National recommendations for enabling better care
Identifying prevention and early intervention for people who experience complex mental health conditions is a Scottish Government priority. To support understanding in this area, we have listed some publications relevant to personality disorder.
The recommendations in these publications can guide the development of patient outcome standards, help determine how well these standards are currently being met and prompt considerations around lived and living experience.
Personality disorder in Scotland: Raising awareness, raising expectations, raising hope
August 2018
A Royal College of Psychiatrists report that examines service development to ensure best possible outcomes for people with a diagnosis of personality disorder.
Mental Welfare Commission: Living with Borderline Personality Disorder
November 2018
A report that examines the experiences of care and support available to people with a diagnosis of borderline personality disorder, their families, carers and professionals involved in delivering care.
The Matrix
Guidance around evidence based interventions that support effective delivery of psychological therapies and interventions across a range of mental health conditions
NICE
Quality standards, resources and guidance that apply to personality disorder. This is due for review.
Personality disorder: No longer a diagnosis or exclusion
23 January 2003
This landmark 2003 policy helped transform personality disorder from a diagnosis that often led to exclusion from services into a condition recognised as deserving of effective treatment, specialist support, and equal access to mental health care.
Coordinated approaches to diagnosis and formulation
There are two main international manuals for the classification of the formal diagnosis of personality. The International Classification of Diseases (ICD) is used in Scotland and the rest of the UK. The adoption of ICD-11 in 2022 saw a fundamental shift in the classification of personality disorder from a categorical to dimensional system. It remains a considerable task for all boards to make the transition to the one diagnostic system. There are significant challenges for clinicians associated with changes to the classification system such as:
- Diagnostic uncertainty and stigma associated with diagnosis
- Lack of consistency in approaches to diagnosis and interventions
- Capturing diagnosis accurately with limited business intelligence
- Co-morbidity with other mental health conditions
Overview of data collected in services that support our understanding of complex mental health conditions
The national data landscape throughout all mental health services is varied and complex. Some common challenges include:
- geographic variation in the makeup of NHS boards and HSCPs
- service capacity for data interpretation, evaluation and reporting
- lack of consistency around clinical, patient and social outcome measures
- limitations and variation in business intelligence
Understanding what other services are measuring can support a more joined‑up approach and provide clearer insight into prevalence and comorbidity. This resource lists commonly used outcome measures in personality disorder services.
While not exhaustive, it reflects current practice and should be considered alongside the International Consortium for Health Outcomes Measurement (ICHOM) recommendations for person‑centered mental health outcomes. These measures are co designed with clinical, academic and lived experience experts and go beyond symptoms to include quality of life and social functioning, which are strong predictors of recovery.
Clinical outcome measures used in pathways and services supporting people with a diagnosis of personality disorder
This resource will be useful if you are seeking to gain a deeper understanding of the outcome measures currently being used in a sample of services that support people with complex mental health conditions.
ICOHM standard set of outcome measures for mental health
This resource will be useful if you want to understand the international recommendations for outcome measures to be used for a range of mental health conditions. The resource provides access to the sets as well as information around where they have been implemented globally.
Summary of an evaluation into the CMHT psychology in the BPD treatment pathway in Greater Glasgow and Clyde
This is a useful example of manual activity data gathering in a snapshot scenario to understand clinical activity with personality disorders of a professional group (Clinical Psychology) It provides a summary of activity figures of patients who attract a diagnosis of PD within CMHT Psychology caseloads.
Summary of NHS Greater Glasgow and Clyde Psychological Therapies Group Service Audit 2024
Useful resources that provide a summary of an audit within a group digital board wide psychological therapy service for people who experience complex mental health conditions, including outcomes from the emotional coping skills and STEPPS interventions. The methods used will be of particular interest to services who wish to conduct their own service audit.
NHS Greater Glasgow and Clyde: Pre and post Dialectical Behaviour Therapy service inpatient data poster
NHS Greater Glasgow and Clyde have evidenced the impact of their DBT service on inpatient bed days. The included poster contains commentary on how inpatient data was obtained manually by the service.
NHS Greater Glasgow and Clyde Evaluation of Emotional Coping Skills in inpatients
Evaluating the Effectiveness of Time-Limited Psychological Therapy under a Service Level Agreement Between NHS Health Boards (NHS Orkney and NHS Shetland)
2025
Personality Disorder and Homelessness Team NHS Greater Glasgow and Clyde: Demonstrating meaningful outcomes in a homelessness setting
This resource presents an evaluation of an SLA between NHS Orkney and NHS Shetland. It outlines methods for services conducting their own evaluations, particularly in remote and rural areas facing challenges in accessing psychological therapies or managing workforce constraints, and who may wish to consider SLAs as a solution. Report also highlights how approaches to data could be improved going forward.
This is a useful resource from a specialist service in NHS Greater Glasgow and Clyde, The Personality Disorder and Homelessness Team, which was presented at the British and Irish Group for the Study of Personality Disorder conference. This resource gives and overview of service outcomes, with specific focus on protected characteristics (age, ethnicity, gender identity, sexual orientation and pregnancy and maternity) and includes referral information, adverse childhood experiences, drug and alcohol misuse as well as service user feedback.
How to meaningfully involve people with lived and living experience in service improvement
The voices of people with lived and living experience are integral to ensuring that services are truly developed for those who use them. Meaningful involvement of these voices promotes empathy, learning, and action.
There are several approaches that can be used to gather information from people with lived and living experience. One of these is through use of regular review of patient feedback on Care Opinion.
Involvement of patients, families and carers in serious adverse event reviews can also be a valuable way to uncover important insights into systems, supporting learning, person centred care and recovery after adverse events. Healthcare Improvement Scotland have produced a National Framework for Reviewing and Learning from Adverse Events in Scotland, with specific guidance around including patients and their loved ones in these reviews.
Patient experiences
Patient stories offer powerful insight into how care is experienced, helping staff understand what happened throughout a patient’s journey and how it felt from their perspective. This can help staff and services to reflect on what worked well, identify areas for improvement, and use these insights to enhance future care.
Patient stories can be constructed in a way that suits the individual, including narratives, poetry and art. The resources provide two examples of patient stories from the NHS Greater Glasgow and Clyde BPD service.
Below you will find resources that increase our understanding of experiences from the perspective of people living with personality disorder.
Scottish Personality Disorder Network animations
Animations created by SPDN that explore individuals’ experiences of receiving a personality disorder diagnosis, the diagnostic process, and critiques of the diagnosis. They also highlight the perspectives of those in caring roles, along with the challenges and stigma associated with the diagnosis. In addition, SPDN offers other informational videos aimed at improving understanding of personality disorder diagnoses
BPD Dialogues Group – patient information leaflet evaluation outcomes: Living with Borderline Personality Disorder
This is a useful example of how people with lived and living experience can be meaningfully involved in the development and implementation of new services. It also highlights the impact that this can have, helping to empower people in their recovery and help support others in their journey.
NHS Greater Glasgow and Clyde: Patient stories from the DBT service
These patient stories provide powerful, first-hand examples of an individual’s experience of care before and after access to the BPD pathway in NHS Greater Glasgow and Clyde, highlighting the impact for the person.
User journey and experience maps
User journey and experience maps visually depict how a person moves through services and can be helpful for understanding access before and after a care pathway is in place. The resources include an example from an EIP pathfinder showing a person’s journey before and after EIP, along with an example patient experience map from the PDIP programme. There are also guidance and templates for creating your own maps.
Journey map guidance
This resource will be useful if you are seeking to engage with patients in your service to understand their experience of care. Includes guidance for interviews, downloadable templates and instructions for use.
Patient journey map from the CONNECT EIP service in NHS Tayside
This resource provides an example visualisation that was created using the patient journey mapping process in the EIP programme.
Patient experience map from the Structured Clinical Management pathway in NHS Dumfries and Galloway
This resource provides an example of a patient experience map that was created using their persons own words, and highlights the emotional impact of their journey through the service.
Patient experience mapping guidance to support interviews
This resource has been designed to help you get the most from the patient experience mapping interview process, with pointers to guide your interviews. It has been designed to be used in conjunction with the event capture cards below.
Event cards to capture information during patient experience mapping interviews
West Lothian HSCP EUPD+cPTSD pathway
This resource will assist you in capturing the relevant information needed to help build user journey or user experience maps. Learn more about journey mapping.
Another useful example of how pathways can be visually depicted, using information captured during pathway reviews. These visualisations and the review process were facilitated with service design input.