Collaborative Care and Borderline Personality Disorder (BPD)

12 July 2019  Connect

Mental Health Professionals' Network (MHPN) is committed to supporting mental health and related health practitioners to collaborate in the care of their patients.

With 43 per cent of inpatients in Australia presenting with a diagnosis of borderline personality disorder (BPD), MHPN encourages members to explore starting or joining a local borderline personality disorder (BPD) network.

We support eight borderline personality disorder (BPD) practitioner networks around Australia with the most recent network starting in the Northern Territory during May.

Attending practitioner network meetings can help you improve patient outcomes; benefit from the experience and knowledge of other practitioners; feel connected to practitioners in your local area; improve referral pathways; become a leader in your professional community; and may improve patient outcomes.

Upcoming BPD Network meetings

  • Tuesday 1 October: Join the Adelaide Borderline Personality Disorder (BPD) Network at Flinders University for the opening night event of Borderline Personality Disorder Awareness Week. The presentation features Professor Anthony Bateman who co-developed mentalisation based treatment for BPD. Adapted versions are now being used in multi-centre trials for antisocial personality disorder, eating disorders, and drug addiction. Catering provided. Register now!
  • Wednesday 2 October: Two Queensland networks are joining forces for a meeting to mark Borderline Personality Disorder Awareness Week on 2 October. ‘BPD: Best Practice Deserved and Delivered’. Register with either Brisbane North Borderline Personality Disorder (BPD) Network or the Ipswich/West Moreton Borderline Personality Disorder (BPD) Network. Catering provided.
  • Tuesday 8 October: The Sydney Borderline Personality Disorder Network and the NSW branch of Australian BPD Foundation are hosting a combined event for Borderline Personality Disorder Awareness Week. They will have a range of speakers, including consumers, carers, treating clinicians and researchers talking about best practice in the treatment of people living with BPD. Register now!

    Wednesday 16 October: Join the Hobart Borderline Personality Disorder (BPD) Network to discuss and share knowledge about dealing with the complexities of BPD, including de-identified cases, ethical dilemmas, differential diagnosis and managing risk. Register now!

    Monday 21 October: The Northern Territory Personality Disorders and Trauma Informed Practice Network presents 'Reflecting on Cross-cultural Approaches to working with Mental Health and Trauma'. Through case studies, you'll learn about working cross-culturally with refugees and asylum seeker clients who have had experiences of trauma and live with mental illness. Register now!

If you have any questions, please contact Networks Team Leader Ingrid Benge.

Borderline personality disorder (BPD) may attract stigma and discrimination in society and interdisciplinary collaboration has the potential to help practitioners turn this around.

MHPN discussed practitioner collaboration, stigma and destigmatisation with:

  • MS MAHLIE JEWELL: Lived experience consumer advocate

Borderline personality disorder is a complex mental health issue, that is treatable and individuals can (and do) recover, says Ms Kate Lewis from Project Air Strategy. 

'In the past borderline personality disorder has been misunderstood and subject to considerable negative stigma', she says. 

'Treatment of personality disorder works best when a collaborative and multidisciplinary approach is taken, and when individuals with personality disorder are actively involved in their treatment'.

Ms Jewell says having a multidisciplinary team was essential to her recovery. Her support team consisted of a GP, psychologist, social worker, support person, neurologist, neuro-psychologist and key academic advisor (during study).

'Allowing communication between these individuals enables them to work together with me to address their role in supporting my goals. This means that every team member understands and accepts their responsibilities; and are able to trust each other to do the same. It leads to a lighter load for everyone and several open streams of support for me to choose from when I am in need', Ms Jewell says.

 

Register via these links for a BPD network to hear about future meetings:

 

Ms Brown says a multidisciplinary approach is 'essential in providing person-centred care'.

She says people living with BPD frequently experience other comorbidities, for e.g. GAD (Generalised Anxiety Disorder); MDD (Major Depressive Disorder); ED (eating disorders); substance use; and physical illness such as chronic pain, PCOS (polycystic ovary syndrome), diabetes or an intellectual disability. 

'Having an interdisciplinary team supporting the person (and family) would, in my opinion go a long way in correctly identifying the person’s unique needs and for these needs to be met in a holistic way'.

'Stigma and myths around BPD lead to discrimination and can be extremely harmful for a person living with BPD, their support systems and even those who provide treatment for them. The cases of medical neglect and inappropriate health care (or lack thereof) are well documented by people with lived experience', says Ms Jewell.

Ms Brown says it's important to understand that 'having BPD is not deliberate; it is a disorder people do not choose to have. With early diagnosis, appropriate treatment and support, the prognosis for people with BPD is positive. There is hope!' 

'Successful treatment of BPD starts with an honest and genuine connection. Those working with it should be highly compassionate, understanding, strengths-based and open to learning from their clients', says Ms Jewell.

'People with BPD are often highly articulate and able to connect very deeply with others; they need to feel safe and supported to do this, and that means being able to trust and rely on the people treating them. Communication is key in this relationship'.

 

BPD MYTHBUSTERS FROM PROJECT AIR STRATEGY

  • BPD is a lifelong mental illness and can’t be treated. This belief is outdated and incorrect. Actually, there is strong evidence to indicate that with effective treatment most people with BPD will achieve symptom remission, and many will achieve recovery (eg. Zanarini et al., 2012).

  • People with BPD are manipulative and attention seeking. Individuals with BPD experience heightened emotions, and can experience immense emotional pain. Sometimes the behaviours displayed by individuals with borderline personality disorder as a means of dealing with these strong emotions are incorrectly perceived by others (including health professionals) as ‘manipulative’ and ‘attention seeking’. In reality, individuals with BPD may be feeling vulnerable and insecure, and needing support to help get their needs met.

  • BPD is a response to trauma. Trauma and adverse childhood events are a risk factor for psychological disorders, however this association is complex. Although some individuals with BPD may carry effects of emotional trauma or invalidation from childhood, it is important to recognise not everyone who experiences trauma develops BPD, and not everyone with BPD has experienced trauma.

  • BPD only occurs in females. For many years, this was thought to be the case. However, within the past 10-15 years, research into our understanding of BPD has progressed substantially. More recent and accurate evidence suggests men and women are equally vulnerable to developing borderline personality disorder.

 

The way forward
According to Project Air, there are several effective evidence-based treatments available for borderline personality disorder, including:

  • dialectical behaviour therapy (DBT)

  • mentalisation based therapy (MBT)

  • schema focused therapy (SFT)

  • transference focused therapy (TFP)  

Despite their differences in theoretical underpinnings, recent research is highlighting that these approaches share factors in common that lead to effective outcomes for people with personality disorder.

Based on these common factors, some of the key ways clinicians can best support individuals with BPD are by:

(1) using structured and manualised treatment approaches

(2) encouraging a sense of agency in individuals (i.e., assume control of themselves)

(3) helping the individual connect feelings to events and actions

(4) being active, responsive and validating

(5) engaging in peer consultation and supervision (Bateman, Gunderson & Mulder, 2015).

 

Ms Jewell says it's important for practitioners to know that treatment programs from BPD can be long-term, expensive and outside of the 'regular boundaries' for psychology.

'This makes sense, given that the most evaluated and perhaps most effective treatment is DBT (Dialectical Behaviour Therapy) which was designed by someone with a lived experience of BPD herself [Marsha Linehan]'.

Ms Jewell believes 'the therapy works because of this, so mental health and other practitioners should be listening to their clients to find out what their needs truly are and working alongside them to achieve their own goals, whatever they might be'.

'I would encourage every mental health and other practitioner to challenge norms in practice; take calculated risks; read research; be positive; find recovery stories; be honest and open; and lastly, to take care of themselves and build a network of support for themselves'.

Ms Brown, who cares for a family member, says support for carers would 'recognise the diverse role of carers as well as the extent of their role. They are experts by experience. They know the person best, probably knew them before they became unwell, and they’re usually available 24/7'.

'It is imperative for carers to feel welcome, included and validated – even when there may be a discrepancy between the carer’s viewpoint and the person with BPD Carers need to be acknowledged as doing the best they can at that particular moment. They also need to be regarded with an attitude of realistic hope and respect – for both themselves and the person with BPD'.

Resources

  • MHPN has eight free webinars available for practitioners to increase their understanding of working with people living with Borderline Personality Disorder (BPD). Participants may use the webinars as self-directed learning for Continuous Professional Development (CPD).

  • Australian BPD Foundation (AUS) now offers Stage 2 of "Effective psychological Treatment for BPD” which is an e-learning program for mental health workers and service providers"to help you gain the knowledge and skills to provide evidence-based treatment and support to the person with BPD and their family/carers.