Spectrum – Theme: Other – Systemic responses to crisis-driven behaviours
Chairs: Cathryn Pilcher (Associate Director, Spectrum), Rita Brown (Carer Consultant, Spectrum)
JH Broadbear1,3, R Ogeil2,3, M McGrath2,3, D Scott2,3, Z Nehme4,5,6, D Lubman2,3, S Rao1,7
1Spectrum, Personality Disorder and Complex Trauma Service, Melbourne, Australia
2Turning Point, Eastern Health, Richmond, VIC, 3121, Australia
3Eastern Health Clinical School, Monash University, Box Hill, VIC, 3128, Australia
4Centre of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
5Department of Paramedicine, Monash University, Frankston, Victoria, Australia
6Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
7School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
Ambulance services are frequently the first responders in situations involving life-threatening behaviours. To evaluate the utilisation of Victorian ambulance services by people with personality disorder (PD), we conducted a retrospective study of coded electronic patient care records from the Victorian-arm of the National Ambulance Surveillance System (NASS) between January 2012 and May 2019. The NASS database includes mental health, self-harm, and/or alcohol and other drug-related ambulance attendances. Records of ‘borderline personality disorder’ (BPD) or ‘other personality disorders’ (OPD) were extracted for analysis and compared with matched ‘other mental health conditions’ records. There were 76,929 ambulance attendances for 9,632 people identified with BPD and/or OPD, with the majority of involving crisis-driven behaviours such as suicide attempts, suicidal ideation, non-suicidal self-harm, and drug and alcohol intoxication/harms. Most attendances (87.9%) were transported to hospital emergency departments. Although accounting for only 4.3% of coded NASS attendances, PD represents a disproportionately large number of ‘self-harm’, ‘suicide attempt’ and ‘suicidal ideation’ presentations. Re-attendance was a prominent feature; 8.3% of people accounted for 49.6% of all attendances involving PD. Two-thirds required ambulance attendance three or more times annually, highlighting the need for better and timelier access to appropriate treatment services to reduce the acute crisis response cycle.
JH Broadbear1,2, JA Rotella3, D Lorenze1, S Rao1,4
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia
2Eastern Health Clinical School, Monash University, Box Hill, VIC, 3128, Australia
3Austin Hospital, Heidelberg, Australia
4School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
People with Borderline Personality Disorder (BPD) are likely to attend the Emergency Department (ED) when experiencing mental health crises. Our study describes the prevalence, features, and outcomes associated with BPD presentations in Outer Eastern Melbourne, Australia. A retrospective electronic audit of 157,364 ED attendances identified 700 unique BPD-related ED presentations between May 2015 and April 2016. For comparison, 583 (81% female) of these 700 cases were matched with ‘depression only’ cases. The 583 matched BPD patients attended ED a total of 2807 times during the audit year compared with 1092 attendances for depression-only patients. BPD patients were more likely to: arrive by ambulance (50%); have comorbid substance abuse (44%); have a psychotic (15%) or bipolar disorder (17%); be under the care of a psychiatrist (31%); be case-managed (42%); and be admitted to an inpatient unit (21%). The majority (73%) of BPD patients attended ED more than once during the audit year (average 4.81 ± 6.63 times; range 2-78). These findings highlight the severity of their presentation and the inadequacy of community services for meeting complex needs associated with BPD. Effective ED referral pathways to BPD-appropriate treatment will reduce the likelihood of crises and reliance on EDs for acute episodic care.
R Brown1, J Hope2, P Buntine3, JH Broadbear1,4, S Rao1,5
1Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
2Eastern Health Clinical School; Mental Health Program, Eastern Health, Melbourne, Australia
3Emergency Medicine, Eastern Health, Melbourne, Australia
4School
5School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
The Emergency Department (ED) environment can be harmful for patients who are experiencing extreme psychological distress and result in considerable anxiety for patients, carers, and staff. To improve outcomes for people with BPD in large metropolitan hospital EDs, a team comprising clinicians, lived-experience staff, and researchers developed a comprehensive package comprising enhanced care pathways, staff training and patient/carer educational resources, all of which featured lived-experience content. Delivery was adapted according to profession and staff rotations. The evaluation comprises pre-intervention and post-intervention staff and consumer/carer surveys. The original pilot intervention had 165 ED clinicians completing the pre-intervention survey, with responses highlighting the need for the education intervention. A minority of participating staff reported ratings of ‘good’ or ‘very good’ in their knowledge about BPD (14%), clinical skills (26.8%) and experience (33.7%). Ratings of ‘high’ or ‘very high’ were also deficient with respect to staff willingness (36.4%), optimism (20.8%), enthusiasm (20.8%) and confidence (18.2%) when working with BPD patients. The second roll-out of the ED intervention is currently underway using refined educational materials and featuring carer and consumer ED experiences in addition to more targeted staff responses to assess the impact of the intervention on staff and consumer/carer experiences of ED.
S Rao1,2, L Bugeja3, J Dwyer4, JH Broadbear1,5
1Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
2School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
3School of Nursing and Midwifery, Monash University, Clayton, Australia
4Coroners Court of Victoria, Southbank, Australia
5Eastern Health Clinical School, Monash University, Box Hill, VIC, 3128, Australia
People diagnosed with Borderline Personality Disorder (BPD) experience intense psychological distress and chronic suicidality, which frequently results in self-destructive behaviours. To examine factors associated with death by suicide in people diagnosed with BPD in Victoria, we conducted a retrospective cross-sectional study using cases identified from the Victorian Suicide Register. Cases with a primary diagnosis of BPD were matched with cases having a primary diagnosis of depression (no personality disorder) on the basis of age, sex, time period and location of usual residence (regional/metropolitan). On the basis of our previous research, we hypothesise that the personality disorder group will show a higher degree of co-morbidity with mental health and medical conditions, service contacts (including hospitalisations), law enforcement contact, early life trauma, interpersonal difficulties, and delayed diagnosis and evidence-based treatment. Between 2009 and 2017, 291 deaths of Victorians diagnosed with personality disorder were determined as suicide by the Coroner. Most were diagnosed with BPD. Despite evidence of regular contact with emergency and mental health services during crisis-driven presentations, people diagnosed with BPD whose lives end in suicide often miss out on receiving BPD-appropriate treatment, representing a clear gap and opportunity to break the cycle of suicidal behaviour.