Dedicated personality disorder services: a qualitative analysis of service structure and treatment process

Background: In response to concerns about the quality of services for people with personality disorder, 11 new community-based services were set up in England. Aims: To identify factors that contribute to high quality care for people with personality disorder from the perspective of different stakeholders. Methods: Qualitative interviews with service users, carers, providers and commissioners of services at each of the 11 sites. Results: Despite marked differences in the structure of the services, key themes emerged concerning their general approach to service delivery. These include the need to combine psychological treatments with social interventions and opportunities for peer support, and the importance of clear boundaries which are shared by service users. Services need to actively involve users both in managing their crises, and in planning future service developments. Differences in the accounts of stakeholders emerged around the assessment process, provision of out-of-hours care, and the range and type of clients dedicated services should try to work with. Conclusions: These data highlight factors which stakeholders believe constitute high quality care for people with PD. Services should pay particular attention to supporting clients during assessment process and developing more effective ways to engage people with high levels of personality disturbance and low levels of motivation to change