Rep36 Understanding Personality Disorder

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4. Recommendations

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flourish with the commitment of key stakeholders
including Government, Service Users, Primary
Health Care Trusts, Forensic Services, Criminal
Justice Agencies and Social Services.
4.2
Staff from a wide range of services
require training to work with personality
disordered individuals
As has been outlined in this document, people
with personality disorders are difficult to treat,
can induce difficult and complex feelings in
those treating them, and can be harmful to
themselves and/or others. Historically, mental
health services have not perceived treating
people with such problems as part of their core
services. As a consequence, many services either
do not provide any services or only provide non-
specialised services to this client group. Other
agencies too often have little awareness of the
difficulties faced by individuals with personality
disorders. As a result, such clients may receive
inappropriate responses to their difficulties
and/or may be excluded from services. 
The National Institute for Mental Health in
England (NIMHE) have published a capabilities
framework for the development of skills for
working with individuals with personality
disorders (NIMHE, 2003). This framework
provides a useful starting point to consider the
skill mix required within the workforce. There
needs to be a comprehensive training initiative
to raise awareness of the problems experienced
by people with personality disorder. Training
needs to range from basic awareness-raising, to
facilitate appropriate identification of individuals
with personality disorder, through intermediate
training, to develop skills in the management and
treatment of individuals with personality disorder,
to specialist training in clinical management to
develop skills in assessment, formulation,
treatment, consultancy and supervision. 
With the increased focus on personality
disorder in health services, it is essential that all
staff groups, and in particular those training to
be clinical and forensic psychologists, be
equipped to deal with clients with these
problems. Theoretical and practical input on the
assessment and treatment of personality disorder
should become a standard component of all
training programmes. Links between personality
theory and personality disorder should also be
covered. Opportunities for supervised practical
experience should be encouraged as part of
adult mental health placements and specialist
multidisciplinary personality disorder teams will
need to offer specialist placements for trainees of
all disciplines to meet future needs for staff with
appropriate skills in this area. Forensic clinical
psychologists generally have particular expertise
in this area and provide an important resource
in planning and providing services and training.