Abstract
Following the publication by the National Institute for Mental Health in England (NIMHE) of Personality Disorder: No Longer A Diagnosis of Exclusion (National Institute for Mental Health in England, 2003), it is perhaps surprising that so soon after there have been threats to the survival of some of the small number of existing specialist personality disorder services to which it refers. Indeed, one of the few in-patient units specialising in such disorders (Webb House in Crewe) closed in July 2004. Such closures or threats argue for closer collaboration in planning between the relevant secondary and tertiary services and also between the Department of Health, the NIMHE and local National Health Service commissioners. Not safeguarding existing tertiary specialist services, at a time of increasing awareness of the needs of patients with personality disorders, may be short-sighted.
Highlights
Following the publication by the National Institute for Mental Health in England (NIMHE) of Personality Disorder: No Longer A Diagnosis of Exclusion (National Institute for Mental Health in England, 2003), it is perhaps surprising that so soon after there have been threats to the survival of some of the small number of existing specialist personality disorder services to which it refers
This paper presents a framework for how tertiarylevel specialist personality disorder services might begin to connect with one another and with secondarylevel services, through the formation of ‘managed clinical networks’ (Kunkler, 2000)
We suggest that there is a need to understand the role of tertiary services such as Webb House, and how they interface with secondary services
Summary
Tertiary services cater for a patient population area greater than that of the local area of their hosting trust, and/or receive the majority of referrals from secondarylevel rather than primary-level services. Tertiary personality disorder services are distinguished from secondary-level psychiatric services by their specialisation They operate some form of ‘selection’ of patients, a seeming luxury unavailable to their referring colleagues. Their inclusion criteria (but, importantly, exclusion criteria) tend to have developed through custom and practice rather than by original design, and seldom through negotiation with those who use or refer to such services Their geographical siting often reflects the residence of a local ‘champion’ more than a consideration of patients’ needs or referrer preference. Recognising the scarcity of their resource and attempting to respond to the ‘system’ surrounding patients, some tertiary personality disorder services have extended their assessment and treatment remit This is to take into account the needs of carers and aspects of the referring professional networks involved with these patients - often high users of local services. The situation is complicated by the absence of agreement on what constitutes ‘severe’ personality disorder (Kernberg, 1984), some workable definitions have been suggested (Dolan et al, 1995; Tyrer & Johnson, 1996)
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