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Borderline personality disorder . Implementing NICE guidance. 2009. NICE clinical guideline 78. What this presentation covers. Background Scope Key priorities for implementation Costs Discussion Find out more . Prevalence and risks.

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slide1

Borderline personality disorder

Implementing NICE guidance

2009

NICE clinical guideline 78

what this presentation covers
What this presentation covers
  • Background
  • Scope
  • Key priorities for implementation
  • Costs
  • Discussion
  • Find out more
slide3

Prevalence and risks

  • Borderline personality disorder is present in just under 1% of the population.
  • Women present to services more often than men.
  • Borderline personality disorder rates are estimated to be 23% among male remand prisoners, 14% among sentenced male prisoners and 20% among female prisoners in England and Wales.
  • 60 -70% of people with borderline personality disorder attempt suicide.
  • Up to 10% of people with borderline personality disorder will commit suicide.
characteristics
Characteristics
  • Borderline personality disorder can be seriously disabling and often takes a huge toll on the individual
  • It is characterised by a pattern of instability of interpersonal relationships, self-image and affects, and by marked impulsivity
  • A common factor is a history of traumatic events during childhood and adolescence
  • People with borderline personality disorder are amongst the most likely to use mental health services
scope of guidance
Scope of guidance
  • Adults diagnosed with borderline personality disorder ; young people with borderline symptoms and people with learning disabilities and borderline personality disorder
  • NHS services providing treatment
  • Interface with other services
  • Effective clinical management
key areas for implementation
Key areas for implementation
  • Access to services
  • Autonomy and choice
  • Developing an optimistic and trusting relationship
  • Managing endings and transitions
  • Assessment
  • Care planning in community mental health teams
  • The role of psychological treatment
  • The role of drug treatment
  • The role of specialist personality disorder services within trusts
access to services
Access to services
  • People with borderline personality disorder should not be excluded from any health or social care service because of their diagnosis or because they have self-harmed
autonomy and choice
Work in partnership with people with borderline personality disorder to develop their autonomy and promote choice by:

ensuring they remain actively involved in finding solutions to their problems, including during crises

encouraging them to consider the different treatment options and life choices available to them, and the consequences of the choices they make.

Autonomy and choice
developing an optimistic and trusting relationship
Explore treatment options in an atmosphere of hope and optimism, explaining that recovery is possible and attainable

Build a trusting relationship, work in an open, engaging and non-judgemental manner, and be consistent and reliable

Bear in mind when providing services that many people will have experienced rejection, abuse and trauma, and will have encountered stigma often associated with self-harm and borderline personality disorder

Developing an optimistic and trusting relationship
managing endings and supporting transitions
The ending of treatments or services, and transition between services can evoke strong emotions and reactions

Anticipate, discuss, structure and phase changes carefully beforehand

Build collaboration with other care providers into the care plan during endings and transitions – include access to services in times of crisis

Ensure and agree support during referral periods to other services

Managing endings and supporting transitions
assessment
Community mental health services should be responsible for the routine assessment, treatment and management of people with borderline personality disorderAssessment
care planning
Develop comprehensive multidisciplinary care plans in collaboration with the service user

Identify the responsibilities of health and social care professionals

Manageable treatment aims and specific steps

Long-term treatment strategy underpinned by realistic goals linked to short-term treatment aims

Crisis plan for when self-management strategies are insufficient

Share care plan with GP and service user

Care planning
the role of psychological treatment
Service characteristics

Explicit and integrated theoretical approach – shared with service user

Structured care in accordance with guideline

Provision for therapist supervision

Consider twice-weekly sessions according to need and context

Do not use brief psychotherapeutic interventions of less than 3 months’ duration

The role of psychological treatment
the role of drug treatment
Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorderThe role of drug treatment
the role of specialist personality disorder services
Assessment and treatment services

Consultation and advice to primary and secondary care services

Diagnostic services when general psychiatric services are in doubt about the diagnosis and/or management

Facilitate information sharing among different services and collaborate with all relevant agencies within the local community

Provide and/or advise on social and psychological interventions, and advise on the safe use of drug treatment in crises and for co-morbidities and insomnia

The role of specialist personality disorder services
the role of specialist personality disorder services16
Develop protocols to govern arrangements for the transition of

young people from CAMHS to adult services

Establish and maintain clear lines of communication between

primary and secondary care

Support, lead and participate in the local and national

development of treatments

Oversee the implementation of this guideline

Develop and provide training programmes on diagnosis and

management

Monitor the provision of services for minority ethnic

groups to ensure equality of service delivery.

The role of specialist personality disorder services
costs
Costs
  • Training healthcare professionals in recognition, diagnosis and treatment
  • Establishing multidisciplinary teams
  • Cross-organisation communication
  • Consultation and treatment with a learning disabilities specialist
  • An increase in the use of services because of greater awareness/diagnoses
  • Provision of patient literature and video materials for treatment options
discussion
Discussion
  • What services currently exist in this area?
  • What provision do we have for people from minority ethnic groups or whose first language is not English?
  • How effective is communication between services?
  • How do we manage people with learning disabilities?
  • How do we build openness and optimism?
  • How do current local prescribing practices compare with the recommendations?
find out more
Find out more
  • Visit www.nice.org.uk/CG78 for:
    • Other guideline formats
    • Costing report
    • Audit support
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