Complex Emotional Needs Project

[Project status – In dissemination]

We have carried out a substantial programme of research on the needs of people with “complex emotional needs”, who may have received a “personality disorder” diagnosis. This research was initiated to inform policy commitments in the 2018 NHS Long Term Plan.

We adopted the term “complex emotional needs” because of concerns regarding the stigma associated with “personality disorder” diagnosis, and the imprecision of such diagnoses. This followed discussions at an initial workshop, and with experts by experience and profession. We have continued to use it, as increasingly NHS services do, as a way of referring to the broad group of service users who may have received a “personality disorder diagnosis” when using mental health services, or have comparable needs. However, we do not see this as definitively the best choice of terminology, and would very much welcome more work on best ways of assessing and describing needs in this area.

We worked with a group of academic experts, clinicians, and lived experience researchers on this programme, publishing a group of reviews and qualitative studies, as listed below. Some key findings include:

  • Service users and clinicians concur on the need for services that prioritise therapeutic relationships, continuity of care, kindness and compassion, and a holistic focus on social and clinical needs. As well as continuity of care, stigmatising views and pessimistic views among health professionals, especially in primary and generic secondary services, are often an impediment to good quality care.
  • Therapeutic pessimism is hard to justify, as many participants in studies of “personality disorder” treatments improve substantially with any specialist treatment, or even with none, often to the extent that they no longer meet “personality disorder” criteria. 
  • The evidence base on effective and cost-effective services is mainly limited to specialist psychotherapies: most of these are similarly effective, with a lack of evidence on which work better for whom. Research lags behind other areas of mental health care, with a lack of evidence in areas including treatments for people with comorbidities, or younger and older people, trauma-focused and trauma-informed approaches, support for parents, socially-focused and co-produced interventions, and service design.

This overview presentation gives a summary of the CEN programme.

The Centre for Mental Health summarised our work and drew out conclusions for policy and service delivery in their report 'Dismissed because of my Diagnosis'


Engagement and events: