Adequate inpatient support

Staff involved in hospital care often believe that people with personality disorders should be kept out of hospital. This belief is based on the observation that such people exploit the opportunities offered by admission and create circumstances whereby it is difficult to discharge them. Much of this opinion is ill founded. Patients with comorbid mental state and personality disorders actually have better outcomes if they have a hospital-oriented programme of care than treatment in the community, whereas the opposite is true in the absence of personality disorder. (64) People with personality disorders have fewer attachment and support figures in the community than others/64' and few community teams can provide the level of support needed when function begins to disintegrate. Few services desire to treat this group of difficult patients and refuse them because they are 'not suitable', but this opinion should carry little weight.

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