Quality statement 1: Structured clinical assessment

Quality statement

Mental health professionals use a structured clinical assessment to diagnose borderline or antisocial personality disorder.

Rationale

Borderline and antisocial personality disorders are complex and difficult to diagnose. Even when borderline or antisocial personality disorder is identified, significant comorbidities are frequently not detected. People often need support that goes beyond healthcare and this makes care planning complex. Carrying out a structured assessment using recognised tools is essential to identify a range of symptoms, make an accurate diagnosis and recognise comorbidities.

Quality measures

Structure

Evidence of local arrangements to ensure that mental health professionals use a structured clinical assessment to diagnose borderline or antisocial personality disorder.

Data source: Local data collection.

Process

Proportion of people with a diagnosis of borderline or antisocial personality disorder who had the diagnosis made by a mental health professional using a structured clinical assessment.

Numerator – the number in the denominator who had the diagnosis made by a mental health professional using a structured clinical assessment.

Denominator – the number of people with a diagnosis of borderline or antisocial personality disorder.

Data source: Local data collection.

What the quality statement means for service providers, mental health professionals, and commissioners

Service providers (mental health trusts) ensure that mental health professionals are trained and competent to carry out a structured clinical assessment to diagnose borderline or antisocial personality disorder.

Mental health professionals carry out and document a structured clinical assessment to diagnose borderline or antisocial personality disorder.

Commissioners (clinical commissioning groups, NHS England local area teams) ensure that they commission services with mental health professionals who are trained and competent to carry out and document a structured clinical assessment to diagnose borderline or antisocial personality disorder.

What the quality statement means for service users and carers

People with possible borderline or antisocial personality disorder have a structured assessment by a specialist in mental health before they are given a diagnosis. The results of the assessment are written in their records. This means that the diagnosis is accurate and that their needs and other health problems are identified from the outset.

Source guidance

Definitions of terms used in this quality statement

Structured clinical assessment

Structured clinical assessment should be undertaken using a standardised and validated tool. The main tools available for diagnosing borderline and antisocial personality disorders include:

  • Diagnostic Interview for DSM–IV Personality Disorders (DIPD–IV)

  • Structured Clinical Interview for DSM–IV Personality Disorders (SCID–II)

  • Structured Interview for DSM–IV Personality (SIDP–IV)

  • International Personality Disorder Examination (IPDE)

  • Personality Assessment Schedule (PAS)

  • Standardised Assessment of Personality (SAP).

[Adapted from Borderline personality disorder (the full guideline CG78), Antisocial personality disorder (the full guideline CG77)].

Equality and diversity considerations

People with borderline or antisocial personality disorder frequently experience a range of comorbid conditions. These may be physical as well as mental health problems. Those working with people with borderline or antisocial personality disorder should always assess all of their needs and offer support accordingly. Diagnosis of borderline or antisocial personality disorder should never exclude people from receiving the help they need.