Reality check

Published: 29/01/2004, Volume II4, No. 5890 Page 45

Emma Forrest on understanding and treating personality disorders

Ask the general public about any mental health condition, and the chances are that their perceptions will be blighted by myth and misunderstanding.

But personality disorders are coupled with an additional uncertainty.

Branded 'untreatable', not only is there a lack of understanding on the part of the public, but mental health services often place sufferers in a vulnerable position, too.

Mental Health Foundation head of strategies for living Toby Williamson says: 'People with the label of personality disorder have been let down by mental health services for too long. As set out in the Mental Health Act 1983, people with this label have been told they are untreatable.'

In response to the National Institute for Mental Health in England policy implementation guide, Personality Disorder: no longer a diagnosis of exclusion, the foundation has launched a twoyear project into good practice when working with and supporting people living in the community and diagnosed with a personality disorder.

Funded by the Department of Health, the Finding Positives in Difficult Places project aims to address the stigma surrounding personality disorder and the difficulties people often face in gaining treatment.

'This client group has problems accessing support, therapy and other treatments, ' says project co-ordinator Paul Turner. 'The stigma... has produced a mindset that there are the deserving and the undeserving mentally ill, and people with personality disorders are seen as the latter. There is a belief that they are just attention seeking and are resistant to treatment. I have found this group is crying out for support.

But it is easy for them to get into a cycle of rejection, which leads to people feeling desperate and can lead to conflict with professionals.'

Mr Turner explains that as the Mental Health Act requires a person to be suffering from a treatable mental disorder in order to gain treatment, personality disorders cannot be assessed under it.He describes the act as a major barrier to sufferers.

'If this group does get access to a hospital bed, they are often discharged quickly but without adequate support waiting for them. Service users talk about needing recovery models and the right kind of therapy, such as cognitive behavioural therapy and diagnostic psychotherapy. But waiting lists can be two or three years.'

Instead of gaining access to therapy, medication such as anti-depressants and tranquilizers may be prescribed alone. Staffing levels are also an issue; they are required to have particular resources, knowledge and supervision, both internal and external.

Mr Turner says: 'Sufferers are often very depressed, often self harm and may be suicidal. Staff may not feel they have the skills to assess someone with the condition. And workers often face burn out.'

There are now concerns from service users that the diagnosis of severe and dangerous personality disorder will brand all personality disorder sufferers under the same label.

Home Office plans will see SDPD sufferers with a long history of violent and sexual crimes being detained, assessed and treated in specialist centres from this year.

Conversely, service users with personality disorders may struggle to be told of their diagnosis.

Mr Turner says: 'People will be labelled but not told what they have been diagnosed as having, because mental health professionals feel it is a difficult diagnosis to give.

They feel the service user will have no hope for a change in their condition, whereas there are service users who talk strongly about recovery. There are examples of people who now lead productive lives.'

To contribute to the project, contact Paul Turner on pturner@mhf. org. uk

Bruce Douglas looks at recent books on mental health practice Community Mental Health Nursing and Dementia Care: practice perspectives Edited by John Keady, Charlotte Clarke and Trevor Adams Open University Press. ISBN 0 335 21142 9.£19.99

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