Personality Disorder ‐ Everybody's Business
| Date | 01 September 2005 |
| Published date | 01 September 2005 |
| DOI | https://doi.org/10.1108/13619322200500023 |
| Pages | 8-15 |
| Author | Frankie Pidd,Nick Benefield,Maria Duggan |
| Subject Matter | Health & social care |
Personality Disorder –
Everybody’s Business
Frankie Pidd
Nick Benefield
Maria Duggan
National Personality Disorder
Development Team
Framework feature
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
ensuresuch 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 wherethey
believe that mental health services have little to offer.
In practice, mainstream health and social careservices
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 arebelieved 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
Tmale 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 areoften high users of mental health services
and other health and social careservices. 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 careis restricted. The costs
of acute psychiatric care, out of area placements, care
at unnecessarily high levels of security because of
restricted access to alternatives, A&E activity,and the
high impact on housing departments are unmeasured
but deemed to be significant. The human costs can be
frustration, humiliation, and repeated failureto find an
appropriate response to need.
Thus, responding to personality disorder becomes
amatter of concernfor many stakeholders across
health and social careservices and in local
communities; in fact, it is everybody’s business.
8The Mental Health Review Volume 10 Issue 3 September 2005 ©Pavilion Publishing (Brighton) 2005
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