They want the NHS to stop the widespread practice of detaining patients with borderline personality disorders, saying many should be cared for in the community instead. They say this detention does not help solve problems but simply exports behaviours such as self harm and suicide into expensive private units where they are not properly dealt with. The experts, from the universities of Manchester and Bangor, together with a leading private consultant, write in Lancet Psychiatry that patients are more likely to recover in the community.
Around 550 young people, diagnosed with borderline personality disorder, are currently locked away. Sometimes detention lasts for years.
It happens when doctors rule that their behaviour is likely to be harmful to themselves. Nearly all of these patients are housed in private specialist units after referral by the NHS.The cost of such care can be up to £250,000 a year.
The study’s lead author Keir Harding, of Chester-based Beam Consultancy, believes the system has turned its back on young people.
He said: “There is strong evidence that locking up people diagnosed with personality disorder makes things worse, not better.
“Many young patients say putting them in mental health units, often many miles from home, has done them more harm than good. Nobody wants to see any young person hurt themselves but sometimes the caring response is more damaging than the self-harm.
“Locking people up in an environment where they couldn’t possibly hurt themselves is not a life. We may keep people from harming themselves but by doing this we are putting them in a living hell. This is a reflection of a risk-averse culture where one of the ways of managing risk is for that to be exported to someone else.
“We are pouring Confinement hell money away on this – which would be good if it worked but I don’t see any good evidence that it does.”
He called on the Government to adopt other ways to treat these patients, many of whom have suffered neglect or abuse.
The Lancet paper says half of patients on acute psychiatric wards have a diagnosis of personality disorder.
It states: “We repeatedly see patients who are sent to units with a promise of specialist care. Sometimes the staff believe this, sometimes they know the reality but patients are not informed.”
It added: “Current expenditure can be used to develop evidencebased community services.
“Most importantly, we must address the culture of fear and blame affecting clinicians and services, and instead enable them to deliver meaningful help.
“This requires cultural shifts and a change in political priorities.”
