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Borderline Personality Disorder

Reference: 23-24400

Date response sent: 18/01/2024

Details of enquiry

  1. Please provide your trust policy for borderline personality disorder diagnosis and treatment.
  2. How much funding is received for the care of borderline personality disorder and how is this money spent?
  3. How many adult patients are there within the trust with a diagnosis of borderline personality disorder?
  4. What specialist treatments or therapeutic interventions do the trust facilitate for all patients diagnosed with borderline personality disorder?
  5. How much does it cost the trust per year to provide medication to adults diagnosed with borderline personality disorder?
  6. How many patients/service users with borderline personality disorder require in-patient care?
  7. How much does it cost the trust to facilitate this in-patient care?
  8. Does the trust provide dialectical behaviour therapy? If so, please provide the numbers of patients/service users who have used this service. If not, is there a plan to implement this treatment?
  9. How many suicides of patients with borderline personality disorder have there been each year?
  10. How many complaints have been lodged in relation to borderline personality disorder treatment?

Response sent

When reviewing the following answers, it may be helpful to be aware that the Tavistock and Portman NHS Foundation Trust is not an acute mental health hospital, we are a specialist mental health Trust providing outpatient, and mainly psychological, services via talking therapies.    We do not provide acute services, nor inpatient patient services, nor detention facilities,  and do not have an  A&E department

  1. Please provide your trust policy for borderline personality disorder diagnosis and treatment.

The Trust does not provide a dedicated service for Border Personality Disorder and Diagnoses and accordingly it does not have a dedicated policy for this condition.

  1. How much funding is received for the care of borderline personality disorder and how is this money spent?

The Trust does not receive a specific funding allocation for Border Personality Disorder and does not provide a dedicated service this condition, though we may sometimes diagnose this in a patient’s secondary and/or pre-existing condition. As part of a psychodynamic formulative assessment/treatment approach, rather than a prescriptive psychiatric diagnosis of Borderline Personality Disorder.

  1. How many adult patients are there within the trust with a diagnosis of borderline personality disorder?

We do not provide Borderline Personality Disorder Assessments, as explained in question 2 above, we employ a psychodynamic formulative assessment/treatment approach, rather than a psychiatric diagnosis of Borderline Personality Disorder.

We estimate that to confirm the recorded number of patients who received a diagnosis of Borderline Personality Disorder at our Trust or elsewhere over the last 5 years would exceed the appropriate limit, under Section 12 of the FOIA.  This limit equates to 18 hours’ of officer time at £25 per hour for answering a whole request.  We would need to examine all adult records over the 5 year period to see/locate whether the information is held, and, where held, to extract it, which we estimate would take circa 10 mins per patient record, totaling around 17 hours per thousand records.  Accordingly the Trust is not obliged to process this question.

  1. What specialist treatments or therapeutic interventions do the trust facilitate for all patients diagnosed with borderline personality disorder?

Not applicable.  We do not provide a dedicated service for borderline personality disorder.

  1. How much does it cost the trust per year to provide medication to adults diagnosed with borderline personality disorder?

Not applicable.  We do not provide a dedicated service for borderline personality disorder.  The Trust does not have a pharmacy.

  1. How many patients/service users with borderline personality disorder require in-patient care?

Not applicable, the Trust does not provide inpatient services

  1. How much does it cost the trust to facilitate this in-patient care?

See above response

  1. Does the trust provide dialectical behaviour therapy? If so, please provide the numbers of patients/service users who have used this service. If not, is there a plan to implement this treatment?

No.

  1. How many suicides of patients with borderline personality disorder have there been each year?

We do not hold this data as a complete data set.

Being an outpatient clinic, we cannot be certain that we hold complete data on all suicide cases, and as advised below, we cannot be certain that all our patients’ deaths have been notified to us.

The Trust has changed its presentation of mortality data to prevent the possibility of individuals being identified through triangulation of data, due to the low number of service users who may be referenced.   Accordingly the Trust no longer splits its mortality data by department, waiting list, active patients, or any other parameters

The rationale for this approach is:

  1. The Trust now follows guidance from the Office of National Statistics (ONS) on disclosure control to protect confidentiality within death statistics, and the Trust will not report mortality numbers by service, due to risks of identification of the low number of service users referenced.

Practical examples of where this has been applied elsewhere are:

  • National Confidentiality Inquiry in Suicide and Safety in Mental Health
  • Ministry of Defence Suicides in the UK regular armed forces: Annual summary and trends over time 1 January 1984 to 31 December 2020
  • Any statistics that are under five will only be referenced as <5
  1. The Trust now complies with “The revised guidance on reporting suicide and severe self-harm to NRLS for all providers except those providing specialist mental health services” issued by the National Patients Safety Agency  (2012).
    • Other providers would meet their responsibilities by ensuring they pass on any information that indicates suicide or self-harm to the relevant specialist mental health trust so they can report it
  2. Trust mortality data, (suicide, death by natural causes, death from other causes) is now published cyclically on our website, though none of these would answer this question of yours, as we no longer split out available data by department or diagnosis for reasons explained above.   Mortality data, as advised to us, may be reached at the following locations on our website:

Annual reports and quality accounts (tavistockandportman.nhs.uk)

Board meetings and board papers (tavistockandportman.nhs.uk)

Freedom of information disclosure log (tavistockandportman.nhs.uk)

  1. How many complaints have been lodged in relation to borderline personality disorder treatment?

We have completed a search of the database used to record and manage complaints up to 10/01/24 and found zero complaints lodged in relation to borderline personality disorder treatment.

 

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