When to consider admission

Personality disorder integrated care pathway
NHS Highland

For the reasons outlined in the introduction, careful consideration should be given to alternative services capable of meeting the person’s needs. However, there may be occasions where in-patient admission is the most appropriate course of action. A description of circumstances when admission should be considered should be detailed in the care plan where possible. Care plans should be available in the case notes. Copies of Care Programme Approach plans are also held in the Assessment Suite at New Craigs Hospital.

Situations where consideration may be given to admission when all other options have been explored and deemed less appropriate include:

  • Management of an acute increase in suicide risk (as opposed to chronic suicide risk which is unlikely to be improved, and may be increased by, admission) or other extremely risky behaviour. Important factors to consider are an acute increase in suicidal intent or impulsivity. Tools such as STORM can be useful in identifying an acute increase on chronic baseline risk.
  • Changes to medication which cannot be managed in the community. This may involve rationalisation of polypharmacy more rapidly than could be done as an outpatient.
  • Intensive assessment which cannot be carried out in the community. This may include clarification of diagnosis. Personality disorder can occasionally present similarly to axis 1 disorders but treatment approaches are usually significantly different.
  • Treatment of co-occurring severe mental state disorders.
The short and long term potential benefits of admission should be weighed against the short and long term risks of harm and discussed with the patient. Consideration of admission to hospital must be balanced against the evidence that admission to hospital (especially lengthy admission) may be harmful for many patients with borderline personality disorder, in terms of extending the duration of the disorder and acute symptomatic deterioration. Any existing care plans, for example CPA care plans, should be considered in the decision-making process.