Tasks ahead of us
Objective | Discussion Paper | Challenges | Progress | Tasks | Solutions | Questions
- To increase awareness and understanding of BPD amongst the general community
- To ensure that every single Australian who experiences BPD is able to access evidence based BPD treatments in an atmosphere that is free of stigma and discrimination.
- To ensure that every single family (parents, partners, children, carers) who have a relative with BPD is adequate supported and educated while they share and support the journey of treatment and recovery of their relative.
- To ensure that every single clinician who comes across a person with BPD during the course of their work is adequately educated, trained, supervised and supported to treat BPD using evidence based interventions.
- To replace the current stigma and discrimination surrounding BPD with hope, optimism and compassion.
- To implement the NHMRC clinical practice guidelines (2012) for management of BPD across the health care sector.
- People with BPD, their families and carers and clinicians interested in working with BPD- all should come together under a single platform to advocate for the change.
- Acknowledge that people with BPD suffer severely. Their families and carers share the burden. Clinicians caring for people with BPD are also impacted when they are not adequately supported.
- Addressing the major gaps in service provisions across Australia.
- We need to advocate for BPD and educate policy makers and influence funding bodies.
- Empowering existing health care sector (GP, public mental health services, psychology, nursing, social workers, private psychiatry etc) to respond to BPD appropriately.
- We need to advocate for inclusion of BPD in the training curriculum for psychologists, mental health nurses, social workers, psychiatrists and GPs. Colleges of psychiatrists, psychologists, nursing, social workers and GPs are all important stakeholders.
- Emergency services staff such as police and ambulance requires education and training in care of BPD.
- BPD patients can often struggle with child custody matters. Child protection services and Family and Children’s courts need to be further educated regarding the impact of BPD on mothers with the disorders and their children. The protective services and courts also need to be educated re the potential for recovery from BPD and the impact of loss of child custody on mother’s mental health whilst maintaining a focus on the best interests of the child.
- Children who have been subjected to traumatic experiences and or environments should receive early interventions and supports. Similarly care providers who ae in those environments need education and support.
- We need to establish a BPD research centre of excellence for the nation.
- We need dedicated BPD specialist centres of clinical excellence across the nation to:
- Advocate for BPD and create awareness
- Teach and train mental health workforce and primary sector in working with people with BPD and their families/carers
- Support and resource the activities of other organizations providing education/training to people with BPD and their families/carers e.g. NEA-BPD in Australia, the Bouverie Centre
- To treat the most complex and severe BPD
- Provide consultations and supervision to clinicians treating BPD in public and private settings
- Develop locally relevant models of care for BPD
- Support and resource the Australian BPD Foundation in its BPD advocacy work
- Take up clinical research and treatment quality assurance activities
- Considering the Spectrum funding example, a recurring annual funding of $ 24 million will help set up a national research centre and state-wide/territory wide specialist centres of clinical excellence across the nation. In other words “a dollar citizen per year” will fund the establishment of such centres across every state and territory of Australia. Although this will not provide treatment access to all BPD patients, it will help remove stigma, improve education and training for clinicians, treat severely unwell BPD patients, develop local models of care, enhance advocacy and help the existing mental health workforce to manage people with BPD better.
- NHMRC Clinical Practice Guidelines for the Management of Borderline Personality Disorder documents the following regarding Specialised BPD Services: “Where available, health professionals should consider referring people with severe and/or enduring BPD to a specialised BPD service (e.g. Spectrum Personality Disorder Service for Victoria) for assessment and ongoing care”. The NHMRC Guidelines set out the role of the specialised BPD Service as:
- Providing treatment for people with BPD who have complex care needs or those at high risk for suicide or significant self-harm
- Providing consultation to primary care services and mental health services
- Providing education, training, supervision and support for health professionals, including support for rural and remote services, education for local general mental health services, and consultation and advice for GPs managing BPD
- Health promotion and advocacy (e.g. raising awareness of BPD and reducing stigma)
- Providing education for families and carers and supporting them
- Undertaking research to develop better treatment models for BPD.
- We need to collaborate with Coroner’s courts regarding examination of factors involved in adverse outcomes for BPD and its interaction with health sectors.
- Drug and alcohol centres should be sensitized and trained to screen for BPD.
- People with BPD involved in Forensic and Criminal justice systems also need to be treated with evidence based interventions.
- We need to thoughtfully consider how the National Disability Insurance Scheme will work for people with BPD.
- Disability support pensions (DSP) for BPD are double edged swords. On one hand a significant number of people with BPD are unemployed and financially disadvantaged and require the assistance of DSP. On the other hand it has been documented that engaging in meaningful work can improve the clinical outcomes. This again requires thoughtful consideration.
- To develop a dedicated nationwide 24 hour telephone helpline for BPD and families.
- Develop a strategy for addressing BPD in rural and remote locations. Telehealth options require consideration to address this issue.
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