Personality disorder: no longer a diagnosis of exclusion

It is perhaps not unfair to suggest that many, if not most, adult mental health services have become psychosis services, dealing with those who are suffering from severe and enduring mental illness. Personality disorders are common, and are also disabling conditions. Many of those who suffer distress as a result of their conditions, or who place a burden on others, are managed by primary care. Only those who suffer the most significant distress or difficulty are referred to secondary services, but provision is patchy even for this group. Some may be admitted to an acute in-patient unit at times of crisis, but many are unable to access secondary mental health services.