Joint Crisis Plans for people with personality disorders

People with personality disorders have long-standing problems in the way that they relate to others and experience the world. By virtue of these problems, such people are at greater risk of harming themselves. Little research has been carried out into the treatment of people with personality disorder. In this study, we will develop a new intervention to be used in the management of people with personality disorder and go on to test its effectiveness in a clinical trial. The main aim of the study is to determine whether a negotiated written plan (between a service user and member of staff) is an effective way of helping people with personality disorder to reduce self-harming behaviour. We will begin by working closely with service users and staff in order to adapt the crisis plan from an existing template developed for people with severe mental illness. We will ask service users and staff to give us their views about the most effective research strategies to be adopted in the subsequent trial. In the trial, we will examine whether crisis plans are an effective way of delaying self-harming behaviour in people with personality disorder. Suitable participants will be allocated to receive either the crisis plan or standard care from a community mental health team. Those allocated to the crisis plan will take part in a meeting with their mental health professional, the purpose of which will be to agree the contents of the crisis plan. All trial participants will be followed-up for at least six months, at which point we will measure changes in their self-harming behaviour, the quality of their relationship with staff, their satisfaction with care and the economic cost of the crisis plans. The study will have important consequences for service users, health professionals and researchers. Not only will it improve understanding about the treatment of a common and costly mental disorder, but we anticipate that the use of crisis plans will promote a culture change in the relationship between clinicians and personality-disordered service users.

The evidence for effective treatments of personality disorder (PD) is extremely limited. People with some types of PD present to services in crisis, threatening self-harm or having committed an act of self-harm. Joint Crisis Plans (JCPs) are aimed at improving the management of crises by increasing the amount of information available during a crisis and empowering patients by ensuring that they have a crucial say in the construction of the crisis plan. JCPs have been shown to reduce the need for involuntary treatment in mental health services. The main aim of this study is to undertake an exploratory randomized controlled trial (RCT) of Joint Crisis Plans for people with PD (J-Pods), in order to test their effectiveness in managing self-harm in this group of patients. The phases of the project are as follows:

Phase 1. The development of J-Pods.
Focus groups will be conducted with service users and staff in order to adapt a previously developed model of Joint Crisis Plans. Further refinement will occur through an established method of acquiring advice from a range of experts (?Delphi? consultation).

Phase 2: A pilot study of J-Pods.
A pilot study will be conducted with a sample of approximately 30 patients, in order to test procedures to be used in the exploratory RCT.

Phase 3: An exploratory randomised controlled trial of J-Pods.
This will be a single-blind RCT of J-Pods compared to a treatment as usual (TAU) control condition involving 120 people with PD who self-harm. The RCT will test the following primary hypothesis: use of a J-Pod will significantly increase the length of time to an act of self-harm compared with TAU. Separate economic and qualitative evaluations will take place to explore the cost-effectiveness of J-Pods and the processes through which they work.


The process of writing a Joint Crisis Plan is one of empowerment of, and negotiation with the service user, and its use would promote a culture change in the relationship between clinicians and PD service users. We will disseminate the findings to service user groups with the assistance of the Service User Research Enterprise at the Institute of Psychiatry. The results will be disseminated to the scientific community in international peer reviewed journals and presented at scientific meetings.