Abstract
Although we commonly work with patients with emotionally unstable personality disorder (EUPD) in community mental health teams (CMHTs), only some enter evidence-based psychological therapies. Many patients are not considered ready to engage in specialist treatments and remain in CMHTs without any clear focus or structure to their treatment, which is unsatisfactory for patients, clinicians and services. We present a fictional case and synthesise available literature and lived experience to explore readiness and ways to promote it. We highlight relevant issues for trainees to consider in practice. Patients with EUPD who have not received specialist treatment can be considered in terms of the transtheoretical model's stages of change. Identifying a patient's stage can help guide how to increase readiness for referral and decide when to refer. Interventions available to all healthcare professionals which may promote readiness include: psychoeducation, personal formulations, crisis planning, goal-setting, peer support, distress tolerance skills, motivational interviewing and mindfulness.
Highlights
We commonly work with patients with emotionally unstable personality disorder (EUPD) in secondary care mental health services
Patients with EUPD present with a very wide range of functioning, risk and support needs, and we suggest that care coordination is decided on a case-by-case basis
EUPD is commonly encountered in mental health services, but some patients are not at a stage where they are ready to engage in specialist treatments
Summary
We commonly work with patients with EUPD in secondary care mental health services. The prevalence of EUPD in this setting is estimated at 20%,1 and it is associated with considerable suffering, psychosocial impairment and high resource use.[2]. NICE advise referring patients with EUPD and dependence on alcohol or substances to appropriate services; the care coordinator should remain involved and provide information on community support networks, e.g. Alcoholics Anonymous.[7] Distinctions can be made between patients using as a form of self-harm, using to manage emotions, and dependent use, overlap does occur. NICE advises discussing the discharge process with the patient and agreeing a care plan with steps to manage distress, cope with future crises and re-engage in the future.[7] This should be clearly communicated to the general practitioner, including how they can access support This approach may be challenging for patients with repeated risky behaviour. Clinicians should be mindful of discharging in response to their countertransference
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
