The use of the Structured Clinical Management (SCM) pathway in an inpatient setting: what has this meant for my recovery?

Abstract

Background: Despite inpatient treatment not being recommended for those with a diagnosis of personality disorder, this may at times be necessary. One of the primary goals of the Structured Clinical Management (SCM) pathway is to reduce unnecessary hospital admissions. The SCM protocol attempts to reflect best generic practice for emotionally unstable personality disorder (EUPD) in the UK focused upon the organisation of care and provision of a therapeutic framework. The aim of the current study was to explore patient experiences of the use of SCM principles of care within an inpatient setting. = Method: Semi-structured interviews were conducted with seven participants under the care of Northamptonshire Healthcare Foundation Trust (NHFT) who were identified through purposeful sampling. All participants were female with a primary diagnosis of EUPD, or with established difficulties in this area, and with exposure to at least two hospital admissions within the previous 12 months. Data was then explored and analysed qualitatively using thematic analysis. Results: Analysis revealed six themes: ‘patient involvement’, ‘a template for care’, ‘shared understanding’, ‘person-centred care’, ‘holding the hope’ and ‘support’. Perception of the quality of care seeming to be contingent upon these factors. Conclusion: Patient experiences of the SCM principles of care and their impact upon recovery within an inpatient setting were influenced by several factors. This included the delivery of person-centred care rather than a more ‘blanket’ approach to implementation. Clinical and research implications are discussed.