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Personality disorder service provision: a review of the recent literature

Sacha Evans (West London Mental Health NHS Trust, London, UK)
Faisil Sethi (South London) (Maudsley NHS Foundation Trust, London, UK)
Oliver Dale (West London Mental Health NHS Trust, London, UK)
Clive Stanton (Prince of Wales Hospital, Eastern Suburbs Mental Health Service, Sydney, Australia) (University of New South Wales, Sydney, Australia)
Rosemary Sedgwick (South London) (Maudsley NHS Foundation Trust, London, UK)
Monica Doran (West London Mental Health NHS Trust, London, UK)
Lucinda Shoolbred (West London Mental Health NHS Trust, London, UK)
Steve Goldsack (Medway Engagement Group and Network, Chatham, UK)
Rex Haigh (Department of Sociology and Social Policy, Nottingham University, Nottingham, UK)

Mental Health Review Journal

ISSN: 1361-9322

Article publication date: 12 June 2017




The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.


A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.


The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.

Research limitations/implications

The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.


This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.



The National Personality Disorder Service Review Group was partly funded by the General Adult Faculty of the Royal College of Psychiatrists through a small project grant, and West London Mental Health NHS trusts’ Research and Development Department.


Evans, S., Sethi, F., Dale, O., Stanton, C., Sedgwick, R., Doran, M., Shoolbred, L., Goldsack, S. and Haigh, R. (2017), "Personality disorder service provision: a review of the recent literature", Mental Health Review Journal, Vol. 22 No. 2, pp. 65-82.



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Copyright © 2017, Emerald Publishing Limited

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