Personality disorder in older adults: a pilot treatment model

We agree with the view of Mordekar & Spence (2008) that personality disorder does not ‘burn out’ with advancing age, that treatment options are limited and that more research into this area of psychiatry is needed, given that the UK has an ageing population.

The Department of Health (2001, 2003) has specifically targeted equity of access to integrated mental health services for people over 65 years of age and for people with personality disorder. In addition, NICE draft guidelines on the management of borderline personality disorder clearly support provision of integrated mental healthcare utilising a multi-model approach to psychotherapy interventions (National Institute for Health and Clinical Excellence, 2008).

We have embraced these recommendations in a pilot service for older adults diagnosable with personality disorder. The service comprises a half-day integrative group psychotherapy programme which adheres to a democratic ‘mini therapeutic community’ model (Pearce & Haig, 2008).

The group is facilitated by a multidisciplinary team embedded collaboratively within the local specialist services for adults of working age with complex needs (the Oxfordshire Complex Needs Service, OCNS), local psychological services and a community mental health team for older adults. Psychodramatic techniques are used to integrate psychodynamic, cognitive and behavioural models, alongside principles of biological psychiatry, into a coherent model that is responsive to individual needs.

The experience of the facilitators who work in similar groups with both working-age and older adults suggests that the various categories of personality disorder encountered in both age-groups are similar and that both groups respond to the therapeutic model and process in a similar manner.

The OCNS treatment ethos for adults of working age is based on a recovery model, and preliminary outcome audit results of an 18-month treatment programme demonstrate psychological and socioeconomic benefits similar to the pilot for older adults (Scott & Attwood, 2008).

There are no apparent reasons why the outcome results from the OCNS mini therapeutic community programme should not be replicated in the older adult service. Early indications from the Social Functioning Questionnaire (SFQ), the Clinical Outcomes in Routine Evaluation (CORE) system, medication audits and client satisfaction data from this pilot group are similarly optimistic. The service is committed to further evaluation and research to demonstrate effectiveness of this model over time.

This pilot programme is unique in the UK and is currently being expanded across Oxfordshire to provide a more comprehensive model of inclusive service delivery to a group of service users traditionally excluded by virtue of diagnosis and age.