eprintid: 10144424 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/14/44/24 datestamp: 2022-03-02 11:46:58 lastmod: 2022-03-02 11:46:58 status_changed: 2022-03-02 11:46:58 type: article metadata_visibility: show sword_depositor: 699 creators_name: DeLeo, Kristiana creators_name: Maconick, Lucy creators_name: McCabe, Rose creators_name: Broeckelmann, Eva creators_name: Sheridan Rains, Luke creators_name: Rowe, Sarah creators_name: Johnson, Sonia title: Experiences of crisis care among service users with complex emotional needs or a diagnosis of 'personality disorder', and other stakeholders: systematic review and meta-synthesis of the qualitative literature ispublished: pub divisions: C07 divisions: D79 divisions: B02 divisions: UCL keywords: Borderline personality disorder, crisis intervention, personality disorders, qualitative research, self-harm note: © The Author(s) 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/). abstract: BACKGROUND: Mental health crises are common in people with complex emotional needs (our preferred working term for people diagnosed with a 'personality disorder'), yet this population is often dissatisfied with the crisis care they receive. Exploring their experiences and views on what could be improved, and those of carers and healthcare staff, is key to developing better services. AIMS: We aimed to synthesise the relevant qualitative literature. METHOD: Five databases were searched. Eligible studies included service users with a diagnosis of personality disorder and their carers or relevant staff, focused on crisis responses and used a qualitative design. Data were analysed with thematic synthesis. RESULTS: Eleven studies were included, most focusing on emergency departments. Four meta-themes emerged: (a) acceptance and rejection when presenting to crisis care: limited options and lack of involvement of carers; (b) interpersonal processes: importance of the therapeutic relationship and establishing a framework for treatment; (c) managing recovery from a crisis: clear recovery plan and negotiating collaboration; and (d) equipping and supporting staff: training and emotional support. CONCLUSIONS: Our findings suggest that emergency departments have major limitations as settings to provide crisis care for people with complex emotional needs, but there is a lack of research exploring alternatives. The quality of the therapeutic relationship was central to how care was experienced, with collaborative and optimistic staff highly valued. Staff reported feeling poorly supported in responding to the needs of this population. Research looking at experiences of a range of care options and how to improve these is needed. date: 2022-03 date_type: published publisher: Royal College of Psychiatrists official_url: https://doi.org/10.1192/bjo.2022.1 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1941678 doi: 10.1192/bjo.2022.1 medium: Electronic pii: S2056472422000011 lyricists_name: Maconick, Lucy lyricists_name: Johnson, Isabella lyricists_name: Rowe, Sarah lyricists_id: LMACO89 lyricists_id: ISJOH12 lyricists_id: SLROW24 actors_name: Kalinowski, Damian actors_id: DKALI47 actors_role: owner funding_acknowledgements: [Health Services and Delivery Research Programme] full_text_status: public publication: BJPsych Open volume: 8 number: 2 article_number: e53 pagerange: e53 event_location: England citation: DeLeo, Kristiana; Maconick, Lucy; McCabe, Rose; Broeckelmann, Eva; Sheridan Rains, Luke; Rowe, Sarah; Johnson, Sonia; (2022) Experiences of crisis care among service users with complex emotional needs or a diagnosis of 'personality disorder', and other stakeholders: systematic review and meta-synthesis of the qualitative literature. BJPsych Open , 8 (2) , Article e53. 10.1192/bjo.2022.1 <https://doi.org/10.1192/bjo.2022.1>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10144424/1/Johnson_Experiences%20of%20crisis%20care%20among%20service%20users%20with%20complex%20emotional%20needs%20or%20a%20diagnosis%20of%20%27personality%20disorder%27%2C%20and%20other%20stakeholders_VoR.pdf