Therapeutic interventions in Australian primary care, youth mental health settings for young people with Borderline Personality Disorder or borderline traits

Abstract

Background This study aimed to investigate what therapeutic interventions were being applied by clinicians working with young people with a diagnosis of Borderline Personality Disorder or borderline traits in Australian primary mental health care settings. Given the current lack of evidence-based guidelines for treatment with this client population, investigating what is being implemented is needed. The study also aimed to determine whether the interventions clinicians are using are effective in reducing distress and increasing functioning for these clients. Methods Participant data came from the national minimum data set for headspace youth mental health centers across Australia. Young people’s data were included in the study if the young person was diagnosed with Borderline Personality Disorder or borderline traits during their first episode of care (N=701). Clinician data that indicated the type of intervention used at each client session and outcome measures routinely captured were analyzed to determine interventions used and outcomes achieved. Results Results demonstrated that CBT was the most frequently used modality of intervention followed by supportive counselling and IPT, but that most clients received a variety of intervention types. There were no or only weak relationships between changes in outcomes and the amount of any type of intervention that was provided. No significant relationship was found with the amount of CBT a client received and changes in symptoms or functioning, despite being the most commonly employed modality. Conclusions The study highlights the need for evidence-based treatment guidelines for early intervention in young people with borderline personality disorder traits.

Adolescent borderline personality disorder: Does early intervention ‘bend the curve’?

“…A recent study of 76 Australian Headspace youth mental health centres found clinicians recorded ‘borderline personality traits’ as the presentation in less than 1% of referrals. 6…”

“…A recent study of 76 Australian Headspace youth mental health centres found clinicians recorded 'borderline personality traits' as the presentation in less than 1% of referrals. 6 Previously, a Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (hereafter the Alliance) set aspirational goals for the field of youth mental health. 5 It was asserted that early BPD should be detected and treated early in youth (ages from 12 to 25 years).…”

The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial

“…Despite this need for appropriate strategies for early intervention to reduce the short-term burden and prevent long-term disabilities, several studies suggest that current mental health services often do not provide an appropriate response to the health needs of these young persons. Data from the Netherlands (14) as well as Australia (15), show that young persons with BPD remain largely undetected in primary services, are not referred to appropriate treatment and are rarely provided appropriate, evidence-based treatments. Brief psychosocial treatments that are common in primary care seem to be less effective for young people with BPD.…”

“…Yet, poor or non-response in these young people is the rule rather than the exception. In a study on primary care in Australia for 12-to 25year-olds, for instance, patients with BPD symptoms showed no progress or deteriorated in terms of social and occupational functioning (45%), psychological stress (60%) and quality of life (69%) (15). Importantly, aside from the lack of efficiency in attaining, this approach generated iatrogenic damage in these youngsters as failed treatment attempts lead to disappointment in and distrust of mental health services (18), which may undermine future care seeking or treatment success.…”