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Context Our team works in a psychiatric hospital unit at the University Hospitals of Geneva (Switzerland). We welcome there for 7 days people in crisis situations who have either suicidal thoughts or suicidal behavior. As factors precipitating the suicidal crisis, these people go through life events that are accompanied by intense interpersonal difficulties or that threaten the image they have of themselves. In our clinical population, approximately 35% of patients suffer from borderline personality disorder (BPD). In these patients, repeated crises and suicidal behavior lead to frequent and damaging relational and therapeutic ruptures. Our objective is to develop a specific approach to this clinical problem. Intervention We have developed a brief psychological intervention informed by mentalization-based treatment (MBT) in 4 stages: welcoming of the patient, affective mentalization of the crisis elements, formulation of the problem, work on discharge and the continuation of outpatient care. This intervention is suitable for a medical-nursing team. From a MBT point of view, the welcoming phase is mainly devoted to mirroring and affective regulation in order to reduce the intensity of psychic disorganization. It is then a question of activating the capacity to mentalize, namely curiosity about mental states, through work on the crisis narrative with an affective focus. We then work with people to construct a formulation of their problem in which they can assume a role. It is about making them "agents" of their crises. Then we can end the intervention by working on both the separation and a projection into the immediate future. The goal is then to extend the psychological work started in our unit at the level of an ambulatory network. The termination phase sees the attachment system reactivated and the reappearance of the difficulties hitherto outside the therapeutic space. Clinical implications MBT is effective for BPD, particularly in reducing suicidal gestures and the number of hospitalizations. We have adjusted its theoretical and clinical device for individuals hospitalized due to a suicidal crisis and who present various and comorbid psychopathological profiles. MBT allows the adaptation and evaluation of empirically based psychotherapeutic tools to different clinical settings but also to different clinical populations.

Building on existing literature, the authors draw the landscape of psychiatric emergencies, and focus on borderline personality disorder, frequently encountered, and strongly linked to death by suicide. A review of knowledge in terms of diagnosis, prognosis, etiology, and treatment, as well as their own experiences, lead them to propose areas of progress that would secure the patient's care pathway. The evolution of society has led psychiatric emergency departments to play the role of a safety net and an entry point to the mental health system. Borderline personality disorder is one of the most common pathologies encountered in psychiatric emergencies. It represents a major concern, long characterized by an often dramatic evolution, and by the human and economic stress it generates. However, since the 1990s, knowledge of this disorder has been refined, and today there are various means of evaluation, good clinical practices and psychotherapeutic treatments, thanks to which significant and lasting improvement is possible. Recent studies highlight the crucial role of hospital caregivers, and the benefit of consolidating their skills by providing them with the knowledge and tools specific to this disorder. They also converge on the interest of setting up specific emergency treatment modalities, particularly highly structured, safe and empowering for the patient, in order to improve their effectiveness. The authors suggest that a case formulation model for persons with borderline personality disorder in emergency would make it possible to activate these two levers of progress, while improving collaboration between hospital and outpatient care. This would also address their main concern of optimizing the patient's therapeutic pathway and reinforcing adherence to treatment that could bring remission, and should be supported by data from empirical research., (Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)