Staff nurse perceptions of the impact of mentalization‐based therapy skills training when working with borderline personality disorder in acute mental health: a qualitative study

Accessible summary People diagnosed with borderline personality disorder (BPD) can raise anxiety in health professionals and constitute a high proportion of psychiatric inpatients in generic settings. Mentalization-based therapy (MBT) is an evidence-based psychological treatment effective in the treatment of people diagnosed with BPD, but this has been used and evaluated only in specialist settings. Mentalization-based treatment skills training (MBT-S) is a new and compact 2-day workshop which aims to provide mental health professionals with MBT skills for use in generic health-care settings and has never been evaluated. This study assesses staff nurse perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in the generalist setting of acute mental health wards. Staff nurses perceived MBT-S as a straightforward but empowering skill set which also contributed to attitudinal change to people diagnosed with BPD. MBT-S promoted empathy as a response to instances of self-harm which removes the potential of a vicious cycle of iatrogenic harm. Staff found MBT-S to be flexible in its structured or ‘off the cuff’ usability, a desirable attribute in acute mental health where people diagnosed with BPD primarily present in crisis and not for long-term structured treatment. Abstract People diagnosed with borderline personality disorder (BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy (MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training (MBT-S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or ‘off the cuff’ discussions. MBT-S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as ‘deliberately difficult’. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT-S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT-S could be viewed as ideal as participants applauded its flexibility. The promotion of empathy also sees a move away from iatrogenic damage caused by unhelpful responses to self-harm. In the context of wider research, this study shows that staff nurses find the MBT-S skill set valuable in the generic inpatient setting of acute mental health.