Psychiatrists' motives for practising in-patient compulsory care of patients with borderline personality disorder (BPD)

Abstract

IntroductionPatients with BPD are often subjected to compulsory care. However, as compulsory care restricts liberty and may have negative effects, it is recommended that it be used sparingly. In this study, we investigate psychiatrists' motives for practising compulsory care of BPD patients. MethodSemi-structured interviews with twelve Swedish psychiatrists from Stockholm County. These interviews were analysed according to descriptive qualitative analysis. ResultsThe qualitative data from our study resulted in three themes: (1) BPD patients are perceived as difficult: interpersonally, in clinical and legal management, and due to suicide risk; (2) there are medical and non-medical motives for compulsory care of BPD patients, and its consequences can vary; and (3) BPD patients have decision competence and sometimes demand to be taken into compulsory care. ConclusionThe interviewed psychiatrists' own judgements and values, rather than clinical and legal directions, were decisive in their practice of compulsory care. For the BPD patients, this can result in vast differences in the mental healthcare offered, depending on which individual psychiatrist they encounter. Socio-political expectations and psychiatrists' personal views seem to lead to more compulsory care of BPD patients than is clinically recommended and legally sanctioned.