A multi-perspective evaluation of a specialist outpatient service for people with personality disorders

This paper reports on a study of a new outpatient service for people with personality disorders (Henderson Outreach Service Team: HOST) during its first 2 years of operation. The study is presented as an example of how service-specific evaluation can be organized using a multiple perspective approach. Four simultaneous strands of investigation were conducted: clinical and socio-demographic characteristics of referrals; clinical activities of the service; service users' views of the service; and views of referring professionals. Findings indicate that HOST referrals had high levels of psychosocial disturbance associated with moderate to severe personality disorders. The service provided psychodynamically oriented individual and group treatments that met service users' needs more appropriately than other local mental health services, but was unable to match the demand for treatment. Referring professionals valued the role of HOST in also providing specialist management advice. High levels of unmet need among the personality disordered population living in the community are highlighted. Findings have contributed to the reshaping of the service and its relationship to its parent institution (a residential therapeutic community), and have implications for the future development of therapeutic community treatment for personality disorders. The role of effectiveness studies in contributing to the mental health evidence base is discussed.