This page gives general information about personality disorder (PD) and the UK situation, in particular in respect of NHS services.
Glossary
CCG. Clinical Commissioning Group. Prior to 2013 local NHS services in England were commissioned by Primary Care Trusts (PCTs). These were replaced by CCGs in the 2012 Health and Social Care Act. CCGs are led by GPs.
CMHT or AMHT. Community or Adult Mental Health Team. These are multidisciplinary teams that provide community based care for people with mental health problems. The majority of people with PD who are in contact with mental health services will receive services from a CMHT or AMHT.
DBT. Dialectical behaviour therapy. A behavioural therapy incorporating mindfulness (meditation training) based on skills training to increase coping skills. Involves the idea that an invalidating environment has contributed to the development of borderline personality disorder in early life, leading to emotional dysregulation.
MBT. Mentalisation based therapy. Mentalisation is a psychological skill, and refers to the ability to consider one’s own and other’s mental states (emotions, wishes, beliefs and so on) in making judgements about situations. People with borderline PD may have more difficulties mentalising in some situations.
TC. Therapeutic Community. An treatment for personality disorder involving mutual support, care and challenge in a group based environment. TCs are also used in the treatment of addictions.
Tiers of PD service provision.
- Tier 1 refers to primary (GP) care. Most people with PD never come into contact with mental health services.
- Tier 2 refers to generic mental health care, normally in a CMHT.
- Tier 3 refers to specialist PD treatment in the community, i.e. not in hospital. Provision differs between areas according to CCG commissioning decisions. Most of the Tier 3 PD services in the UK are listed on the services page.
- Tier 4 services are residential non forensic PD services. Some are commissioned by NHS England, and incur no cost to local referrers. Others will require funding by local CCGs. See services page for list.
- Tier 5 and 6 services are medium and high secure forensic services, respectively. Following the implementation of new specifications for medium secure services in England in 2014, people with PD are admitted to tiers 5 and 6 only if they pose a risk to others.