Psychosocial treatment for severe personality disorder
Background In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care. Aims To evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period. Method Two samples allocated to the in-patienttreatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake. Results Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patientsin the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group. Conclusions Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model.