NHS Highland Personality Disorder Integrated Care Pathway

Introduction

1. PD-ICP Introduction
This Personality Disorder Integrated Care Pathway Document (PD-ICP) has been developed by a working group composed of a wide range of NHS Highland employees from different professional backgrounds, volunteers and service users. Every effort was made to consult widely at each stage of development to ensure that the main aims of producing a clinically useful and well-used document were met.

This document updates and incorporates the NHS Highland Borderline Personality Disorder ICP (BPD-ICP) which was originally completed in 2009. Whereas the 2009 BPD-ICP related only to borderline personality disorder, this PD-ICP pertains to personality disorder more broadly.

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1.1 Language and terminology
The sensitive nature of language and terminology remained apparent throughout the development process. Agreement on terminology was sometimes difficult—for example, some people preferred the term ‘patient’, some preferred ‘service user’ and some preferred ‘individual’. For the sake of clarity, the decision was made to use the term ‘patient’ throughout the document and to use the broad term ‘clinician’ to refer to health workers and social care workers employed by NHS Highland. It was also decided to use the term ‘social network member’ rather than ‘carer’, ‘family member’ or ‘friend’. The term ‘carer’ in particular was felt to carry connotations of patients as passive recipients of care rather than active participants in their own recovery. Aside from this one instance, no inference should be drawn from the use of these particular terms as the choices were made by the working group on a practical rather than a theoretical basis.

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1.2 What is an ICP?

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In addition to these aims, this ICP aims to provide a single point where information, referral forms and other resources pertaining to personality disorder can be easily found. In addition, it allows for NHS Highland’s philosophy of care in relation to personality disorder to be made explicit.

1.3 What is Personality Disorder and why is an ICP necessary?
Personality disorder refers to a complex mental disorder, not explainable by an other adult mental disorder, which represents a enduring and pervasive disturbance in the characterological constitution and behavioural tendencies of an individual, usually involving several areas of personality, and is nearly always associated with considerable personal and social disruption and distress. (World Health Organisation, 1993)

Personality disorder is common, affecting upwards of ten per cent of the general population. The condition is typically associated with significant impairment of functioning and high levels of distress for the sufferer and other people. People with personality disorder frequently have contact with many different services and agencies including primary care, Accident and Emergency, secondary care physical health services, mental health services, housing, social work and criminal justice. Not uncommonly, these services find it challenging to effectively work with this group of people. This ICP aims to provide guidance to promote best practice within NHS Highland and is based on best available evidence. Although there is a significant risk of iatrogenic harm if this patient group are managed inappropriately, many components of the disorder are eminently treatable and meaningful sustained recovery is common.

1.4 How to use this ICP
This ICP has been divided into sections, each dealing with a particular aspect of the care and treatment of personality disorder. The sections have been designed to stand alone and there will inevitably be some overlap of content. Although the ICP itself is primarily a good practice statement providing clinical guidance, another key aim has been to make easily available in one place a repository of useful information, referral forms, educational materials and other resources. The additional material can be located in the appendices, which will be updated as required. The guidance in the body of the ICP itself will be reviewed on a yearly basis. The Personality Disorder Service will take the lead in the updating and reviewing process. The ICP is primarily intended to be used electronically and there are internal and external click-able links throughout.

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