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Clinical characteristics and care pathways of patients with personality disorder who died by suicide

  • Sandra Flynn (a1), Jane Graney (a1), Thabiso Nyathi (a2), Jessica Raphael (a1), Seri Abraham (a3), Sandeep Singh-Dernevik (a1), Alyson Williams (a1), Nav Kapur (a1), Louis Appleby (a1) and Jenny Shaw (a1)...
  • Please note a correction has been issued for this article.

Abstract

Background

It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments.

Aims

To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance.

Method

National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK.

Results

The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients.

Conclusions

Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Sandra Flynn. Email: sandra.m.flynn@manchester.ac.uk

Footnotes

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Declaration of interest: L.A. chairs the Suicide Prevention Advisory Group at the Department of Health and is a non-executive Director for the Care Quality Commission. N.K. is Chair of the Guideline Development Group for the National Institute for Health and Care Excellence (NICE) depression in adults’ guideline and a topic expert for the NICE suicide prevention guideline. He is a member of the National Suicide Prevention Advisory Group (England).

Footnotes

References

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Keywords

Clinical characteristics and care pathways of patients with personality disorder who died by suicide

  • Sandra Flynn (a1), Jane Graney (a1), Thabiso Nyathi (a2), Jessica Raphael (a1), Seri Abraham (a3), Sandeep Singh-Dernevik (a1), Alyson Williams (a1), Nav Kapur (a1), Louis Appleby (a1) and Jenny Shaw (a1)...
  • Please note a correction has been issued for this article.

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A correction has been issued for this article: