When should I consider referring a patient with a personality disorder to specialist mental health services?

Consider referring a patient with a personality disorder to specialist mental health services when:

• They present in primary care with repeated self-harm, persistent risk-taking behaviour, or marked emotional instability, especially if borderline personality disorder is suspected. For patients under 18 years, refer to CAMHS for assessment ¹.
• They are in crisis with increasing distress or risk to self or others that does not subside despite attempts to manage anxiety and improve coping skills ¹.
• They request further help from specialist services ¹.
• There is a mental health disorder of a nature or severity requiring specialist management, high levels of distress, or increasing risk of self-harm ⁵.
• For antisocial personality disorder, if the person is seeking help and the presenting complaint relates directly to the personality disorder, consider referral to specialist personality disorder or forensic services ².
• When behaviour is severe, complex, or does not respond to primary care management, or when there are comorbid mental disorders requiring specialist assessment and treatment ¹,²,³.

Additional considerations: Before inpatient admission for borderline personality disorder, refer first to crisis resolution and home treatment teams or other alternatives to admission ¹. For young people with severe borderline personality disorder, access to tier 4 specialist services including inpatient and specialist outpatient programmes should be ensured ¹.