Rep36 Understanding Personality Disorder

4.1.1 Government Policy and Service
Development
The National Institute for Mental Health in
England (NIMHE) recently published guidelines
for the treatment of personality disorders
(NIMHE, 2003), which have been well received.
There is a welcome focus in the guidelines upon
the inclusion of those with personality disorders
within core mental health services and
recognition that personality disorders are
treatable conditions. The guidelines recognise
that people with personality disorders present to
services as complex and emotionally difficult
individuals. They often produce feelings of
anxiety, anger, helplessness or confusion in staff
trying to assess their needs. This has resulted in a
tendency to exclude these individuals from active
treatment and to respond to their needs in crisis.
Many individuals with personality disorder avoid
services either because they do not receive an
appropriate response or because they only
present when in acute emotional distress and
then disengage when that distress resolves.
Therefore, for many reasons both to do with the
services and the individual, those with
personality disorders have been difficult to
engage and treat. The guidelines recommend
the formation of specialist personality disorder
teams that could be an important bridge
between services and individuals with personality
disorder. Such teams could promote a longer-
term approach to treatment, stressing the need
to develop care packages aimed at preparing the
individual for treatment, the delivery of a
treatment package and support following
treatment. However, not all individuals with
personality disorders are able to engage in a
treatment process. These individuals may present
significant risks to themselves or others and need
intervention from mental health services.
Therefore, it will be necessary to develop the
skills of staff within health, social care and
criminal justice agencies to recognise, support
and manage these individuals in a positive and
constructive manner. Specialist personality
disorder teams could have a positive impact
upon the treatment of individuals with personality
disorder providing the service model includes: 
I
Clear inclusion/exclusion criteria and care
pathways; 
I
A clear, coherent, evidence based therapeutic
model of personality disorder;
I
A circumscribed therapeutic role for some
referred clients;
I
Residential and non-residential facilities;
I
A strong assessment, training and
consultancy role to enable general services to
contain the majority of people in a locality
with personality disorder.
The changes to working practices that would
result from the development of specialist
personality disorder services are likely to result
in an increased demand for psychological
services. Psychologists have particular skills in
assessment and formulation that would be
invaluable to any specialist multidisciplinary
personality disorder team. However, the services
outlined in this document can only develop and