Understanding failures of NHS policy implementation in relation to borderline personality disorder: Learning lessons and moving towards an authentic person-centred service

Abstract

Despite an increasing number of policies and guidelines relating to psychological therapies within the NHS, there is little clear evidence of many of the intended benefits actually accruing from their implementation. Drawing on the work of Tom Main and others, this paper examines some of the emotional and unconscious factors, in both staff and patients, which determine the fate of policies and specifically the extent to which they become authentically embedded within a hospital system. Unanticipated or unintended effects of past policy implementation in relation to borderline personality disorder are discussed in the context of secondary and tertiary level NHS psychotherapy services. These effects include the risk that the latter services become sidelined by cheaper initiatives and interventions at primary care level, irrespective of the evidence base in relation to borderline personality disorder. Given the financial and human costs of policy failure, the paper proposes a significant and active role for psychodynamic psychotherapists in promoting a more thoughtful approach to local policy implementation so as to lead toward a service that is genuinely patient-centred.