Community mental health teams

Personality disorder integrated care pathway
NHS Highland

People with personality disorder make up a significant component of the clinical load of CMHTs. This will include people with a primary problem of personality disorder and people with other mental disorders whose treatment may be made more challenging by coexisting personality disorder or whose personality functions as a contributing factor to other mental disorders. Most people with personality disorder in mental health services receive their treatment from generalist rather than specialist services and this is likely always to be the case.

The value of a multidisciplinary team approach in treating personality disorder cannot be over-estimated and increasing evidence is emerging which suggests that generalist multi-disciplinary care based upon a shared psychologically-informed care plan can be as effective as specific psychological treatments for personality disorder. In some instances it may be clinically indicated to limit the number of professionals involved with a patient at any one time. In all cases, it is of real importance that someone in the team functions as a caseholder, keyworker or point of contact, and maintains an overview of the persons care and treatment, ideally for the duration of their involvement with the team.

Over the past decade or so, documents such as the report “Personality Disorder in Scotland: Demanding Patients or Deserving People” (Scottish Executive Mental Health Division and Centre for Change and Innovation, 2004) have emphasised that no one should be excluded from services solely on the basis of a diagnosis of personality disorder. While such exclusion did unfortunately happen in the past, this practice is now regarded as absolutely unacceptable, not least because of the ever-increasing evidence base of effective treatments for personality disorder.

The most recent version of this document was published in 2018, available here: Personality Disorder in Scotland: Demanding Patients or Deserving People?