Bed shortages warning over personality disorder services

Reforms to services for people with severe personality disorders in southern England could lead to a shortage of beds, an expert fears.

Diana Menzies, consultant psychiatrist in psychotherapy for South West London and St George’s Mental Health NHS Trust, questioned whether the 30 beds proposed would be enough to meet need in London, South Central, South East Coast and East of England.

Last week, a committee representing 62 primary care trusts announced plans to commission one residential unit and four outreach services – one for each region – for people requiring “tier 4” personality disorder services for the most severe cases.

Limited outreach

Historically, the NHS has provided limited outreach provision and 44 beds across the regions, based at the Cassell Hospital, Richmond, and the Henderson Hospital, Sutton.

The Henderson closed its residential therapeutic community in May 2008 due to falling referrals despite a campaign to keep it open. However, 232 people received residential care for complex personality disorders in 2008-9, with beds purchased from the private sector.

Menzies, who provides assessments and training out of the Henderson, said the proposed unit would need to provide for people with a range of needs, which would be a challenge with 30 beds.

Waiting lists warning

She warned people may not be referred for treatment if there were long waiting lists for residential care and may then lose the motivation to undertake treatment.

However, Menzies welcomed the fact that funding for the residential and outreach services would be secured, reportedly for three years, as last week’s decision is binding on the 62 PCTs, who would each contribute money.

She said her trust was considering bidding to run the service, but would need to adapt the Henderson model to do so.

Adapting Henderson model

She said “They want people with different sorts of problems to be treated including those who the Henderson didn’t manage to provide services for previously. We would certainly need to adapt.”

Under the plans, the residential unit would act as a “hub” for the four outreach services, which themselves would link up with local services across the four regions providing services for people with less severe personality disorders.

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