How do general hospitals respond to patients diagnosed with a personality disorder who are distressed.

Patients with a diagnosis of personality disorder are at risk of poor physical health outcomes and reduced life expectancy. To date, research in the area of personality disorder and physical health has mostly been epidemiological. There has been very little research on what happens when patients with a diagnosis of personality disorder are admitted to NHS general hospital wards. This PhD thesis aims to explain how general hospitals respond to patients diagnosed with a personality disorder who are distressed. An explanatory sequential design was used to integrate mixed methods data from: 1) a scoping review of the literature (n=10); 2a) a QUAN web-based survey of patients diagnosed with a personality disorder (n=65) and carers (n=5); 2b) embedded [QUAL] telephone interviews with patients diagnosed with a personality disorder (n=12); 3a) QUAN web-based survey of general hospital professionals (n=58); and 3b) QUAL telephone interviews with mental health liaison professionals (n=13). The primary data were analysed using QUAL framework analysis and QUAN descriptive statistics. The findings were integrated through mixed methods triangulation. This research identified that general hospitals respond iatrogenically to patients diagnosed with a personality disorder. Five themes were identified across the integrated data: Workforce, Service delivery, Service design, Organisational stress, and Adverse events. There were three overarching meta-themes: Systems and logistics, Structures, and Outcomes. An explanatory framework of the interrelationship between the themes and meta themes is proposed. Considerable efforts are required to reduce organisational stress and to ensure that patients with a diagnosis of personality disorder are not subject to adverse experiences in NHS general hospitals.