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Managing personality disorder in primary care

  • 5% of the population suffers from one or more personality disorders (PD). These are long-term, disabling conditions which cause a great deal of distress to patients and place a significant burden on the health economy
  • 24% of people attending GP consultations suffer from PD: they attend five times more frequently than other patients. They feel dissatisfied with GP care, are less concordant with treatment and are more stressful for GPs to manage. They consult repeatedly and engage in ‘difficult consulting behaviour’.
  • 45% of patients with medically unexplained motor symptoms (persistent physical symptoms) suffer from PD.
  • People with PD cost more in terms of medication, psychiatric care and social care than people with major depressive disorder.
  • 8% of people with emotionally unstable (borderline) PD die by suicide, but also self-harm regularly in a non-lethal way, and account for 9% of mental health-related visits to emergency departments. They are ten times more likely to present to emergency departments than the rest of the population.
  • GPs and others working in primary care lack confidence in dealing with this demanding patient group leading to high stress levels
  • PD makes other conditions harder to treat; people suffering from PD and depression or anxiety are less likely to respond to antidepressants, CBT and self-help.

Patients with PD can become demanding, overwrought, anxious and seemingly unmanageable when seeking help in primary care and clinicians and teams need more support and help to manage this patient cohort effectively, both for the patient and the clinicians.

Changing attitudes and practice systems can be hard and the Personality Disorder Positive Outcomes Programme (PDPOP) uses relatively high intensity, whole practice team training to provide the energy and engagement to start this process. Identifying a practice lead and supporting them to deliver an action plan (including follow-on training) is intended to make this sustainable and create a regional network of local PD champions.

Training and development activity is delivered by co-facilitators including a GP, an experienced psychological therapist and an expert by experience (STAR) within a positive and supportive framework. This will ensure clinical knowledge and guidance is of a high standard.

All training and development programmes consist of:

  • four hours of face-to-face whole team training on PD for practice team(s)
  • provision of follow-on training materials and support for practice leads to deliver a follow-on training session to their team(s)
  • support for practices to identify organisational changes to align the system and ensure agreed, supported and consistent care of patients with personality disorder
  • ongoing CPD support to practice leads through the use of complex case discussion by video conference.