise evidence of service-users’ and families’ subjective experience of mental health care for borderline personality disorder. Methods: Multiple computerised databases were searched using comprehensive terms. All relevant, English language empirical studies were included. We read and critically assessed all papers independently. Study findings were subject to a meta-synthesis. Results: A total of 38 studies were included. Analysis revealed four themes for service-users: assessment and diagnosis; approach of professionals; therapeutic interventions, and service provision; two broad themes for family/carers: support, burden, and information; and experience of professional and therapeutic approaches. Both groups expected to receive professional healthcare, and were clear they valued professionalism, respect, compassion and the therapeutic nature of positive relationships with professionals. Expectations were jeopardised where difficulties with knowledge, communication, information sharing, and support were perceived. Conclusions: Service-users and families/carers should expect to receive high quality, fair and equal care. In light of current evidence, a cultural shift towards more relational, person centred and recovery-focused care could improve experiences.