Psychosocial treatment for severe personality disorder - 36-month follow-up

Background In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care. Aims To evaluate the clinical effectiveness of these two psychosocial specialist programmes-over a 3-year' follow-up period. Method Two samples allocated to the in-patient treatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6,12, 24 and 36 months after intake. Results Improvements-were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patients in the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group. Conclusions Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model. Declaration of interest Grants from the Henry Smith and Welton Foundations.