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This paper reports on a qualitative study of UK mental health practitioners' experiences of working with the contested condition, dangerous and severe personality disorder (DSPD). Our interviews focused on the issues of treatability, risk assessment and decision-making in multi-disciplinary teams. We discuss the approach of values-based medicine (VBM) as a useful framework for interpreting the data: respondents cited both explicit values (based on occupational training) and implicit values (based on personal beliefs and subjective perceptions). There was evidence of conflicting values -- within individuals, between occupational groups, and between individuals in occupational groups -- which led to widespread uncertainty and caution about whether and how those with 'dangerous' personality disorders could be treated. These disputes were resolved by a 'slide to pragmatism', whereby practitioners, reluctantly acknowledging their own empowerment in the process, sought to make whichever choice was least risky for their own professional reputation, and most pragmatic, given the resources available. [ABSTRACT FROM AUTHOR]

Recent years have seen an international move towards home treatment of acute mental health difficulties. This has been based upon trial data which do little to develop understanding of how or why this approach is as effective as it seems to be. In order to explore this question the study interviewed patients who had recently used the services of a crisis resolution home treatment (CRHT) team in the English East Midlands. Triangulated parallel qualitative analyses of 33 semi-structured interviews conducted by service users trained in research techniques demonstrated that successful CRHT reflected practitioners' ability to provide clients with a sense of feeling safe, accepted and understood. Unhelpful outcomes followed when participants did not experience such unconditionally supportive relationships. These findings further endorse the primacy of relational factors in mental health practice. They are discussed in relation to the Dodo Bird verdict upon psychological therapies and systemic difficulties acknowledging an inconvenient truth. [ABSTRACT FROM AUTHOR]