Treatment and Management

Personality disorder integrated care pathway
NHS Highland

Evidence is emerging that structured multidisciplinary treatment based upon a sound formulation can be of equal benefit to specific psychotherapies in the treatment of personality disorder. CMHTs are well placed to enable the continuity of care which is so important in maintaining consistency in the treatment of personality disorder, and to oversee the treatment plan over the longer term.

As well as this more general approach, all CMHTs should be regularly delivering STEPPS groups for patients with borderline personality disorder and similar difficulties (see Psychosocial Section). CMHTs can usefully deliver focused preparatory work for STEPPS groups in the period between referral to the team and the start of the next STEPPS group, for example anxiety management strategies for people who experience anxiety in group settings.

Aside from treatment directed towards personality disorder itself, community teams play a vital role in wider treatment and management including treatment of comorbidity, management and monitoring of medication and environmental management. Any treatment offered by the team should be focused and time-limited (although perhaps of long duration). At any given time, both the clinician and the patient should be absolutely clear about the nature and purpose of the work they are undertaking. Open-ended, unstructured contact should be avoided as this may encourage unhelpful dependence.

If a patient is unwilling to engage in their treatment plan, motivation work may be indicated. However, sometimes, despite motivational strategies, a patient may still decide that they do not wish to engage in treatment at that time. In these cases, it may be less harmful to discharge a patient rather than engage in unfocused, unstructured, dependence-inducing contact.