Spectrum – Theme: Other – Community-based model of care for people with personality disorder
Chair: Rita Brown, Carer Consultant/Lived Experience Team Leader, Spectrum
Sathya Rao, Parvaneh Heidari, Haris Constantinou, Marianne Weddell, Jason Webb
Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
Despite its high community prevalence, professional mental health (MH) training rarely includes content related to the treatment of personality disorder. In 2018, the Victorian Government committed funding for the Personality Disorder Initiative (PDI), committing $9.16 million over four years. The initiative was designed to build the expertise and capability of the clinical MH workforce within six Area Mental Health Services (AMHSs) to assess, treat and support people with severe personality disorder. Spectrum designed the program to maximise confidence, competence and willingness of these specialists to work with people with personality disorder and provide training to their AMHS colleagues.
The evaluation of the PDI is multi-tiered, comprising: (i) baseline and post-intervention surveys of the Victorian MH workforce; (ii) baseline, mid-program and post-program surveys of participating AMHS staff; (iii) qualitative interviews with AMHS clients; and (iv) clinical and social outcomes of people diagnosed with personality disorder from participating AMHSs.
The pre-implementation Victorian Mental Health Clinician Survey highlighted the perceived lack of professional training in diagnosing, managing, and treating personality disorder. The first round of the PDI is complete; newly trained specialists are treating people with personality disorder within their AMHS. Collection of workforce and consumer outcomes is in its final stages.
2. Community residential mental health - PARC Ironbark Program
Cathryn Pilcher1, Joy Quek2, Jillian Broadbear1, Aghareed Al-Qassab1, Sathya Rao1, Chris Murphy3
1Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
2Austin Health, Melbourne, Australia
3Mind Australia Limited, Melbourne, Australia
Victorian mental health Prevention and Recovery Care (PARC) services are short-term mental health services that treat people experiencing a severe and acute mental health episode using clinical and psychosocial support with a recovery focus. A primary diagnosis of a personality disorder, or personality traits, has a substantial impact on clients’ ability to effectively engage with the PARC program. There is a paucity of evidence regarding interventions for consumers with borderline personality disorder (BPD) in a PARC (or equivalent) setting. To address this, we co-developed a structured group program for emotion dysregulation/BPD, run three times weekly by PARC staff for all PARC residents. Residents with a diagnosis of BPD were invited to participate in the program evaluation. Preliminary results show a significant reduction in BPD symptoms at discharge. The impact of the program for PARC staff was also evaluated, showing that staff have a more positive regard for clients with BPD and feel empowered to support and treat these clients. The study will include other PARC services, with expansion facilitated by the manualisation of the Ironbark program and formal PARC staff training and supervision. This approach marks an important step towards the inclusion of psychological treatments within all mental health services.
3. Clinical outcomes and quality of life following specialist psychotherapy in the public sector
Sathya Rao, Aghareed Al-Qassab, Jillian Broadbear
Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
Spectrum offers evidence-based psychotherapeutic treatment to people suffering from severe and complex personality disorder. Spectrum’s Service Evaluation Program comprehensively evaluates the efficacy of specialised psychotherapy across a wide range of clinical outcomes. All clients admitted to Spectrum over a three-year period were invited to participate in the evaluation program. Clinical, social and functional outcomes were measured using validated instruments at four time points: Baseline, 6, 12 and 18 months/discharge. Data for 114 clients were analysed. A significant reduction in the prevalence and severity for all subtypes of personality disorder, including BPD, was measured at discharge, with 86% achieving remission. The majority of clients (74%) were at or below the clinical threshold for depressed mood. BPD symptom severity was higher in clients who reported self-harming behaviours and suicidal ideation compared to participants who did not. Self-rated social and functional outcomes were significantly better for participants who did not report experiencing suicidal ideation at discharge. There was also a substantial reduction in emotion dysregulation and in disordered eating scores at discharge. These findings support the efficacy of BPD-appropriate psychotherapy treatment in the public mental health sector for people with severe and complex PD.
4. Recognising BPD in older adults
Hemalatha Jayaram1, Josephine Beatson1, Francine Moss2, Jillian Broadbear1
1Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
2St George’s Hospital, Melbourne, Australia
The diagnosis of Borderline Personality Disorder (BPD) in older adults is often missed, however these people often suffer greatly and their needs can pose challenges for those who care for them. In the absence of validated screening tools for the detection of BPD in older patients (60 years+), we developed a screening tool - the BPD in Older Adults (BPD-OA) - that reflects the changing symptomology of BPD during the aging process. Its sensitivity and reliability was evaluated in a proof-of-concept study in (i) 20 BPD-confirmed and (ii) 20 age- and gender-matched BPD-negative elderly participants, all of whom were referred to aged psychiatry services. Chi-Square analysis clearly showed that the BPD-OA was able to discriminate BPD from non-BPD populations. The BPD-OA was refined based on these preliminary results and is currently being trialled in six older adult psychiatry services. All newly referred clients are invited to participate. The QuickSCID-5 and SCID-5-PD are used to verify psychiatric diagnoses along with the Geriatric Depression Scale given the comorbidity between BPD and depression. Once validated, the BPD-OA will serve as a brief, simple and reliable screening tool, the use of which will prompt a more comprehensive evaluation, facilitating staff preparedness and patient care.
5. Expression and experience of BPD in men
Jillian Broadbear, Michael Bhagwandas, Aghareed Al-Qassab, Lukas Cheney, Sathya Rao
Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
The community prevalence of borderline personality disorder (BPD) is similar in men and women, however women are far more likely to receive diagnosis and treatment. Diagnostic features described in DSM and ICD reflect the female presentation, with treatment programs designed for and evaluated primarily in female clients. The tendency to exhibit more externalising behaviours can lead to a diagnosis of antisocial personality disorder in men and reticence of clinicians to engage with them in treatment. Men struggling with BPD symptoms may instead come into contact with drug and alcohol services and the criminal justice system. Lived-experience studies of BPD in men are scarce. The current study used in-depth semi-structured interviews to investigate the experience of BPD, its aetiology, diagnosis, and treatment in eight men whose ages ranged from 27 to 76 years. Thematic analysis highlighted commonalities in their experiences. Break downs in relationships were catalysts for help-seeking. Gendered stereotypes were apparent, with men demonstrating a tendency to prioritise self-sufficiency over having close relationships. Clarifying how men experience BPD and obtaining insight into male diagnostic features is critically important, both to recognise and diagnose BPD earlier as well as to optimise treatment interventions for this vulnerable and often isolated population.