Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Consider referring a patient with a personality disorder to specialist mental health services when:
- They present in primary care with repeated self-harm, persistent risk-taking behaviour, or marked emotional instability, especially if borderline personality disorder is suspected. For patients under 18 years, refer to CAMHS for assessment NICE CG78.
- They are in crisis with increasing distress or risk to self or others that does not subside despite attempts to manage anxiety and improve coping skills NICE CG78.
- They request further help from specialist services NICE CG78.
- There is a mental health disorder of a nature or severity requiring specialist management, high levels of distress, or increasing risk of self-harm NICE CKS.
- For antisocial personality disorder, if the person is seeking help and the presenting complaint relates directly to the personality disorder, consider referral to specialist personality disorder or forensic services NICE CG77.
- When behaviour is severe, complex, or does not respond to primary care management, or when there are comorbid mental disorders requiring specialist assessment and treatment NICE CG78,NICE CG77,NICE CKS.
Additional considerations: Before inpatient admission for borderline personality disorder, refer first to crisis resolution and home treatment teams or other alternatives to admission NICE CG78. For young people with severe borderline personality disorder, access to tier 4 specialist services including inpatient and specialist outpatient programmes should be ensured NICE CG78.