Published: 30/01/2003, Volume II3, No. 5840 Page 9

The government has proposed the creation of new services to treat and manage people suffering from personality disorder.

But new guidance - which also attempts to take account of a broader definition of mental disorder, as proposed by the draft Mental Health Bill - has been criticised for containing contradictions and for not having funding attached to it.

The guidance recommends the creation of specialist multi-disciplinary personality disorder teams to target complex cases and the development of specialist day patient services in areas of 'high concentrations of morbidity'.

Personality Disorder - No Longer a Diagnosis of Exclusion takes account of legislation due to result in many people with personality disorders - including psychopathic disorder - being subject to compulsory detention for the first time.

It says that the Department of Health intends to pump-prime a small number of personality disorder centres within regional forensic services for the dedicated 'assessment, treatment and management of personality disordered offenders'. But although the paper says funding will be available to trusts to develop the services over the next three years no specific monies have been listed.

It quotes a recent questionnaire sent out to mental health services in 2002 which found that 83 per cent of adult mental health trusts had no dedicated personality disorder service.More than a quarter of respondents (28 per cent) had no identified service at all.

Sainsbury Centre for Mental Health chief executive Dr Matt Muijen was scathing: 'It [the guidance] talks in this wonderfully sensitive language about dealing ensuring the inclusion of these people, about ending the stigma associated with a diagnosis.

'But then its response is blatantly about pushing them into the isolation of specialist services. In many ways It is a classic New Labour document.'

He said the paper was full of 'contradictions' such as placing an emphasis on the use of specialist services while admitting that the personality disorder requires a broad range of interventions and treatments.

'There are of course going to be concerns about delivering the services mentioned. It will involve a huge amount of work. [Mental health] trusts are dealing with creating the crisis resolution teams and it is not yet clear where, in terms of priority, this paper is going to sit. Is it going to have specific targets which trusts will have to meet?'

But mental health charity MACA said: 'We are pleased the government has recognised that people with a personality disorder are often excluded from care and support.

'This guidance, if taken seriously by health service commissioners and providers and properly resourced, should significantly improve both the level and quality of services for this group.'

www. doh. gov. uk/mentalhealth/ personalitydisorder. htm