Quality standard

Quality statement 5: Managing transitions

Quality statement 5: Managing transitions

Quality statement

People with borderline or antisocial personality disorder agree a structured and phased plan with their care provider before their services change or are withdrawn.

Rationale

Once in treatment, people with borderline or antisocial personality disorder may build a strong attachment with practitioners and services that support them. Any change to the familiar arrangements is likely to cause anxiety and be associated with an increased risk of crisis. Self‑harming behaviour and suicide attempts often occur at the time of change. Discussing changes in advance and coming up with a structured and phased plan acceptable to the service user, gives them a greater sense of control and reduces associated anxiety. People with borderline or antisocial personality disorder also need to know that they can access services easily in time of crisis. Integrating services is important to establish clear pathways for transitions between services and agencies, and facilitating well‑organised services, care and support.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements that people with borderline or antisocial personality disorder agree with their care provider a structured and phased plan before their services change or are withdrawn.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

b) Evidence of local arrangements to ensure that people with borderline or antisocial personality disorder can easily access services in time of crisis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

Process

Proportion of changes to services or service withdrawals that have been planned and agreed beforehand by people with borderline or antisocial personality disorder and their care provider.

Numerator – number in the denominator planned and agreed beforehand by people with borderline or antisocial personality disorder and their care provider.

Denominator – changes to services or service withdrawals for people with borderline or antisocial personality disorder.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Service user experience of integrated care.

Data source: Adult Social Care Outcomes Framework

b) Frequency of crisis situations linked to transitions.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

c) Evidence from experience surveys and feedback that service users feel actively involved in shared decision‑making.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient surveys.

What the quality statement means for different audiences

Service providers (mental health trusts, primary care services, social services, care homes, probation and prison services) ensure that systems and processes are in place for people with borderline or antisocial personality disorder to agree with their care provider a structured and phased plan before their services change or are withdrawn. This should include plans for accessing services at times of crisis.

Health and social care practitioners ensure that they agree with people with borderline or antisocial personality disorder a structured and phased plan before their services change or are withdrawn. This should include plans for accessing services at times of crisis.

Commissioners commission services that allow people with borderline or antisocial personality disorder to agree with their care provider a structured and phased plan before their services change or are withdrawn. This should include plans for accessing services at times of crisis.

People with borderline or antisocial personality disorder agree with the people providing their care a plan setting out how their services will change before any changes happen. The plan includes what will happen if services are stopped and how they can get help if they have a crisis.

Definitions of terms used in this quality statement

Changes to services

Changes to services include but are not limited to:

  • transition from 1 service to another

  • transfers from inpatient and detention settings to community settings

  • transition from child and adolescent mental health services to adult mental health services

  • discharges after crisis

  • withdrawal of treatment or services

  • ending of treatments or services

  • changes to therapeutic relationship.

Any changes need to be discussed, agreed and documented in a care plan written in collaboration with the service user to enable smooth transitions. The care plan should clearly identify the roles and responsibilities of all health and social care practitioners involved for each person with a personality disorder. [Adapted from NICE's guideline on antisocial personality disorder and NICE's guideline on borderline personality disorder]

Equality and diversity considerations

Specialist mental health services should ensure that interpreters and advocates are present if any changes need to be discussed with a service user who may have difficulties in understanding the meaning and implications of these changes.