Personality disorder and pathways to inpatient psychiatric care

The impact of personality disorder on pathways into psychiatric care is unknown.

To examine associations between personality disorder status, length of pathway into inpatient psychiatric care, and involvement of the criminal justice service in the pathway into care.

The Structured Clinical Interview for DSM-IV personality disorders (SCID-II) and a modified WHO Pathways Encounter Form were administered to a sample of 153 consecutive inpatients admitted to acute wards in one inner London borough over a 4-month period. Diagnosis, socio-demographic variables, social support and substance misuse were also ascertained.

The presence of personality disorder was not associated with significant differences in the number of carers, time spent along the pathway, or probability of criminal justice system involvement. However, all three personality disorder clusters were significantly associated with increased use of Accident and Emergency (A & E) services.

Given the high levels of contact with A & E services, casualty staff should receive improved training in the assessment and management of patients with personality disorders. Improved detection of personality disorder within A & E departments could lead to earlier diversion to mental health services and a consequential improvement in the planning of subsequent treatment.