The importance of being humane: a case study of a positive practice ward and a mixed methods exploration of the development and acceptability of the personal narrative model

Scant research explores positive practice within specialist inpatient services for service users (SUs) with a diagnosis of borderline personality disorder (BPD). Few collaboratively developed models of psychological formulation exist despite it being a possible support for positive practice for SUs with a diagnosis of BPD. This research employed a two-stream Mixed Methods-Case Study design to address these gaps. In Stream 1 an interview-based case study of SU (n = 6) and staff (n = 10) perspectives on a positive practice specialist ward (Poppy) identified explanatory factors of positive experience as well as barriers. Psychological formulation was identified as a means to support existing positive practice while addressing identified barriers, including the care-planning processes. Stream 2 entailed a mixed-methods acceptability exploration of the model of formulation developed collaboratively for this research (the Personal Narrative Model; PNM). This included a focus group with Poppy staff (n = 7) and an online phase of qualitative and quantitative surveys (n = 26) and interviews (n = 8) with a wider practitioner and lived experience sample. Findings revealed positive practice is defined by staff and SUs as good relationships, staff specialist training and knowledge, and sharing responsibility for risk and recovery. Care-planning was seen as collaborative, but staff found the process lacks meaning. The PNM was suggested to address this. Logistical and other barriers impeded its implementation at Poppy; however, the online phase confirmed general acceptability. Participants reported support would be required to address the risk of narrative for staff and SUs. Overlap across participants and research phases identified both implementation challenges (e.g., staff resistance and barriers to collaboration) and ways to address them. The contribution to knowledge includes: (a) explanatory factors of positive experiences in a specialist context; (b) acceptability of the PNM, which possibly addresses less positive practice (aversion to narrative; theoretical incoherence of care-planning); and (c) challenges of applying new practices in a specialist inpatient context and recommendations for their management.