It is widely recognised that people given a diagnosis of personality disorder have often not been given the support they need and had difficult experiences of mental health services. In 2003, the Government wrote 'No longer a Diagnosis of Exclusion', a strategy for improving access to support and treatment for people given a diagnosis of PD. The strategy made it clear that people given a diagnosis of PD should not be turned away from mental health services. It focused on developing specialist PD services and improving access to mainstream mental health services (for a copy go to the Resources section of this site - opens in new window).
How are mental health services set up?
Health services are organised into levels and it can be helpful to understand how this works if you are trying to find support or are working with others to campaign for improvements to services.
Primary Care Trust – Each region, at the moment, has a Primary Care Trust (PCT) which is given money by the government (Department of Health) to buy health and social care services. They have a responsibility to find out what local people need and then to decide how best to meet these needs. PCTs do not make these important decisions on their own but should involve local people (i.e. members of the public) who use services or care for someone who does, and local charities and organisations that provide services. They then 'commission' or pay other organisations to provide those services.
Primary Care Services – This refers to our GPs who are often the first people we turn to when we feel we need support. They may be able to help you themselves or may refer you on to mental health services.
Secondary Care Services – These are specialist mental health services – for example, your local Mental Health NHS Trust which runs community mental health teams, psychiatric hospitals, crisis resolution teams, assertive outreach teams, psychotherapy services etc within your area.
Voluntary Sector – As well as services run by the NHS, your local PCT may well fund charities and other independent organisations to run services to support people with mental health issues. For example, local Mind associations, Rethink, and other smaller local organisations are often paid to run day services, support groups, advocacy services, and so on. You often do not need a referral from doctor to go along to these services.
Specialist Services: tertiary level – These services are based around particular needs and are more specialised than general mental health services, for example, specialist personality disorder services. The government report 'No longer a Diagnosis of Exclusion' stated that local areas should develop specialist PD services. Some areas have made more progress than others in doing this, and some have decided this is not the best way to meet people's needs. As a result, the support available in each area is very different, with some places offering a range of services to choose from, and others with no specialist services at all.