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Treatment models for those with severe mental illness and comorbid personality disorder^*

Department of Psychological Medicine, Imperial College, London, UK

Correspondence: Professor Peter Tyrer, Paterson Centre, 20 South Wharf Road, London W2 1PD, UK

Declaration of interest P.T. is the head of a group (IMPALOX) that receives funding from the Home Office to evaluate the new assessments for dangerous and severe personality disorder.

^* Paper presented at the second conference of the British and Irish Group for the Study of Personality Disorders (BIGSPD), University of Leicester, UK, 31 January to 3 February 2001.

Background Dual diagnosis of personality disorder and severe mental illness is an important clinical association that has been under-researched with regard to clinical management.

Aims To compare the outcomes of different treatment models.

Method The outcome of patients with this combined diagnosis was compared in a systematic review of three randomised controlled trials in which different forms of community outreach treatment or intensive case management were compared with standard care.

Results The results from the three studies showed that the outcome of comorbid diagnoses was worse than that of single diagnoses. Although assertive approaches reduced in-patient care, they sometimes did so at the expense of increasing social dysfunction and behavioural disturbance.

Conclusions For those with comorbid severe mental illness and personality disorder, the policy of assertive outreach and care in community settings may be inappropriate for both public and patients unless modified to take account of the special needs of this group.

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