title: Improving services for people with personality disorders: views of experienced clinicians.
abstract: People with personality disorders are frequent users of both inpatient and outpatient psychiatric services, representing a significantly large proportion of all mental health clients. Despite this, most services find it a challenge to offer the most appropriate and effective treatment models for people with personality disorders. This paper is a report of a study of clinician opinions about how organizations can improve the delivery of services to people with personality disorders. Data was collected from experienced clinicians attending a personality disorders clinical and scientific meeting who were asked to work together in groups and present solutions for how organizations can improve the services provided to people with personality disorders. Qualitative data was collected and thematically and semantically analyzed using Nvivo and Leximancer. The Nvivo analysis revealed five main areas in which clinicians believe organizations can improve services for people with personality disorders. These focused on: (i) more training and education for health professionals and carers; (ii) better support through supervision and leadership; (iii) adoption of a more consistent evidence-based approach to client management and treatment; (iv) clearer guidelines and protocols; and (v) changed attitudes about personality disorder to decrease stigma. The Leximancer analysis of responses indicated the identified themes were not distinct; rather they were interconnected and related to one another, semantically. In summary, clinicians across a large and diverse geographical area developed a consensus that mainstream management of personality disorder is largely poor and inadequate. The findings lend support to an integrative and collaborative whole-service approach that enhances evidence-based practice in the community.
authors.affiliation: Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Fanaian
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lewis
authors.forename: Brin F S
authors.initials: BF
authors.lastname: Grenyer
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000193:education / Q000523:psychology; D003419:Crisis Intervention; D003695:Delivery of Health Care / Q000458:organization & administration; D055318:Evidence-Based Nursing; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D007857:Leadership; D008297:Male; D008611:Mentors; D008875:Middle Aged; D008960:Models, Psychological; D010554:Personality Disorders / Q000451:nursing* / Q000523:psychology / Q000534:rehabilitation; D058996:Quality Improvement / Q000458:organization & administration*; D012308:Risk Management
keywords: clinician perspectives; mental health; personality disorder; psychiatric services; qualitative research