Out of area placements for people with "Personality Disorder": Making the case for a local intensive psychotherapeutic alternative

Objectives: The use of Out of Area (OoA) psychiatric placements for people with "Personality Disorder" (PD) is widespread in the UK. An innovative local intensive psychotherapeutic service, adapted to the transdiagnostic presentations of the most complex PD patients, likely to be placed out of the area, was devised in the English County of Devon. This paper reports the findings of a Freedom of Information (FOI) request to commissioners attempting to quantify PD OoA placements in England and the cost offset of the local therapeutic alternative to OoA placements in Devon.

Design and methods: Data from FOI requests was combined with publicly available sources to assess the scale of OoA placements for people with PD in England. OoA service use and cost data were used to examine the cost offset and effectiveness of the local alternative to OoA placements in Devon. The results found a lack of transparency and excessive use of OoA placements despite UK Government intentions. Data from the local therapeutic service demonstrated cost-effectiveness, reducing OoA placements and increasing the availability of psychotherapeutic services. This paper suggests the number of OoA placements can be reduced for people with severe and complex PD. The local therapeutic service provides a model for future rehabilitation pathways.