Welcome to Country: Songwoman Maroochy, Conference Elder
Ministerial Opening Address: Greg Hunt, MP Federal Minister for Health
Platinum Sponsor Address: Maureen Lewis, CEO, The National Mental Health Commission
Keynote Address: Comparison of the different therapies currently available to treat BPD: Professor Brin Grenyer.
Keynote Address: “Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?” Validating the impact of complex trauma without diagnosing disorder: Dr Haley Peckham.
Gold Sponsor Address: Queensland State Manager, Mind Australia
Keynote Address: Consumer and Carer Perspective on Living with BPD: Our Recovery Story - at the presenters request this video is unavailable.
Keynote Address: Stigma, Discrimination and Life on the Borderline: Mahlie Jewell.
Creating Connections Between Government and Non-Government Services for People with BPD in Ipswich
Melissa Kent, & Suellen McKerlie.
Better Practice Deserved: Dr Peggy Brown AO
Songwoman Maroochy welcomes us to her Country in a moving ceremony
The National Health and Medical Research Council published in 2012 the Clinical practice guideline for the management of borderline personality disorder. This presentation provides an overview of the clinical practice guideline and the specific recommendations for treatment of BPD. There are a number of therapy types that have been evaluated including Dialectical Behaviour Therapy, Cognitive Behavioural Therapy, Mentalisation Based Therapy and Transference Focused Therapy. In addition, there are a number of treatments that innovate with different durations of therapy, generalised approaches, targets for special groups, and multi-modal approaches. In addition, cost-benefit data provides further evidence for specific types of approaches. The presentation will review the different models of treatment, overview their clinical effectiveness, and provide general guidelines for what are the key considerations in seeking and providing effective treatment of BPD.
Professor Brin Grenyer
Brin Grenyer is Professor of Clinical Psychology at the University of Wollongong and Director of the Project Air Strategy for Personality Disorders, in partnership with NSW Health. He is also Foundation Chair of the Psychology Board of Australia. He was a member of the NHMRC Borderline Personality Disorder Guideline Development Committee, and is on the RANZCP Advisory Group for a Consumer Guide on Borderline Personality Disorder. He is on the Editorial Boards of Psychotherapy Research and Personality and Mental Health, and is active in clinical practice and research through Northfields Psychology Clinic.
“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?” Validating the impact of complex trauma without diagnosing disorder
This beautiful quote comes from the pen of J.K. Rowling in Harry Potter and the Deathly Hallows and shows Professor Dumbledore validating Harry’s experience. Consider the opposite, “It’s all in your head!” suggesting you’re making something up, claiming compassion and understanding that you have no legitimate entitlement to. One way to legitimise ‘what’s in your head’ is to be diagnosed with a mental illness. Diagnosis validates suffering and struggles and may bring relief and clarity but maybe also stigma and a sense of powerlessness. Neuroscience offers us another way. Mechanisms of neuroplasticity have evolved to help us adapt to the environment we encounter. We learn from what has happened to anticipate what will happen. This helps us to survive and reproduce in our environment. From the level of our DNA, to the changing rate at which we create new neurons, through to our neural pathways within and between the regions of our brains; experiences sculpt our brains. Neuroplastic mechanisms shape our brains for the precise environment we experience whether that environment is benevolent, benign, impoverished or abusive. Mechanisms that enhance our capacity to anticipate our environment are survival positive, but in traumatising environments the experiences we have shape our brains to anticipate further trauma. We become threat focused, anxious, aggressive, defensive, or withdrawn, which may serve our survival even as they cause us to suffer, but is this suffering illness per se? The suffering and struggle is real and, in our heads, but is an outcome of our functional neuroplastic mechanisms adapting to a harsh environment.
This presentation explores how we validate the profound and enduring impact of early experiences. Diagnosis of mental disorder is one way to validate psychological and emotional suffering but neuroplasticity, by describing how experiences shape brains, offers consumers a non-pathologising alternative which some may prefer.
Dr Haley Peckham
Haley has been curious about brain and mind since she could think. Whilst studying philosophy, Haley worked with children in out-of-home care and was intrigued and saddened to learn that these children have a high risk of developing mental health issues later. Wanting to understand how our lives shape our brains, Haley became a mental health nurse, began her own psychotherapy and studied neuroscience. Last year, Haley gained a PhD from Melbourne University on the topic of neuroplasticity: how experiences shape brains. She wants to share her understanding of the biology of complex trauma and the necessity for trauma-informed care.
This video is not available.
(NB Contains some images that may be distressing for some viewers)
In her presentation she talks about her experiences of stigma and discrimination. Mahlie is also the graphic designer who has designed the 2018 "Know BPD. NO Stigma" campaign.
'BPD as one of the most stigmatised and discriminated mental illnesses of our time, I talk about the ways in which the label “BPD” has affected my relationships, both personal and professional and the ways in which you learn to navigate a world that doesn’t really understand you. This presentation shows my journey from confused and misunderstood girl who was labelled “too broken” to a strong proud woman who lives every day as a warrior who survived the judgement of others. I look at the ways we must respond to those who discriminate against us and the way we need to re-educate the world with kindness and empathy and support our fellow peers to embrace their “BPD” label and see the beauty beneath the borderline.”
Conceptions, connections, collaboration. This is how the journey to creating an integrated government and non-government approach to services for people with BPD in the Ipswich region began.
Melissa and Suellen will present on the unique and innovative approach to facilitating Dialectical Behaviour Therapy (DBT) programs within Queensland Health and within a non-government organisation, and the integration of the two workforces and programs. Some preliminary results will be presented.
Melissa is a clinical psychologist in private practice, DBT Coordinator at Partners In Recovery West Moreton-Oxley, and a PhD candidate at the University of Queensland Faculty of Medicine. Her area of special interest is working with people with BPD and complex trauma.
Suellen is a clinical nurse currently employed at the Community Care Unit in Gailes, Queensland. She is interested in and passionate about helping people with BPD and other complex disorders.
Background: This project, completed by SANE Australia with the support of the National Mental Health Commission, sought to understand how best to meet the needs of Australians living with Personality Disorder, with an emphasis on Borderline Personality Disorder (BPD).
Methods: This project involved three components: a literature review of evidence-based treatment approaches, an environmental scan of key activities underway in Australia, and semi-structured interviews and focus groups involving people living with BPD and their carers, family members and other support persons.
Results: The literature review identified several evidence-based approaches to psychotherapy, as well as guidelines for working with people with BPD from leading research and advocacy groups. The environmental scan identified several specialist services in Australia, typically clustered around capital cities in Victoria, New South Wales, South Australia and Western Australia. There was a lack of specialist services in the Northern Territory and Tasmania, and in rural and remote locations. Most services operated privately. Major themes identified in the qualitative study were ‘identity and discovery’, ‘(mis)communication’, ‘barriers and complexities’, ‘finding what works (for me)’, ‘an uncertain future’, and ‘carer-specific issues’. Themes will be presented and discussed with reference to current policies and practice guidelines, as identified in the literature review and environmental scan. Participants typically described long, non-linear journeys with treatment and support services, impacted by stigma. Participants reported frustration with financial barriers, waiting lists and availability of specialist support.
Discussion: Although a number of evidence-based psychotherapeutic approaches have been identified, it appears that that the current Australia mental health system does not adequately support the needs of people living with BPD.
Recommendations identified by the report will be discussed.
Elise Carrotte: Elise is an experienced Research Assistant and has worked at SANE Australia since December 2017. She has a background in public health research and has more recently focused on mental health research in the Australian context. Elise is also a provisional psychologist with experience in cognitive behaviour therapy (CBT) and dialectical behaviour therapy (DBT). Her research and professional interests include Borderline Personality Disorder, Eating Disorders, women's health and youth mental health.
Borderline Personality Disorder in men is often underdiagnosed, misdiagnosed as Anti Social Personality Disorder or other mental illnesses. Men are more likely to suffer from co-morbid substance abuse issues, intermittent explosive anger and feelings of isolation in discussing emotion and a blanket denial of mental health problems. These factors make accessing treatment difficult and more likely for a male with BPD to become incarcerated, lose family and children and remain isolated within a community.
Some DBT groups may be female dominated that present further problems and make participation in treatments difficult for men. Treatments involving BPD and men may appear to be rarely discussed that reinforce a stigma that women only suffer from BPD. Men may find accessing treatment difficult on fronts of legal, medical and psychological help and may take a 'macho man' approach (e.g. I don't need help/I'll just have a drink/It will blow over). Is it correct in asserting within a court, medical or psychiatric environment that men are antisocial? Is it worth digging deeper to find out the cause of a feeling rather than the anger that overshadows another emotion?
More often than not, sadly, those with BPD in crisis situations are provoked even further into explosive outbursts. These scenarios may be considered to make it difficult for men in particular to express their emotions in a way that identifies a need for assistance and treatment rather than punishment. While responsibility should be promoted more in both genders, approaches may differ. Courts may attempt to punish an offender in a rehabilitative manner however may inadvertently continue a cycle of crisis. Associating BPD with female attributes is factually incorrect and continues a cycle of stigma against men.
Terminology and language around both genders is an important role towards accessible treatment and a desire for men to seek help.
Peggy presentation looks at alternative ways of looking at B...P....D in terms of what BPD is, attitude of services and funding.
She has a Big Picture Dream (BPD) that we can make a difference through training, support (psychosocial, housing etc). We need some Big Bold Policy Decisions........we need politicians to set up and take notice and prioritise.
Dr Brown is a consultant psychiatrist who has held clinical and administrative positions in psychiatry in Queensland, the Australian Capital Territory, the Northern Territory, and in the United Kingdom. She has also previously held the roles of Director-General of ACT Health and CEO of the National Mental Health Commission.
Currently, she works part-time at Metro South Addictions and Mental Health Service in Brisbane and serves as a Senior Clinical Advisor to the Australian Commission on Safety and Quality in Health Care on a project relating to digital mental health services.
Peggy is also a Member of the Agency Management Committee of AHPRA (the Australian Health Practitioner Regulatory Agency) and a member of the Pharmaceutical Benefits Advisory Committee.
Carers of people with borderline personality disorder (BPD) are known to experience anxiety about their caring role but are also interested in strategies to help. Treatment guidelines advocate involving carers in comprehensive therapy approaches. As part of a comprehensive carer program we conducted a randomized controlled trial of group psychoeducation. Group psychoeducation involved 6-8 carers per group and focused on improving relationship patterns between carers and relatives with BPD, psychoeducation about the disorder, peer support and self-care strategies, and skills to reduce mental health burden. At followup those in the intervention reported improvements in dyadic adjustment with their relative with BPD, greater family empowerment, and reduced expressed emotion, and these improvements were sustained at a 12 month follow-up. There were improvements in carers perceptions of being able to play a more active role, such as interacting with service providers. The program demonstrates that providing structured group programs for carers can be an effective way of extending community-based interventions.
Brin F.S. Grenyer, Rachel Bailey, Kate L. Lewis, Michael Matthias, Toni Garrety, Annemarie Bickerton.
Professor Brin Grenyer
See above for his bio.