Personality disorder and pathways to inpatient psychiatric care.
BACKGROUND
The impact of personality disorder on pathways into psychiatric care is unknown.


OBJECTIVE
To examine associations between personality disorder status, length of pathway into inpatient psychiatric care, and involvement of the criminal justice service in the pathway into care.


METHODS
The Structured Clinical Interview for DSM-IV personality disorders (SCID-II) and a modified WHO Pathways Encounter Form were administered to a sample of 153 consecutive inpatients admitted to acute wards in one inner London borough over a 4-month period. Diagnosis, socio-demographic variables, social support and substance misuse were also ascertained.


RESULTS
The presence of personality disorder was not associated with significant differences in the number of carers, time spent along the pathway, or probability of criminal justice system involvement. However, all three personality disorder clusters were significantly associated with increased use of Accident and Emergency (A & E) services.


CONCLUSIONS
Given the high levels of contact with A & E services, casualty staff should receive improved training in the assessment and management of patients with personality disorders. Improved detection of personality disorder within A & E departments could lead to earlier diversion to mental health services and a consequential improvement in the planning of subsequent treatment.
Hayward
Marianne
M
Health Services Research Dept., Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF UK. m.hayward@iop.kcl.ac.uk
Moran
Paul
P
D000328:Adult; D003266:Continuity of Patient Care; D003417:Criminal Psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007406:Interview, Psychological; D008131:London / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors; D019037:Urban Health Services