Brain Sciences


Study calls for new approach to treating people with complex emotional needs

24 February 2022

A new study co-authored by Professor Sonia Johnson and Associate Professor Bryn Lloyd Evans (Division of Psychiatry) identifies major limitations in the mental health support provided to people with complex emotional needs and calls for a longer-term therapeutic approach.

Photo is of a man and a woman sitting opposite each other in conversation. The woman is a psychiatrist and is taking notes.

The study, which was led by researchers from King’s College London and published in BMC Psychiatry, investigates the experiences of people who have received a diagnosis of a ‘personality disorder’ or have used services designed for people with this diagnosis.

The researchers interviewed 30 people from across England living with complex emotional needs. While there was some evidence of positive experiences, especially in specialist services for this group, respondents reported many negative experiences of care.

Overall, the feedback provided by respondents was divided into four areas that they felt could be improved upon: staff understanding, interpersonal connection, consistency and continuity in care, and adaptability and accessibility in care.

The ‘personality disorder’ diagnosis is often criticised for being stigmatising, and some report it gives a sense of hopelessness about the effectiveness of future treatment. As a consequence, many people given that ‘label’ feel frustrated and further marginalised by their experiences of mental health services.

Study participants shared a desire to see staff treat them in a non-stigmatising and compassionate way that recognised their individuality. The researchers suggest that ‘relational practice’, which focuses on establishing and maintaining longer-term therapeutic relationships that look at the individual’s wider social needs alongside their health and psychological needs would improve the support for service users within the community and reduce the demands on other parts of the healthcare service.

Dr Kylee Trevillion, the study’s first author from the NIHR Mental Health Policy Research Unit at King’s College London, said: “While there were pockets of good experiences reported, our study shows that people living with complex emotional needs feel that community services are not often providing the kind of care that people need. Complex emotional needs relate to more than a single experience or factor, and good care needs to reflect this. Relational practice looks at the whole person, sees the interconnectedness of their experiences, and seeks to work with the service user to help them manage their lives.”

Professor Sonia Johnson said:

"Care for people living with mental health condition lags behind care for people with physical health conditions, and people with a "personality disorder" diagnosis are often still more disadvantaged than people with other mental health diagnoses. Stigmatising attitudes not just among the public but among health professionals are a particularly pressing problem. This study shows that people with a "personality disorder" diagnosis have clear and practical ideas about how care could be improved.  These include involving service users in service development, acknowledging the impact of trauma, reconsidering the use of diagnosis, focusing on social as well as psychological needs, and greatly improving access and continuity of care in all parts of the system."


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