The Cassel Personality Disorder Day Service Study (CEDASS)
We are supporting the development of a research study exploring the effectiveness of specialist day services for people with personality disorder and complex trauma. Personality disorder is a mental health condition affecting 4.4% of the adult population. These disorders severely impact an individual’s outcomes, with sufferers dying on average 18 years earlier. It is estimated that between 45 and 77% of those who commit suicide have a personality disorder and whilst 80% were in contact with mental health services, only 5% had been in contact with specialist personality disorder services. In 2003, a seminal paper “Personality Disorder: No Longer a Diagnosis of Exclusion” was published by the Department of Health. It established pilot services across the country to develop best practice and provide the opportunity for evaluation. Since then, increasing evidence has supported the development of NICE guidance in 2008 and more lately 2015 which echoed the call for specialist services. In 2015 the National Personality Disorder Service Survey found that only 55% of people had access to specialist services and when they did the quality and capacity of such services was unlikely to meet guidance.
More recent research brings weight to longstanding concerns that mainstream services are ineffective when operating alone. A lack of a meaningful alternatives means patients use acute psychiatric inpatient services frequently, require lengthy hospital stays or become reliant on crisis services as well as A&E, primary care. This disorganized engagement with services is extremely costly, of little therapeutic benefit and often harmful. There are a small number of peer reviewed publications examining the effectiveness of such services but a substantial body of unpublished literature also exists. It is therefore time that a metanalysis was conducted so as to bring this data together and to bring the full weight of the scientific evidence to what has become a very topical issue.
This will be the first meta-analysis of clinical and cost outcomes of specialist personality disorder day services in the United Kingdom. The overall objective of this project is to build a health economic case for investment in specialist services for individuals with severe personality disorders.