New Position Paper: Development of Services for Treatment of Personality Disorder in Adult Mental Health Services
Newly published position paper titled Development of Services for Treatment of Personality Disorder in Adult Mental Health Services outlines how development of specialised services is vital in the care of vulnerable people with complex mental health needs.
A lack of dedicated services for people with personality disorders is leaving individuals diagnosed without access to treatments that would greatly support their quality of life, and pushing them further to the margins of our health service and society as a whole.
To begin a conversation toward establishing a more robust system of care for those affected by these disorders, a dedicated special interest group within the College of Psychiatrists of Ireland has published a position paper that identifies the level of unmet need in Ireland and make recommendations for the future development and improvement of services.
Individuals diagnosed with personality disorders experience enduring difficulties in their ways of thinking, feeling, and behaving. These negatively effect their ability to function in everyday life and often causing significant distress.
“It is estimated that a diagnosis of borderline personality disorder features in up to 20% of clinical presentations to mental health outpatient clinics in Ireland.”
Often further co-occurring mental health needs present, such as addiction, depression or anxiety, with those with personality disorder having a higher likelihood of emergency presentations and suicidality. The wider effects on people’s lives and on society as a whole can be also seen: higher health service utilisation, poorer physical health outcomes, interactions with the criminal justice system and greater economic toll. Delivering evidence-based treatments as a first line for people with personality disorders would help to alleviate significant harm for both the individual and costs for health services.
The position paper looks to begin with the following four key actions:
- Identify the prevalence and level of unmet need of personality disorders in Ireland, with a focus on adult mental health services.
- Review the scientific evidence on treatments for personality disorders and international treatment guidelines and treatment guidelines.
- Establish the current level of service provision for personality disorder in Ireland.
- Make recommendations to the Health Service Executive and College of Psychiatrists of Ireland for the further development of personality disorder treatment in Ireland.
In support of their aim of improving service provision, the Personality Disorder Special Interest Group has previously conducted a survey of College members which sought to identify existing service offerings in adult mental health services for the treatment of personality disorders. Only 57% of respondents stated that they had an evidence based treatment in their service while a worrying 9% of respondents were unaware of any specific interventions offered. Nearly half of respondents identified a lack of resources as the main obstacle to delivering an appropriate service for people with personality disorder.
The group also hopes for greater collaboration with service users in the design and delivery of services that support patient autonomy and choice, hope and trusting therapeutic relationships between patient and clinician.
Despite the existence of several well-evidenced and cost-effective treatments for personality disorders, the newest mental health policy for Ireland, ‘Sharing the Vision: A Mental Health Policy for Everyone’, which was launched in 2022, does not specifically refer to pathways or services for those with personality disorders at all.
To address the concerning lack of treatments for personality disorders on offer in Irish mental health services, the paper makes the following recommendations:
- Implementation of the recommendation of ‘A Vision for Change’ to provide both localised and specialist services including evidence-based treatments of people with personality disorders, and to further commission a National Clinical Programme for personality disorders to further develop the provision of services within Ireland.
- The establishment and funding of specialist consultant medical psychotherapist posts that will in turn provide the expertise and leadership necessary to manage specialist personality disorder services.
- To ensure the expectation that services for people with personality disorders will be offered throughout the country and not just in a few locations or pilot sites.
- To develop a wider educational programme about personality disorders, broadening knowledge and awareness of personality disorder within the health service more broadly and also associated agencies such as social care and the criminal justice system.
- The establishment of a mechanism that would include the patient voice in the development training and services.