Initial outcomes of a therapeutic community-based outpatient programme in the management of personality disorder

Purpose - This study aims to describe the effectiveness of two arms of a personality disorder service: a modified mentalization based therapy (MBT) day programme and an open access service-user network (SUN) support. Both arms utilised therapeutic community principles in service delivery. Design/methodology/approach - Personality disorder subtypes for all patients entering the modified MBT programme were diagnosed at a clinical assessment interview and corroborated through use of a standardized semi-structured interview (SCID II). All patients were also allowed open access to a service user network community support group (SUN Project). Outcome measures were applied at baseline, mid-therapy and end of therapy and included self-report measures of depression, anxiety, general symptom distress, interpersonal function, social adjustment and patient satisfaction. Clinician-rated measures of general health and functioning were also used. Data analysis used paired sample T-tests and Wilcoxon Rank Sum tests, depending upon the assessment of parametric or nonparametric tests of trend. The open access nature of the SUN Project demanded a different data collection method. All members received a Standardized Assessment of Personality - abbreviated scale (SAPAS). Two validated empowerment questionnaires were sent to all SUN members that had achieved six months of membership: the first relating to the six-month period before joining the SUN and the second to the six-month period after joining the SUN Project. Paired sample T-tests were used to compare sets of empowerment scores. Findings - Patients who completed 18 months of MBT-tc treatment showed a statistically significant improvement on the clinician-administered measures relating to psychological, social and occupational functioning, compared to baseline. Patients also reported statistically significant improvement in using the brief symptom inventory. All SUN members perceived significant increases in empowerment across the five score subscales. No completed suicidal acts were recorded within the period of analysis within either arm of the service. Originality/value - An integrated therapeutic community day service appears to afford improvements in perceived empowerment and symptom severity for patients. Further data collection with a larger sample is needed to clarify whether these outcomes support the development of a wider integration of the relatively low cost SUN Project model and MBT within therapeutic communities.