Clinical characteristics and care pathways of patients with personality disorder who died by suicide
BackgroundIt is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments.AimsTo des...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2020-03-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472420000113/type/journal_article |
| _version_ | 1811157000724152320 |
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| author | Sandra Flynn Jane Graney Thabiso Nyathi Jessica Raphael Seri Abraham Sandeep Singh-Dernevik Alyson Williams Nav Kapur Louis Appleby Jenny Shaw |
| author_facet | Sandra Flynn Jane Graney Thabiso Nyathi Jessica Raphael Seri Abraham Sandeep Singh-Dernevik Alyson Williams Nav Kapur Louis Appleby Jenny Shaw |
| author_sort | Sandra Flynn |
| collection | DOAJ |
| description | BackgroundIt is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments.AimsTo describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance.MethodNational consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK.ResultsThe majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients.ConclusionsContinuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided. |
| first_indexed | 2024-04-10T05:00:10Z |
| format | Article |
| id | doaj.art-4ce5534dabb2476383ca764ab50e61c8 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T05:00:10Z |
| publishDate | 2020-03-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-4ce5534dabb2476383ca764ab50e61c82023-03-09T12:28:56ZengCambridge University PressBJPsych Open2056-47242020-03-01610.1192/bjo.2020.11Clinical characteristics and care pathways of patients with personality disorder who died by suicideSandra Flynn0https://orcid.org/0000-0003-1413-0992Jane Graney1Thabiso Nyathi2Jessica Raphael3Seri Abraham4Sandeep Singh-Dernevik5Alyson Williams6Nav Kapur7Louis Appleby8Jenny Shaw9Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKGreater Manchester Mental Health NHS Foundation Trust, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKPennine Care NHS Foundation Trust, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UKBackgroundIt is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments.AimsTo describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance.MethodNational consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK.ResultsThe majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients.ConclusionsContinuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.https://www.cambridge.org/core/product/identifier/S2056472420000113/type/journal_articlePersonality disordersuicide and self-harmmental health services |
| spellingShingle | Sandra Flynn Jane Graney Thabiso Nyathi Jessica Raphael Seri Abraham Sandeep Singh-Dernevik Alyson Williams Nav Kapur Louis Appleby Jenny Shaw Clinical characteristics and care pathways of patients with personality disorder who died by suicide BJPsych Open Personality disorder suicide and self-harm mental health services |
| title | Clinical characteristics and care pathways of patients with personality disorder who died by suicide |
| title_full | Clinical characteristics and care pathways of patients with personality disorder who died by suicide |
| title_fullStr | Clinical characteristics and care pathways of patients with personality disorder who died by suicide |
| title_full_unstemmed | Clinical characteristics and care pathways of patients with personality disorder who died by suicide |
| title_short | Clinical characteristics and care pathways of patients with personality disorder who died by suicide |
| title_sort | clinical characteristics and care pathways of patients with personality disorder who died by suicide |
| topic | Personality disorder suicide and self-harm mental health services |
| url | https://www.cambridge.org/core/product/identifier/S2056472420000113/type/journal_article |
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