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, 19 (1), 341

Evaluation of a Brief Intervention Within a Stepped Care Whole of Service Model for Personality Disorder


Evaluation of a Brief Intervention Within a Stepped Care Whole of Service Model for Personality Disorder

Elizabeth Huxley et al. BMC Psychiatry.


Background: Although there is growing evidence that stepped models of care are useful for providing appropriate, person centered care, there are very few studies applied to personality disorders. A brief, four session, psychological treatment intervention for personality disorder within a whole of service stepped care model was evaluated. The intervention stepped between acute emergency crisis mental health services and longer-term outpatient treatments.

Methods: Study 1 used service utilization data from 191 individuals referred to the brief intervention at a single community health site in a metropolitan health service. Proportions of individuals retained across the intervention and the referral pathways accessed following the intervention were examined. Study 2 examined 67 individuals referred to the brief intervention across 4 different sites in metropolitan health services. A range of measures of symptoms and quality of life were administered at the first and last session of the intervention. Effect sizes were calculated to examine mean changes across the course of the intervention.

Results: Study 1 found that 84.29% of individuals referred to the intervention attended at least 1 session, 60.21% attended 2 sessions or more and 41.89% attended 3 or more sessions. 13.61% of the sample required their care to be "stepped up" within the service, whereas 29.31% were referred to other treatment providers following referral to the intervention. Study 2 found a significant reduction in borderline personality disorder symptom severity and distress following the intervention, and an increase in quality of life. The largest reduction was found for suicidal ideation (d = 1.01).

Conclusions: Brief psychological intervention was a useful step between acute services and longer-term treatments in this stepped model of care for personality disorder. Suicide risk and symptom severity reduced and quality of life improved, with only a small proportion of individuals requiring ongoing support from the health service following the intervention.

Keywords: Borderline personality disorder; Brief intervention; Crisis intervention; Model of care; Personality disorder; Stepped care; Suicide prevention.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig. 1
Fig. 1
Illustration of brief intervention as part of a stepped model of care
Fig. 2
Fig. 2
Flow chart of participants referred to the brief intervention, sessions attended and outcome

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    1. Beckwith H, Moran PF, Reilly J. Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personal Ment Health. 2014;8(2):91–101. doi: 10.1002/pmh.1252. - DOI - PubMed
    1. Paris J. Borderline personality disorder. Can Med Assoc J. 2005;172:1579–1583. doi: 10.1503/cmaj.045281. - DOI - PMC - PubMed
    1. Pascual JC, Corcoles D, Castano J, Gines JM, Gurrea A, Martin-Santos R, et al. Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service. Psychiatr Serv. 2007;58(9):1199–1204. doi: 10.1176/ - DOI - PubMed
    1. Lewis KL, Fanaian M, Kotze B, Grenyer BFS. Mental health presentations to acute psychiatric services: three-year study of prevalence and admission risk for personality disorders compared to psychotic, affective, substance or other disorders. BJPsych Open. 2019;5(1):E1. doi: 10.1192/bjo.2018.72. - DOI - PMC - PubMed
    1. McMain SF, Links PS, Gnam WH, Guimond T, Cardish RJ, Korman L, et al. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1365–1374. doi: 10.1176/appi.ajp.2009.09010039. - DOI - PubMed

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