Current state of the evidence on community treatments for people with complex emotional needs: a scoping review
Abstract Background Improving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN—our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care sh...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-04171-z |
| _version_ | 1798002971464695808 |
|---|---|
| author | Sarah Ledden Luke Sheridan Rains Merle Schlief Phoebe Barnett Brian Chi Fung Ching Brendan Hallam Mia Maria Günak Thomas Steare Jennie Parker Sarah Labovitch Sian Oram Steve Pilling Sonia Johnson the C. E. N. Mental Health Policy Research Unit Group |
| author_facet | Sarah Ledden Luke Sheridan Rains Merle Schlief Phoebe Barnett Brian Chi Fung Ching Brendan Hallam Mia Maria Günak Thomas Steare Jennie Parker Sarah Labovitch Sian Oram Steve Pilling Sonia Johnson the C. E. N. Mental Health Policy Research Unit Group |
| author_sort | Sarah Ledden |
| collection | DOAJ |
| description | Abstract Background Improving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN—our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. Methods We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. Results We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people’s lives, peer support, or ways of designing effective services. Conclusions Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group. |
| first_indexed | 2024-04-11T12:00:50Z |
| format | Article |
| id | doaj.art-5c8669a4b8f447e5b6fafe6b5ffd901e |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-11T12:00:50Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-5c8669a4b8f447e5b6fafe6b5ffd901e2022-12-22T04:24:51ZengBMCBMC Psychiatry1471-244X2022-09-0122113610.1186/s12888-022-04171-zCurrent state of the evidence on community treatments for people with complex emotional needs: a scoping reviewSarah Ledden0Luke Sheridan Rains1Merle Schlief2Phoebe Barnett3Brian Chi Fung Ching4Brendan Hallam5Mia Maria Günak6Thomas Steare7Jennie Parker8Sarah Labovitch9Sian Oram10Steve Pilling11Sonia Johnson12the C. E. N. Mental Health Policy Research Unit GroupDivision of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonDivision of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit Co-Production Group, University College LondonNIHR Mental Health Policy Research Unit Co-Production Group, University College LondonNIHR Mental Health Policy Research Unit, Department of Health Service and Population Research, King’s College LondonCentre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonAbstract Background Improving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN—our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. Methods We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. Results We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people’s lives, peer support, or ways of designing effective services. Conclusions Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.https://doi.org/10.1186/s12888-022-04171-zComplex emotional needsPersonality disorderScoping review |
| spellingShingle | Sarah Ledden Luke Sheridan Rains Merle Schlief Phoebe Barnett Brian Chi Fung Ching Brendan Hallam Mia Maria Günak Thomas Steare Jennie Parker Sarah Labovitch Sian Oram Steve Pilling Sonia Johnson the C. E. N. Mental Health Policy Research Unit Group Current state of the evidence on community treatments for people with complex emotional needs: a scoping review BMC Psychiatry Complex emotional needs Personality disorder Scoping review |
| title | Current state of the evidence on community treatments for people with complex emotional needs: a scoping review |
| title_full | Current state of the evidence on community treatments for people with complex emotional needs: a scoping review |
| title_fullStr | Current state of the evidence on community treatments for people with complex emotional needs: a scoping review |
| title_full_unstemmed | Current state of the evidence on community treatments for people with complex emotional needs: a scoping review |
| title_short | Current state of the evidence on community treatments for people with complex emotional needs: a scoping review |
| title_sort | current state of the evidence on community treatments for people with complex emotional needs a scoping review |
| topic | Complex emotional needs Personality disorder Scoping review |
| url | https://doi.org/10.1186/s12888-022-04171-z |
| work_keys_str_mv | AT sarahledden currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT lukesheridanrains currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT merleschlief currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT phoebebarnett currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT brianchifungching currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT brendanhallam currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT miamariagunak currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT thomassteare currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT jennieparker currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT sarahlabovitch currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT sianoram currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT stevepilling currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT soniajohnson currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview AT thecenmentalhealthpolicyresearchunitgroup currentstateoftheevidenceoncommunitytreatmentsforpeoplewithcomplexemotionalneedsascopingreview |