Personality disorders: Co-ordinating care
Co-ordinating multiple clinicians
The American Psychiatric Association guidelines on BPD highlight the importance of co-ordinating treatment provided by multiple clinicians. Co-ordination involves:
- clearly defining roles
- determining what to do in a crisis
- regularly communicating within the care team
- documenting team communication
It is important to identify which clinician is assuming primary or overall responsibility.
The primary care provider role in co-ordination
Patients with personality disorders often see other clinicians for therapy while seeing the primary care physician for medication. Primary care providers should be aware of treatment the patient is receiving elsewhere because different therapies may inadvertently promote regression. Some therapies place greater value on uncovering early trauma and difficult emotional experiences, and although this sometimes is necessary, it may occur before the patient is ready for that therapeutic work.
If your patient is seeing a therapist and is getting worse, you need to be aware of this and raise your concern with the patient and the therapist. This ensures that the patient is being treated appropriately and also manages your medico-legal liability. If negative events occur in psychotherapy that result in a patient's self-harm or suicide, the primary care provider is likely to be included in any litigation the family pursues.
The role of psychiatrists
When treating patients with personality disorders it is always best if psychiatrists can be involved, either to manage any comorbid psychiatric diagnosis or to facilitate psychotherapeutic involvement. However, primary care providers are familiar with the difficulties in getting patients seen by psychiatrists, who are not able to treat large numbers of patients because of the labour-intensive nature of psychiatric care and other considerations.
Borderline personality disorder: recognition and management (NICE guideline CG78, 2009)
Antisocial personality disorder: prevention and management (NICE guideline CG77], 2008)
Clinical Practice Guideline for the Management of Borderline Personality Disorder (National Health and Medical Research Council, 2012)
Treatment guidelines for personality disorders (Project Air, 2015)