Exploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia

Wlodarczyk, Julian; Lawn, Sharon; Powell, Kathryn; Crawford, Gregory B.; McMahon, Janne; Burke, Judy; Woodforde, Lyn; Kent, Martha; Howell, Cate; Litt, John

doi:10.3390/ijerph15122763

Cited by 17 publications

(43 citation statements)

References 34 publications

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“…A total of 29 papers (drawing on 27 unique datasets) were eligible for inclusion (37, 43-70) (Fig 1), representing perspectives from at least 550 clinicians. Clinicians represented a variety of professions and included psychologists, social workers, psychiatric nurses, occupational therapists, psychiatrists, family doctors (known as General Practitioners or ‘GPs’ in the UK) and counsellors (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

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Section: Resultsmentioning

confidence: 99%

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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“…Consulting with consumers regarding the support they receive, and offering to include peer support in treatment plans is recommended [42]. Further, increasing the availability and accessibility of peer support for both consumers with BPD and their carers is important, including making health professionals aware of peer support options to inform referrals [51].…”

Section: Discussionmentioning

confidence: 99%

Using peer workers with lived experience to support the treatment of borderline personality disorder: a qualitative study of consumer, carer and clinician perspectives

Barr

Townsend

Grenyer

2020

bord personal disord emot dysregul

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Background: Peer support is a recovery oriented approach where consumers and carers are introduced to people with lived experience of the disorder who have recovered. Paid roles within health services for such consumer peer workers and carer peer workers (or 'specialists') are increasingly common. To date specific studies on such peer support for consumers with borderline personality disorder (BPD) and their carers has not been conducted. Methods: This qualitative study used interviews to explore perceptions and models of peer support for BPD from the perspectives of 12 consumers, 12 carers, and 12 mental health professionals. Participant responses were analyzed using reflexive thematic analysis within a phenomenological methodology. Results: All groups described how consumer peer workers may provide hope, connection, and validation to a consumer's lived experience. Offering both traditional mental health treatment plus peer support, and giving consumers choice regarding a consumer peer worker was welcomed. Differences in opinion were found regarding the consumer peer worker's role in relation to the mental health team, including whether consumer peer workers should access medical records. Perspectives differed regarding the consumer peer worker and carer peer worker positions, highlighting potential role confusion. Carers discussed the value of receiving support from carer peer workers and consumer peer workers. Mental health professionals described how consumer peer workers can experience workplace stigma and problems with boundary setting, and acknowledged a need for peer workers to be valued by having a duty of care and confidentiality code to follow and be offered supervision. Conclusions: Two models of peer support for BPD emerged: an integrated model where consumer peer workers work within the mental health team, and a complementary model where consumer peer workers are separate from the mental health team. Based on these findings we provide recommendations for services to help support such peer work for consumers with BPD and their carers.

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“…This complex set of circumstances has led to uncertainty and controversy amongst mental health professionals in disclosing a diagnosis of BPD to an individual, especially adolescents, due to concern for potential stigmatizing effects (Ring & Lawn, 2019 ; Wlodarczyk et al., 2018 ). However, recent research has shown that disclosing the diagnosis to the individual assists them in understanding their experiences and in receiving effective treatment (Courtney & Makinen, 2016 ; Kaess et al., 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Consumer perspective from people with a diagnosis of Borderline Personality Disorder (BPD) on BPD management—How are the Australian NHMRC BPD guidelines faring in practice?

Proctor

Lawn

McMahon³

2020

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? Internationally, stigma towards people with mental illness has reduced due to greater understanding, education and advocacy in the community, and more focus on recovery‐oriented care within practice guidelines. However, many people with a diagnosis of BPD continue to experience stigma and difficulty accessing health services. Contributing factors include lack of understanding of BPD and effective management by health professionals, stigma from the general population and within healthcare services, and financial and geographical barriers. Mental health nurses comprise a large part of the healthcare workforce responsible for the day‐to‐day care of people diagnosed with BPD. What the paper adds to existing knowledge This paper investigates how Australian consumer perspectives on BPD management have changed over time. Comments from a large survey, delivered to consumers in 2011 (N = 153) and 2017 (N = 424), were analysed for common themes. Themes were broadly related to NHMRC BPD Guidelines sections released in 2013. These data sets therefore present an opportunity to evaluate changes in consumer perspectives pre‐ and post‐Guideline release. Although no direct causal relationship can be drawn, analysing these changes can potentially assist with understanding the impact of the Guidelines in practice. No such analysis of the Australian Guidelines has been conducted to date in the existing literature. What are the implications for practice? Many people diagnosed with BPD continue to experience stigma, barriers to treatment and difficulty accessing appropriate services. Widespread practical implementation of the Guidelines was not apparent; however, improved general awareness and understanding of BPD from consumers and health professionals were evident. Improved education and practice across each and all aspects of the Guidelines are indicated. The Guidelines need review to ensure they are in‐line with current evidence‐based practice, as well as effective health professional education, support and funding to embed the revised Guidelines into practice. Abstract IntroductionInternationally, many individuals diagnosed with BPD continue to experience stigma within health care and are more likely to be viewed as manipulative and evoke negative responses from clinicians, compared with other mental health consumers. Aim/QuestionTo understand Australian consumer perspectives regarding BPD management, and how these have changed between 2011 and 2017. To comment on how NHMRC BPD Guidelines, released 2013, are faring in practice. MethodIndividuals who identified a BPD diagnosis completed a 75‐question survey, delivered online Australia‐wide, in 2011 (N = 153) and 2017 (N = 424), providing comparative data sets to evaluate changes in consumer perspective on BPD management. ResultsMany people diagnosed with BPD experience difficulties when seeking help, stigma within health services and barriers to treatment. Improved general awareness, communication and understanding of BP...

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Exploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia

Cited by 17 publications

References 34 publications

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Using peer workers with lived experience to support the treatment of borderline personality disorder: a qualitative study of consumer, carer and clinician perspectives

Consumer perspective from people with a diagnosis of Borderline Personality Disorder (BPD) on BPD management—How are the Australian NHMRC BPD guidelines faring in practice?

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