HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector. 

Patients with a personality disorder diagnosis are commonly described as falling through the gaps in NHS mental health services.

Conversations with this cohort of patients, as well as the GPs who are often left to support them, reveal just how difficult it is for someone with a personality disorder diagnosis to access a community mental health service.

Some even report being barred from their community mental health team precisely because of their diagnosis, while a trawl through charity Inquest’s website reveals an uncomfortable number of tragic stories of patients, particularly women, with a PD diagnosis from coroners’ courts.

Yesterday, NHS England’s clinical standard review set out some clear ambitions for community mental health teams – with brand new waiting time targets.

Within its proposals was a clear recognition of a “personality disorder” diagnosis as something for which patients should be accessing community mental health services.

This is a step in the right direction.

However, the responses from a recent data request HSJ made to trusts and clinical commissioning groups has suggested community services will have difficult terrain to navigate before they reach a place where the needs of this broad patient group are properly and consistently met.

Black holes

A freedom of information request to CCGs and trusts over the existence of specific services for patients with a PD diagnosis, their waiting lists, and the investment these services have received over the years has produced the written equivalent of a blank stare.

The various black holes and empty spaces within mental health data are a well-reported theme. However, for a group of patients very commonly cited as some of the most frequent users of NHS services, the lack of data and awareness is hard to justify.

South London and Maudsley FT, which was able to provide some figures, provides an example of how prevalent PD is within the general population. According to the trust, almost 13 per cent of its active patients have a PD as a primary diagnosis.

Across the 15 mental health trusts that did hold some minimal data, around 16,000 patients with a PD diagnosis were identified. But the majority of these were not being treated within a specific service, so information on waiting times and spend on treatment was lacking.

Those trusts that couldn’t provide any figures primarily blamed the lack of a centralised pathway for personality disorders, meaning there was no system mechanism to track these patients.

Labels and pathways

The diagnosis “personality disorder” is justifiably controversial. It leaves patients with a stigmatising label, and one that most argue doesn’t fit the experience of those suffering from it.

Because of the way the NHS is structured to treat patients, a pathway usually follows a diagnosis.

So, what should the pathway look like? For the policy brains creating the CMHT pathways, a consensus statement on personality disorders published last year by MIND would be a good thing to take heed of.

If enabled to move away from severity thresholds to needs-based access, there is no reason patients can’t be well served within a CMHT or primary care network.

However, for this to happen, the needs of this group must first be better understood, and the blind spots in the data addressed.


This was a big week for mental health with the unveiling of new urgent and emergency care targets.

Having emergency targets for mental health is undeniably a win for the sector, but the announcement leaves quite a few questions unanswered. Keep an eye out tomorrow for Performance Watch, where a few of those questions will be posed. 

Mental Health Matters is written by HSJ’s new mental health correspondent, Rebecca Thomas. Tell her what you think, or about issues she could write about, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.