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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Science of Psychiatry: Making an Impact


This piece of research was taken from 'Research and psychiatry - making an impact'

Improving the treatment of personality disorder

Imperial College London
Type of research
Personality disorders
Impact on
Therapy type

Decades of research have examined the way personality disorder is perceived and managed, and used evidence to change harmful government policy and create improved services for sufferers.

In 1993 expert assessments of personality disorders often yielded inefficient, unreliable diagnoses. Professor Peter Tyrer and his colleagues at Imperial College London decided to tackle the issue and following three years of work they introduced the first reliable assessment tool—a simple classification system, based on severity, that doctors could use to finally make reliably rated assessments of personality disorder. What’s more, the new system enabled the condition to be treated much more economically than before. The impact of this work is still being felt and based on this approach, the World Health Organisation is currently changing its classification of this disorder, for better understanding across the board.

The work of Tyrer and his colleagues led to new research, again at Imperial, which shed light on the impacts of personality disorder. The researchers showed that untreated personality disorder goes hand-in-hand with long-term morbidity, and that the presence of personality disorders reduces the effect of treatment for other mental health problems. With greater understanding and improved diagnoses came greater acceptance and awareness of this condition both amongst healthcare professionals and members of the public. However, the question remained as to whether or not the importance of treating personality disorder was embedded in national health care.

Eleven years ago a survey of mental health Trusts across England reported that four out of five Trusts did not provide specialist services to people with personality disorder, and one third stated that they provided ‘no service’ at all. Where specialist services were provided users reported the care was highly valued and that it greatly helped their health. As a result of these findings and after seeing the evidence for their value, it was recommended that specialist services should be expanded. Since then, the Department of Health has set up a dedicated website on personality disorder for users and providers of mental health services. This includes a directory of specialist services for people with personality disorder and there are now over 100 such services provided throughout the UK.

The team from Imperial have also used evidence to demonstrate how a government-led programme was not only wasting money but hindering the improvement of patients in the prison system. The researchers conducted a clinical trial with 75 prisoners in the Dangerous and Severe Personality Disorder programme. Prisoners were either placed in specialist units for assessment or left on a waiting list as a control. The progress of the two groups was measured and, after one year, the results concluded that those under specialist assessment actually showed increased aggression and poorer social functioning compared to the group on the waiting list. The Dangerous and Severe Personality Disorder programme is estimated to have cost £200,000,000, however, the evidence demonstrated that its lack of patient benefit was not worth the funding. Thanks to this research the programme was closed in 2009, and the resources have since been invested into providing more focussed psychologically-informed treatment for a far larger number of personality disordered offenders.

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