What is the personality disorder gap?

Primary mental health services like Integrated Access to Psychological Therapies (IAPT) may not feel able to hold the level of risk involved with a client with complex needs.

If a client appears to be chaotic and is perceived as unable to engage with support sessions, they may not be offered the service. And if an offer of support is made, it may not be appropriate for someone who may need more long-term therapy.

Secondary providers sometimes use services like IAPT as a discharge option when it is not always the right fit, but there’s nowhere else appropriate to refer the client. People also mention inconsistencies in response to referrals, which can create a lack of clarity for both referrers and clients.

Meanwhile, personality disorders are often not perceived as a serious mental illness. Also, the client may not meet the threshold for secondary mental health support if their risk is assessed as not high enough.

This client group can find engagement and sustained service use challenging, and secondary providers may not be able to offer a service or could discharge clients who can’t engage within certain boundaries.

Some feel that there is sometimes a lack of clear criteria for accessing secondary services and there’s a struggle to meet demand due to limited resources.

So – some people cannot access either primary or secondary provision and end up in the falling through the gap. The people who fall into this gap still need support, and often turn to trauma services or emergency response for help.