Feasibility and preliminary results of a Collaborative Care program for patients with severe personality disorders: A comparative multiple case study

Submitted Chapter 3 74 ABSTRACT Background A substantial group of patients with severe personality disorders does not benefit from structured psychotherapy. For those patients we developed a Col-laborative Care program (CCP), managed by (community) mental health nurses. We aimed to investigate the feasibility and preliminary outcomes of this CCP for patients with severe borderline personality disorder or personality disorders NOS. Methods Mixed methods were used in a comparative multiple case study, including 26 cases, to compare the CCP with Care as Usual. Data were collected among patients, informal carers and nurses at baseline, and at five and nine months follow up. Results A significant decrease in severity of borderline symptoms was found, despite incomplete implementation of the CCP and the small sample size. Some other outcomes, although not significant, showed medium effect sizes. In the experimental condition a significantly higher Mental Health Care utilization was found. Three core elements of the CCP were: 1) improved goal orientation in the treatment process; 2) a stronger appeal to self-management skills of patients; and 3) improved skills in establishing and maintaining effective therapeutic relationships. Conclusions This CCP may be beneficial for patients with severe personality disorders who did not benefit nor have access to structured psychotherapy. However, experimental research is needed to confirm the preliminary outcomes of this study.