Search results

People with a borderline personality disorder (BPD) diagnosis can require support from mental health services for managing risk behaviour. Current routine inpatient and community treatment can be unhelpful for this group. Positive risk taking has been developed to help community teams manage risk with people with a BPD. This study aims to explore experiences of risk management in an NHS Trust where positive risk taking is being implemented with people with a BPD.

Interpretative phenomenological analysis is the methodology of transcripts from semi-structured interviews. Nine adults with a diagnosis of BPD and current or previous experiences of risk management approaches were sampled from one NHS Trust.

Limited resources and interpersonal barriers had a negative impact on experiences of Positive risk taking. Participants experienced one-off risk assessments and short-term interventions such as medication which they described as “meaningless”. Traumatic experiences could make it difficult to establish therapeutic relationships and elicit unhelpful responses from professionals. Participants could only feel “taken seriously” when in crisis which contributed towards an increase in risky behaviour. Positive risk taking was contingent upon collaborative and consistent professional relationships which created a “safety net”, enabling open communication and responsibility taking which challenged recovery-relapse patterns of service use.

Positive risk taking approaches to risk management may benefit people with a BPD. Findings complement those from other studies emphasising the importance of compassion and empathy when working with personality disorder. Training and increased resources are required to implement effective risk management with this group.

Findings expand upon the sparse existing research in the area of risk management using the Positive risk taking approach with people with a BPD diagnosis, and provide idiographic understanding which is clinically meaningful. Participants’ experiences suggest Positive risk taking may provide a framework for improving quality of life and decreasing service use for people diagnosed with BPD engaging in risk management with Community Mental Health Teams, which facilitates recovery and other benefits.

The purpose of this paper is to report on the use and content of written guidance produced by mental health services in England and Wales describing hospital leave for informally admitted patients.

Guidance on leave was requested from National Health Service (NHS) mental health trusts in England and health boards in Wales (n = 61) using a Freedom of Information submission. Data were analysed using content analysis.

In total, 32 organisations had a leave policy for informal patients. Policies varied considerably in content and quality. The content of policies was not supported by research evidence. Organisations appeared to have developed their policies by either adapting or copying the guidance on section 17 leave outlined in the Mental Health Act Codes of Practice for England and Wales (Department of Health, 2016; Welsh Government, 2016). Definitions of important terms, for example, leave and hospital premises, were either absent or poorly defined. Finally, some organisations appeared to be operating pseudo-legal coercive contracts to prevent informal patients from leaving hospital wards.

Research should be undertaken to explore the impact of local policies on the informal patient’s right to life and liberty.

All NHS organisations need to develop an evidence-based policy to facilitate the informal patient’s right to take leave. A set of national standards that organisations are required to comply with would help to standardise the content of leave policies.

To the best of the author’s knowledge, this is the first study to examine the use and content of local policies describing how informal patients can take leave from hospital.

Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery.

In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles.

As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders.

This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes.

The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

The purpose of this paper is to describe the pattern of self-harm (SH) and proven prison rule-breaking (PRB) behaviour in prisoners receiving treatment for personality disorders (PDs) within a high security prison.

A comparative quantitative case study design supported the understanding of the frequency and pattern of SH and PRB behaviour across two stages of a PD treatment programme for 74 male prisoners. Data obtained from the prison’s records were analysed using dependent t-tests, χ² test of independence and time-frequency analyses.

Inferential statistics showed that the frequency of SH and PRB behaviour statistically increased across two phases of the PD treatment programme; however, the method of SH or type of PRB behaviour engaged in did not change. Mapping the frequencies of incidents using a time-frequency analysis shows the patterns of both behaviours to be erratic, peaking in the latter phase of treatment, yet the frequency of incidents tended to decline over time.

This is the first study to explore SH and PRB behaviours in men across two phases of a PD treatment programme. This study highlights the need for continued psychological support alongside the PD treatment programme with a focus on supporting men in treatment to effectively manage their SH and PRB behaviour.

Borderline personality disorder (BPD) is a controversial psychiatric diagnosis. Despite an increasing amount of research looking at the BPD diagnosis when applied to young people, there is limited understanding of the key viewpoints of mental health professionals working with young people in the UK. This research aims to use Q-methodology to contribute to understanding the multiple views of the diagnosis.

Q-statements about views of the BPD diagnosis were selected from relevant journals, internet sites and social media platforms and were validated by a Q-methodology research group, the research supervisors and an online group of individuals with BPD. Q-sorts were then used to explore the viewpoints of 27 mental health professionals in the UK working with children and adolescents. Analysis of the data was completed using Q-methodology analysis software.

Three main factors emerged from the data, explaining 66% of the variance. Of the 27 participants, 24 loaded onto these three factors, defined as: harmful not helpful; language and optimism; and caution and specialist services. Three Q-sorts did not load significantly onto any one factor.

There appears to be at least three ways of understanding the BPD diagnosis for young people. It may be useful for clinicians to consider and share their own viewpoint, be open to difference and formulate difficulties from an individual perspective.

Borderline personality disorder (BPD) is a complex condition characterized by a number of psychosocial difficulties that typically involve considerable suffering for individuals with the condition. Recovery from BPD may involve specific processes such as work on how the self is perceived by the individual with BPD and his or her relationships which differ from those common to recovery from other mental health conditions. The details of the processes that may best promote changes within the self and relationships are yet to be established. The paper aims to discuss these issues.

In total, 17 consumers from a specialist BPD service were interviewed to identify factors they have experienced that contribute to recovery from BPD. Thematic analysis within a grounded theory framework was used to understand key themes within the interview data. The emphasis was on specific conditions of change rather than the more global goals for recovery suggested by recent models.

Key themes identified included five conditions of change: support from others; accepting the need for change; working on trauma without blaming oneself; curiosity about oneself; and reflecting on one’s behavior. To apply these conditions of change more broadly, clinicians working in the BPD field need to support processes that promote BPD-specific recovery identified by consumers rather than focusing exclusively on the more general recovery principles previously identified within the literature.

The specific factors identified by consumers as supporting recovery in BPD are significant because they involve specific skills or attitudes rather than aspirations or goals. These specific skills may be constructively supported in clinical practice.

This study aims to consider the nineteenth century relationship between biological markers and employment. This relationship is also considered for different occupations and by race.

Using a large source of nineteenth century Texas state prison records, regression models illustrate the relationships between stature, body mass index (BMI), other observable characteristics and employment outcomes.

Among the nineteenth century Texas working class, stature and BMIs were not significant in the decision to participate in the southwest's labor market but were significant in Texas occupation selection. The probability of being farmers and unskilled workers were comparable by race. However, whites had easier access to white‐collar and skilled occupations.

Relationships between stature and BMI in developing countries may not be related to the decision to work; however, a relationship between these biological markers and occupation selection may exist.

This paper is one of the few that consider the relationship between biological markers and employment outcomes. By considering the relationship between stature, BMI, and employment outcomes as the US economy develops, inferences can be drawn for the health and employment relationship in developing economies.

Consultation services are recommended to support mental health staff working with service users diagnosable with personality disorder. However, there is scarce literature examining the impact of delivering and receiving consultation services. This study aims to investigate the impact of a pilot co-produced consultation service aiding clinical teams in the engagement of service users diagnosable with personality disorder.

This is a qualitative evaluation using a focus group and five semi-structured interviews to explore the experience of delivering and receiving the consultation service. Data were analysed using thematic analysis. Clinical and demographic characteristics were obtained on service users referred.

The consultation staff focus group produced two overarching themes: “Disrupting the system” and “Mirroring the service and the service users consulted”. The staff consultee semi-structured interviews produced two overarching themes: “Experience of working with personality disorder” and “Experience of the consultation service”. Staff described working with personality disorder as challenging. The consultation process was experienced as a helpful and reassuring space to gain a new perspective on the work. However, the service was felt to be limited; in that, it lacked follow-on treatment.

This study adds to the body of literature on consultation for service users diagnosable with personality disorder and demonstrates its function in service provision. It sheds light on staff experience of delivering and receiving a consultation service, including the use of a co-production model.

The label “Personality Disorder” continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by critical practitioners and academics are tempered by acknowledgement of certain positive social consequences of obtaining a diagnosis. This study aims to engage service users and staff in a process of inquiry to better understand the complexities of views on the terminology of Personality Disorder.

This study set out to qualitatively explore the views of a range of people with lived, occupational and dual lived experience/occupational expertise, relating to the diagnostic label of Personality Disorder, via participatory and critical group debate. The World Café approach is an innovative methodology for participatory inquiry into subjective views suited to exploring the contested subject matter.

This study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words “personality” and “disorder” are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered.

The findings have the potential to contribute to the ongoing critical debate regarding the value of the Personality Disorder construct in the provision of care and support. Specific emphasis upon the relational framing of care provision offers a means to ameliorate some of the negative impacts of terminology. Perspectives are influenced in the way the label is understood, hence, attention is required to enhance these processes in clinical practice. There is much more study required to overcome stigmatisation, prejudice, and lack of knowledge and understanding. Further research identifying means for challenging stigma and the factors contributing to positive clinical interactions are required.

This study brings together a wide range of views and experiences of mental health professionals, individuals lived experiences and those who align to both lived and occupational expertise. A safe space was provided via the uniquely co-produced World Café research event to bring together discussion and debates from mixed perspectives makes this a novel study. The focus being on perspectives towards contested language, labelling and social impact adds to scholarship in this field.