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BPD Crisis Admission Avoidance — MRCPsych Paper B MCQ

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ModeratePersonality DisordersBPD Crisis Admission AvoidanceMRCPsych Paper B

A 26-year-old woman with an established diagnosis of borderline personality disorder presents in crisis after making several cuts to her forearm. The injuries require dressings but no further medical treatment. Following psychosocial and risk assessment, she denies current suicidal intent or plans, is not psychotic or intoxicated, and collaborates in updating her crisis plan. A crisis resolution and home treatment team can review her daily. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Refer her to the crisis resolution and home treatment team with crisis-plan use and prompt follow-up

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

B is correct. NICE recommends exploring alternatives to admission during a crisis and referring a person with borderline personality disorder to a crisis resolution and home treatment team, or another available alternative, before considering acute inpatient admission. Here, the injuries have been treated, there is no current suicidal intent, psychosis or intoxication, and she can collaborate with a crisis plan while receiving daily community review. Admission is considered when significant risk to self or others cannot be managed by other services, not automatically after every episode of self-harm. Prolonged admission is not routine treatment for the underlying personality disorder. Ending contact because injuries are minor is unsafe and discriminatory. Mental Health Act detention requires its statutory criteria to be met; diagnosis and self-harm alone are insufficient.

Reference: National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management (CG78), sections 1.3.7 and 1.4, 2009, updated presentation July 2024. https://www.nice.org.uk/guidance/cg78/chapter/Recommendations