An earlier evaluation (Fox et al., 2014) highlighted reductions in risk behaviours and restrictive practices for women admitted to low secure dialectical behaviour therapy (DBT) unit. Since then, a value-based healthcare model has been adopted.

To explore changes in health, social and psychological functioning, risk, quality of life, and in incidents of violence and restrictive practices, over the initial 12-month period of admission to a specialist DBT service.

Data were extracted from electronic clinical records for 41 women with emotionally unstable personality disorder admitted to a specialist integrated practice unit (IPU) providing a comprehensive DBT programme. Secondary analysis was conducted on an anonymous dataset of routinely collected outcome measures at baseline admission, and 6 and 12 months post-admission. ANOVAs and pairwise post hoc comparisons, and non-parametric equivalents, were conducted to examine changes in outcomes.

Findings showed statistically significant improvements in mental health scores on the ReQOL (p<.01), global, wellbeing, problems, functioning and risk scores on the COREOM (all p<.01), and severe disturbance, emotional wellbeing, socioeconomic status, risk and need scores on the HoNOS-Secure (all p<.05). Significant reductions in risk behaviours (p<.01) and restrictive practices (p<.01) were also apparent. The most substantiative improvements were largely demonstrated over a 12-month admission period.

Admission to the DBT IPU yielded significant improvements on outcomes pertaining to quality of life, psychological distress, and risk. Importantly, these are outcomes that aligned with patients’ perceptions of recovery.

Dialectical behaviour therapy (DBT) is a recommended treatment of patients with borderline personality disorder, yet there are few descriptions of the approach in public community mental health settings where the majority of such patients present. This study describes the development and evaluation of a DBT programme in an Irish setting.

The DBT programme was run over a six month period. Participants were assessed at baseline and post intervention with the following instruments: The Structured Clinical Interview for DSM III R personality disorders (SCID II), the clinical Outcomes in Routine Evaluation (CORE) and the symptom checklist 90 Revised (SCL-90-Revised). Inpatient bed usage was determined from case note review.

Outcome data was available for eight subjects. Significant improvement (p < 0.005) was seen on all CORE subscales. SCL-90-R showed significant improvement (p < 0.05) on the global severity index and on the positive symptom distress index. A decrease in self harming behaviour was found. Subjects' inpatient bed days dropped from a mean of 58 in the year pre intervention to a mean of four days in the year post intervention. A novel finding was that 43% of subjects who originally fulfilled criteria for avoidant personality disorder no longer did so post intervention.

The study found that DBT can be applied in a community mental health setting with benefits similar to more specialist settings. Significant difficulties were encountered in implementing the programme. The clinical implications are that specialist psychotherapy services need to be an integral part of psychiatric services to achieve better outcomes for patients with borderline personality disorder.