Caring for complex emotional needs: a systematic review of structured clinical management and an empirical study of specialist team working practices

Jones, Louisa 2026. Caring for complex emotional needs: a systematic review of structured clinical management and an empirical study of specialist team working practices. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Objective: Structured Clinical Management (SCM) is a manualised, low intensity intervention designed for delivery in generalist mental health settings for clinicians working with adults with borderline personality disorder (BPD). This review aimed to synthesise the current evidence base on SCM’s effectiveness, compare outcomes with comparators, and identify factors influencing implementation, drawing on Proctor et al.’s (2011) framework of implementation outcomes, including acceptability, feasibility, fidelity, sustainability, appropriateness across settings and populations and the training and organisational considerations required for delivery. Method: A mixed-methods systematic review was conducted. Six electronic databases and grey literature were searched with no date restrictions, but only English-language publications were included. Studies were included if they evaluated SCM in adults aged 18 or older in community settings and provided either patient- or service-level outcome data. Studies were excluded if they focused on forensic, inpatient or child populations to maintain diagnostic and service context specificity. Methodological quality was assessed using the Mixed Methods Appraisal Tool, which enabled consistent appraisal across all included study designs. Results: Eleven papers representing eight datasets met the inclusion criteria. Findings from randomised controlled trials found SCM was associated with significant reductions in self-harm, suicidality and symptom severity, with sustained effects at eight-year follow-up. Compared with SCM, Mentalisation Based Therapy showed superior recovery rates at eight-year follow-up, particularly for higher severity presentations. Service evaluations found SCM led to reductions in hospital admissions, though crisis contacts showed variable patterns across studies, alongside preliminary findings of adapting SCM for older adult populations and crisis services. Implementation of SCM was feasible across community mental health teams, crisis services, and specialist hubs, with implementation dependent on structured training, supervision, and organisational support. Fidelity to the manual was inconsistently reported. Adaptations for older adult populations and delivery in a crisis service were found to be appropriate across settings, and several studies reported continued SCM delivery beyond pilot phases, suggesting sustainability. SCM was acceptable to staff and participants, who rated it positively and reported that SCM was helpful and built confidence. Conclusion: SCM is associated with meaningful clinical improvements and demonstrates utility as a service-level framework in generalist settings. However, the evidence base is sparse and limited by trials authored by the developers of SCM as the primary contributor studies. Uncontrolled designs, although providing ecological validity, are limited by power and confounding variables. The current research focuses predominantly on BPD diagnosed participants, limiting generalisability to subthreshold presentations for whom low-intensity interventions may be most suited. Future research should prioritise independent, adequately powered studies that incorporate broader presentations and lived-experience perspectives.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Uncontrolled Keywords:	Keywords: Structured Clinical Management, Borderline Personality Disorder, Complex emotional needs, implementation
Funders:	N/A
Date of First Compliant Deposit:	5 October 2026
Last Modified:	05 Oct 2026 11:34
URI:	https://orca.cardiff.ac.uk/id/eprint/189786

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