1. ‘Learning the Lessons’ – an Evaluation of Community Services for Adults with Personality Disorder

People who have a personality disorder have long-term emotional problems that affect the way they see themselves and get on others. These problems make people at greater risk of mental health and social problems, suicide and self-harm.

‘We have been commissioned to evaluate these new services. We want to find out if and how they help people and to use this information to make recommendations for future service development’

Dr Mike Crawford (Evaluation Lead)

In many areas of the country there are few services for people with a personality disorder. In order to improve this situation the NHS has funded eleven new community services for people with these problems.

The project started in April 2006. Since then we have conducted interviews with managers and clinical staff aimed at finding out how services are organised and the different types of treatment they provide.

We will be going back to the services later this year to find out how they developed and how this affected the care they provided. We will supplement this data with information on the number of referrals each service receives, what services people are provided with and information about mental health, social functioning and use of other services among a sample of the people they treat.

We will also be collecting information from users and carers about what they think makes a good service for people with PD. This data will be collected by trained service user researchers supervised by the Mental Health Foundation.

We plan to involve users and providers of services in synthesising findings from the different parts of the study and will be conducting a survey of representatives of these groups in Autumn 2006.

Final project report available here.

2. Medium Secure & Community Forensic Services

A collaborative project – Imperial College London, University College London, Mental Health Foundation, Institute of Psychiatry, University of Liverpool

Description of the evaluation

The overall objective of this study is to investigate the operation of the three pilot forensic services for people with personality disorder. The methodology employed is a mixed-methods research programme involving four modules:

Module 1 – Cross-sectional investigation of client characteristics

A six-month referral cohort of clients has been assessed using a range of quantitative measures. Maximum use has been made of routinely collected data. In addition, these data have been supplemented by measures of behaviour, therapeutic alliance and cost.

Module 2 – Description of service characteristics

Detailed information about the resources of each service has been gathered from staff questionnaires and qualitative interviews with staff. Provisional results from the qualitative interviews have been fed back to the staff in the setting of three focus groups.

Module 3 – Investigation of the outcome of clients at 6-month follow-up

A detailed analysis of the process and outcome of service delivery at each service is being carried out, approximately 6 months after the clients were recruited into the study. This will involve a follow-up of clients assessed in Module 1 who have remained in the treatment programme. Both quantitative and qualitative data will be collected. The results will be validated through feedback to the participating clients. Primary outcome measures will be: i) change in therapeutic alliance score and ii) change in service costs.

Module 4 – An investigation of team outcomes

Staff that participated in the module 2 interviews will be asked to participate in a follow-up qualitative interview. The interview will focus on the strengths and weaknesses of staff training, factors underlying effective team functioning and the factors associated with successful and unsuccessful engagement of clients with treatment. Participant reaction to the findings will be assessed, by feeding the provisional results back to the staff in the setting of focus groups.

Main outputs from the study

The main outputs from this study will be three detailed case studies, using multiple sources of data. We will be comparing the appropriateness, effectiveness, and acceptability of the three services. 

Final report available here.


Paul Moran (Principal Investigator), Mike Slade, Diana Rose, Paul McCrone – HSRD, Institute of Psychiatry

Jeremy Coid – St Bartholomew’s Hospital

Mike Crawford, Peter Tyrer – Imperial College

David Mudd – University of Teeside

David Armstrong – Kings College London

Research workers: – Ruth Spence, Zoe Fortune