The National Institute for Health and Clinical Excellence (NICE) guidelines state that patients with Borderline Personality Disorder (BPD) should not be prescribed medication for the individual symptoms related to the illness and that psychological interventions should be considered as part of their management. We aimed to assess the use of medication and access to psychological therapies in an inpatient population, after the implementation of NICE guidance introduced in January 2009.

This was a retrospective study. Case notes of patients with a diagnosis of BPD (ICD-10 F60.3 and F60.31), discharged from four acute inpatient wards in Sheffield for a period of twelve months, were studied using a structured questionnaire based on BPD NICE guidance (2009).

There were 68 discharges, involving 47 patients, with BPD accounting for 10.1% of the 670 total discharges. Of the 68 discharges, 78% were prescribed drug treatment specifically for BPD (including antipsychotics, antidepressants, mood stabilisers and anxiolytics), whilst 45% were prescribed medication without documented evidence a co-morbid diagnosis existed, and 41.2% received 3 or more medications. Of the 47 patients, only 17% received a structured psychological intervention which included cognitive analytical therapy (n = 4), cognitive behavioural therapy (n = 3) and dialectical behavioural therapy (n = 1).

Despite NICE recommendations, patients with BPD continue to receive a variety of psychotropic medications and to have limited interventions from psychological services with a high proportion receiving unstructured therapy. Reasons (including service costs and evidence of effectiveness of all treatments) need to be explored.