Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-17T18:07:49.218Z Has data issue: false hasContentIssue false
  • English
  • Français

Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

Published online by Cambridge University Press:  08 September 2020

Gary Lamph Open the ORCID record for Gary Lamph [Opens in a new window] ,
John Baker ,
Tommy Dickinson  and
Karina Lovell
Gary Lamph*
Affiliation:
Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
John Baker
Affiliation:
Faculty of Medicine and Health, University of Leeds, Leeds, UK
Tommy Dickinson
Affiliation:
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, UK
Karina Lovell
Affiliation:
Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
*
*Corresponding author. Email: glamph@uclan.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England.

Aims:

This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment.

Method:

A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach.

Results:

Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important.

Conclusions:

For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

Keywords

Improving Access to Psychological Therapies (IAPT)personality disorderprimary care
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 2 , March 2021 , pp. 144 - 158
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSMIVTR) (4th edn text rev.). APA, Washington DC.Google Scholar
Crawford, M. J., Thana, L., Parker, J., Turner, O., Carnet, A., McMurran, M., Moran, P., Weaver, T., Barrett, B., Roberts, S., Claringbold, A., Basset, P., Sanatinia, R. & Spong, A. (2020). Structured psychological support for people with personality disorder: feasibility randomized controlled trial of a low-intensity intervention. BJPsychiatry Open, 6, e25. doi: 10.1192/bjo.2020.7 CrossRefGoogle ScholarPubMed
Crawford, M. J., Thana, L., Parker, J., Turner, O., Xing, K. P., McMurran, M., Moran, P., Weaver, T., Barrett, B., Claringbold, A., Basset, P., & Sanatinia, R. (2018) Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder. Trials, 19, 547. https://doi.org./10.1186/s13063-018-2920-0 CrossRefGoogle ScholarPubMed
Davidson, K. (2002). Cognitive Therapy for Personality Disorders. Arnold: London.Google Scholar
Department of Health (2008). Improving Access to Psychological Therapies Implementation Plan: National Guidelines for Regional Delivery. Crown Copyright: London.Google Scholar
Department of Health (2009). Recognising Complexity: Commissioning Guidance for Personality Disorder Services. Crown Copyright: London.Google Scholar
Department of Health (2011). Talking Therapies: A Four-Year Plan of Action. A Supporting Document to No Health Without Mental Health: A Cross Government Mental Health Outcomes Strategy for People of All Ages. Crown Copyright: London.Google Scholar
Evans, L., Green, S., Sharma, K., Marinho, F & Thomas, P. (2014). Improving access to primary mental health services: are link workers the answer? Journal of Primary Care, 6, 23–28.CrossRefGoogle Scholar
French, L., Moran, P., Wiles, N., Kessler, D. & Turner, K. M. (2019). GP’s views and experiences of managing patients with personality disorder: a qualitative interview study. British Medical Journal Open, 9, e026616. doi: 10.1136/bmjopen-2018-026616 Google Scholar
Gale, N. K., Heath, G., Cameron, E., Rashid, S. & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, 117.CrossRefGoogle ScholarPubMed
Goddard, E., Wingrove, J., & Moran, P. (2015). The impact of comorbid personality difficulties on response to IAPT treatment for depression and anxiety. Behaviour Research and Therapy, 73, 1–7.CrossRefGoogle ScholarPubMed
Grant, N., Hotopf, M., Breen, G., Cleare, A. M., Grey, N., Hepgul, N., King, S., Moran, P., Pariante, C. M., Wingrove, J., Young, A. H & Tylee, A. (2014). Predicting outcome following psychological therapy in IAPT (PROMPT): a naturalistic project protocol. BMC Psychiatry, 14, 170–178.CrossRefGoogle ScholarPubMed
Hepgul, N., King, S., Amarasinghe, M., Breen, G., Grant, N., Grey, N., Hotopf, M., Moran, P., Pariante, C. M., Tylee, A., Wingrove, J., Young, A. H., & Cleare, A, J. (2016). Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT). BMC Psychiatry, 16, 52. doi: 10.1186/s12888-016-0736-6 CrossRefGoogle Scholar
Lamph, G.. (2018). Enhancing understanding of the experience of people with common mental health disorders and co-morbid personality disorder traits who present to primary care IAPT services. PhD thesis, University of Manchester Institutional Repository. ISNI 0000 0004 7658 0064. https://www.research.manchester.ac.uk/portal/en/theses/enhancing-understanding-of-the-experience-of-people-with-common-mental-health-disorders-and-comorbid-personality-disorder-traits-who-present-to-primary-care-iapt-services(95a9bf9d-e814-48bc-b0e3-892f8b6687d6).html Google Scholar
Lamph, G., Baker, J., Dickinson, T., & Lovell, K. (2019). Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services; a qualitative study exploring professionals perspectives. Personality and Mental Health, 13, 168–179. ISSN 1932-862.CrossRefGoogle ScholarPubMed
Laporte, L., Paris, J., Bergevin, T., Fraser, R & Cardin, J. F. (2018). Clinical outcomes of a stepped care programme for borderline personality disorder. Personality and Mental Health, 12, 252–264.CrossRefGoogle Scholar
Livesley, W. J. (2005). Principles and strategies for treating personality disorder. Canadian Journal of Psychiatry, 50, 442–450.CrossRefGoogle ScholarPubMed
Livesley, W. J., Lang, K. L & Vernon, P. A. (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archive of General Psychiatry, 55, 941–948.CrossRefGoogle ScholarPubMed
Mind (2018). Shining Lights in Dark Corners of People’s Lives; The Consensus Statement for People with Complex Mental Health Difficulties who are diagnosed with a Personality Disorder. https://www.mind.org.uk/media/21163353/consensus-statement-final.pdf (last accessed 16 August 2018).Google Scholar
Moran, P., & Crawford, M. J. (2013). Assessing the severity of borderline personality disorder. British Journal of Psychiatry, 203, 163–164.CrossRefGoogle ScholarPubMed
Moran, P., Leese, M., Lee, T., Walters, P., Thormicroft, G., & Mann, A. (2003). Standardised Assessment of Personality – Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry, 183, 228–232.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE) (2009). Borderline Personality Disorder: Treatment and Management. www.nice.org.uk (last accessed 16 August 2018).Google Scholar
Paris, J. (2013). Stepped care: an alternative to routine extended treatment for patients with borderline personality disorder. Psychiatric Services, 64, 1035–1037.CrossRefGoogle ScholarPubMed
Paris, J. (2017). Stepped Care for Borderline Personality Disorder, Making Treatment Brief, Effective, and Accessible. Academic Press: London.Google Scholar
Public Health England (2019). Public Health Profiles. https://fingertips.phe.org.uk/search/ethnicity#pat/6/ati/102/par/E12000002 (last accessed 24 May 2019).Google Scholar
Ritchie, J., Lewis, J., McNaughton-Nicholls, C., & Ormston, R. (2014). Qualitative Research Practice, A Guide for Social Science Students and Researchers (2nd edn). London: Sage.Google Scholar
Richards, D. A., Bowe, P., Pagel, C., Weaver, A., Utley, M., Cape, J., Pilling, S., Lovell, K., Gilbody, S., Leibowitz, J., Owens, L., Paxton, R., Hennessy, S., Simpson, A., Gallivan, S., Tomson, D., & Vasilakism, C. (2012). Delivering Stepped Care: An Analysis of Implementation in Routine Practice. Implementation Science, 7:3. http://www.implementationscience.com/content/7/1/3 (last accessed 14 June 2019).CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (2020). PS01/20: Services for people diagnosed with personality disorder. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps01_20.pdf?sfvrsn=85af7fbc_2 (last accessed 29 May 2020).Google Scholar
Sampson, M. J., McCubbin, R. A., & Tyrer, P. (2006). Personality Disorder and Community Mental Health Teams, A Practitioner Guide. Wiley: Chichester.CrossRefGoogle Scholar
Sweeney, A., Clement, S., Filson, B., & Kennedy, A. (2016). Trauma-informed mental healthcare in the UK: what is it and how can we further its development? Mental Health Review Journal, 21, 174–192.CrossRefGoogle Scholar
Tyrer, P., & Duggan, C. (2007) NICE Guidelines for the Treatment of Personality Disorder. Psychiatry, 7, 109–111.CrossRefGoogle Scholar
World Health Organization (2019). International Statistical Classification of Diseases and Related Health Problems (11th revision). http://www.who.int/classifications/icd/en/ (last accessed 29 May 2020).Google Scholar
Submit a response

Comments

No Comments have been published for this article.