NICE Guidelines on Recognising and Managing Borderline Personality Disorder – 1.4 Inpatient services

The following guidance is based on the best available evidence. The full guideline gives details of the methods and evidence used to develop the guidance. People have the right to be involved in discussions and make informed decisions about their care, as described in your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.4.1.1

Before considering admission to an acute psychiatric inpatient unit for a person with borderline personality disorder, first refer them to a crisis resolution and home treatment team or other locally available alternative to admission.

1.4.1.2

Only consider people with borderline personality disorder for admission to an acute psychiatric inpatient unit for:

  • the management of crises involving significant risk to self or others that cannot be managed within other services, or
  • detention under the Mental Health Act (for any reason).

1.4.1.3

When considering inpatient care for a person with borderline personality disorder, actively involve them in the decision and:

  • ensure the decision is based on an explicit, joint understanding of the potential benefits and likely harm that may result from admission
  • agree the length and purpose of the admission in advance
  • ensure that when, in extreme circumstances, compulsory treatment is used, management on a voluntary basis is resumed at the earliest opportunity.

1.4.1.4

Arrange a formal CPA review for people with borderline personality disorder who have been admitted twice or more in the previous 6 months.

1.4.1.5

NHS trusts providing CAMHS should ensure that young people with severe borderline personality disorder have access to tier 4 specialist services if required, which may include:

  • inpatient treatment tailored to the needs of young people with borderline personality disorder
  • specialist outpatient programmes
  • home treatment teams.

© NICE (2009) Borderline personality disorder: recognition and management
Clinical guideline [CG78]. Available from https://www.nice.org.uk/guidance/cg78. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

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