Organisational challenges to providing services for personality disordered people
People with a diagnosis of personality disorder have diﬀerent needs compared to people with a diagnosis of mental illness but nevertheless have been catered for by traditional psychiatric services, where they have often been inadequately managed rather than eﬀectively treated. It is principally because they did not respond to these services, that these clients have been deemed ‘untreatable’ – an inevitable consequence of receiving services not designed to meet their needs. People with personality disorder are not a homogeneous group; therefore one service model will not be appropriate for all. Those with the most severe psychopathology require a residential facility (hospital or prison unit) to ensure safe containment to implement eﬀective treatment; those with less severe psychopathology are more appropriately treated in outpatient and/or day services. The organisational challenges discussed are primarily relevant to the provision of residential services but are also relevant to other contexts.