raditionally, personality disorder (PD) has been seen as ‘nobody’s business’. National mental health policy development has frequently focused on concepts of serious and enduring mental illness that exclude personality disorder; and mental health services in turn have often mirrored such thinking in their exclusion criteria. While there are a handful of long-standing specialist PD units, the majority of health and social care services do not specifically cater for people with a personality disorder and comprehensive strategies to ensure such needs are addressed through mainstream mental health services are the exception rather than the norm. NHS commissioners often feel that they are squeezed between delivering the NSF targets and balancing the books of health/social care economies in serious deficit. In this context it is difficult to see how personality disorder gets a look-in. Many clinicians and practitioners have been reluctant to venture into areas where they feel they have limited skills and capacity and where they believe that mental health services have little to offer. In practice, mainstream health and social care services and criminal justice agencies, as well as a variety of independent sector services, respond as best they can to the needs of personality disordered people. However, personality disorders are common conditions: while estimates vary, studies indicate a prevalence of 10% to 13% in the adult population and 36% to 67% in psychiatric hospital populations (Department of Health, 2003). Between 50% and 78% of adult prisoners are believed to meet the criteria for one or more personality disorder diagnoses (Singleton et al, 1998) and it is estimated that up to two-thirds of T male mentally disordered offenders have one or more personality disorder diagnoses (Blackburn et al, 2003). People with personality disorders are more likely than other groups in the population to experience alcohol and drug problems in addition to other mental health problems including depression, anxiety, obsessive-compulsive disorders, PTSD etc. They are also likely to experience difficulties with relationships, housing, employment and financial stability. Because of these complex needs people with personality disorders are often high users of mental health services and other health and social care services. Significant numbers of offenders with personality disorder will receive care and management from social services, voluntary organisations, housing departments and probation, with little or no input or support from mental health services. Often, because of the dearth of mental health services for people with personality disorder, and because of clinical reluctance, patients will find themselves repeatedly rejected from services. This may lead to increasingly maladaptive behaviour and inappropriate use of emergency and crisis services because access to suitable care is restricted. The costs of acute psychiatric care, out of area placements, care at unnecessarily high levels of security because of restricted access to alternatives, AE in fact, it is everybody’s business.
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Dec 14, 2009
David P Farrington 
Open Access
