Evaluation of international guidance for the community treatment of complex emotional needs: A systematic review

BackgroundGuidelines for the treatment and management of "personality disorder" were introduced to provide guidance on best practice from evidence and views of key stakeholders. However, this guidance varies as there is yet to be an overall, internationally recognised consensus on the best mental health care for people with complex emotional needs (CEN - our preferred working term for the needs of people using services for or related to "personality disorder"). AimsWe aimed to identify and synthesise recommendations made by different mental health organisations from across the world on community treatment for people with CEN. MethodsThis systematic review consisted of three stages: 1. systematic literature and guideline search, 2. quality appraisal, and 3. data synthesis. We combined a search strategy involving both systematic searching of bibliographic databases and supplementary search methods of grey literature. Key informants were also contacted to further identify relevant guidelines. Codebook thematic analysis was then conducted. The quality of all included guidelines was assessed and considered alongside results. ResultsAfter synthesising 29 guidelines from 11 countries and 1 international organisation, we identified four main domains, with a total of 27 themes. Important key principles on which there was consensus included continuity of care, equity of access, accessibility of services, availability of specialist care, taking a whole systems approach, trauma informed approaches, and collaborative care planning and decision making. ConclusionsExisting international guidelines shared consensus on a set of principles for the community treatment of CEN. However, half of the guidelines were of lower methodological quality, with many recommendations not backed by evidence.