Borderline personality disorder Mental and Behavioural Disorders Specific personality disorders
Conditions
Interventions
This is a single-centre pilot randomised controlled trial of JCPs compared with a treatment as usual control condition for people with BPD. The total duration of the study will be two years.
Experim
Sponsors
King's College London (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Service users (both males and females) aged 18 years or older 2. Current contact with a local Community Mental Health Team (CMHT) (will include assessment and brief treatment, continuing care, home treatment and out-patient clinics attached to these teams) 3. A primary clinical diagnosis of emotionally unstable personality disorder (International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] code F60.3) 4. An episode of self-harm in the previous year
Exclusion criteria
Exclusion criteria: 1. Service users aged under 18 years of age 2. Those unable to give informed consent 3. Those unable to speak English. Fluency in English is necessary to complete the assessment instruments (many of which have not been validated in non-English languages) and to fully participate in the development of the Joint Crisis Plans. 4. Primary diagnosis of psychosis 5. Current in-patients will not be recruited to avoid any perceived potential coercion to participate, nor any patient subject to a compulsory community treatment order No other exclusions will be made, to maximise the external validity of the trial.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Self-harm history, assessed by a questionnaire at baseline and 6 months (trial end). Previous research indicates that JCPs for psychotic patients give them a greater sense of control over their health management and that one of the perpetuating factors for repeat self-harm is a sense of loss of control. We therefore think that in people with BPD (whose contact with mental health services is frequently characterised by the experience of disempowerment), self-harm is a reasonable choice for a primary outcome variable in a randomised controlled trial. Self-harm is also a major clinical problem in this patient population and is of great relevance from a public health perspective, given that it is a risk factor for suicide. Therefore, if JCPs could be shown to lead to an improvement in some aspect of self-harm behaviour, or the management of self-harm, this would be of great clinical relevance However, at this stage, we have no firm empirical evidence to show whether this is the case, or indeed which aspect of this behaviour might be affected by a JCP. There is no gold standard for measure of self-harm and possible candidates include: incidence, frequency, severity, help-seeking behaviour prior to and after a self-harm event. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Client's experience of the treatment that he or she received at a particular service, assessed by the Treatment Experience Scale assessed at baseline and 6 months 2. Service Engagement Scale at baseline, 6 months (trial end) and trial drop-out 3. The Work and Social Adjustment Scale (WSAS) at baseline and 6 months (trial end) 4. Euroqol EQ-5D at baseline and 6 months (trial end) 5. Client Satisfaction Questionnaire at baseline and 6 months (trial end) 6. Working Alliance Inventory - short version (WAI-S) (client version) at baseline and 6 months (trial end). This is a measure of how well a client and a clinician work together. 7. WAI-S (staff version) at baseline, 6 months (trial end) and trial drop-out 8. Adult Service Use Schedule (ADSUS) to assess which services clients have accessed in the preceding 6 months, for health economics purposes, carried out at baseline and 6 months (trial end) 9. Alcohol Use Disorders Identification Test (AUDIT) at baseline 10. Hospital Anxiety and Depression scale (HADS) at baseline | — |
Countries
United Kingdom
Outcome results
None listed