Perinatal mental health practitioners’ experiences supporting mothers with Emotionally Unstable Personality Disorder: a qualitative study

BACKGROUND: Emotionally Unstable Personality Disorder (EUPD) is a controversial and potentially stigmatising diagnosis, especially in women. Limited research exists on how mothers diagnosed with EUPD engage with perinatal mental health services and no United Kingdom studies have explored perinatal mental health staff perspectives on working with this population. AIM: To explore perinatal mental health staff's experiences of working with mothers diagnosed with EUPD and their views on service provision. METHOD: Reflexive Thematic Analysis was used to analyse semi-structured interviews with 13 perinatal mental health staff from three National Health Service (NHS) trusts in England. All participants had direct involvement with mothers diagnosed with EUPD. RESULTS: Six themes emerged: 1) We're in This Together: the importance of building therapeutic relationships; 2) The Fit Between Staff and Service: what draws staff to this work; 3) The Importance of Feeling Valued: support needs for staff; 4) Navigating a Complex System: service constraints affecting staff; 5) Let's Talk About Labels: the stigma and complexity of the diagnosis and 6) Where Does the Responsibility Lie?: systemic service issues impacting mothers diagnosed with EUPD. CONCLUSION: This study highlights the complexities faced by perinatal mental health staff supporting mothers with EUPD. Staff stressed the importance of relational working but also identified social, organisational and systemic barriers to effective care. Findings suggest the need for trauma-informed EUPD care pathways in perinatal services and enhanced staff support structures. Clearer role guidance for staff and improved cross-agency coordination of care would ensure sustainable, equitable care.