Personality disorder programme No longer a diagnosis of exclusion

A problem that has confronted all specialist personality disorder services is how to achieve a representative proportion of black and minority ethnic service users for the population they serve. A new service in the East End of London identified this problem in their study.

Consultant Psychiatrist, Dr Tennyson Lee (from the Tower Hamlets PD Service) explores the issues and reveals his team’s findings in an article in The Psychiatrist. He sets out below the methodology, results and clinical implications.

Aims and method Using the National Institute for Health and Clinical Excellence (NICE) guidelines on borderline personality disorder as a framework, we describe the profile of the first 100 individuals referred to a personality disorder service in London, captured through the use of record review and case study.

Results The referral population ethnic profile does not match the wider population of the borough; a third of the borough is Bangladeshi (1), but only 9% of those referred to the service are. Of those diagnosed with borderline personality disorder and on psychotropic medications, only one person had a clear current indication based on NICE guidelines. Of the 100 individuals who were referred to the service, a quarter were accepted to the programme; a third either did not want to proceed with the assessment or were unprepared for an intensive programme.

Clinical implications The under-representation of black and minority ethnic individuals in referrals in the personality disorder service needs to be actively addressed. Interventions are required to support psychiatrists in reviewing their prescribing practice regarding individuals with borderline personality disorder. Access to the service needs to be improved.

A full version of the article may be found at http://pb.rcpsych.org/cgi/content/abstract/35/1/22.

1. Office for National Statistics. 2001 Census. ONS (http://www.statistics.gov.uk/census2001/access_results.asp)