Summary: A study reveals that people with borderline personality disorder and their caregivers face stigma and discrimination from mental health service providers after suicide attempts and episodes of self-harm.
Font: Flinders University
People with a diagnosis of borderline personality disorder and their carers report experiencing discrimination and stigma when seeking health services after self-harming or attempting suicide, leading to inadequate suicide prevention treatment and care, they say. the authors of a new large-scale review.
Flinders University researchers call for better use of existing resources to improve health and community services and staff training, which would not only improve the health and well-being of all Australians, but also contribute significantly to a reduction in emergency department visits and hospital admissions.
Led by Pauline Klein, an occasional scholar and doctoral candidate at the Flinders University School of Medicine and Public Health, the research team conducted an international literature review to investigate people with a diagnosis of borderline personality disorder. , their caregivers and the experiences of health professionals. of health services.
“Our goal was to identify any challenges, gaps, and barriers in health services and supports, as well as recommendations to address these issues,” says Ms. Klein.
Borderline personality disorder affects one to two percent of the world’s population but has high rates of self-harm and suicide, leading to frequent visits to emergency departments and mental health services, the review found.
“Unlike schizophrenia, borderline personality disorder is much less likely to respond to medication, as previous research found longer-term solutions, such as face-to-face therapy and ongoing support, better suited to managing the underlying trauma. which is believed to have led to the disorder for many of the people who experience it,” says co-author Dr. Kate Fairweather, a mental health epidemiologist and professor of public health/health equity at Flinders University.
The review identified significant structural problems in the health system for people diagnosed with borderline personality disorder and their caregivers, including the limited public health services and community group programs available to meet the urgent demand for support.
“We found that available public health services and programs have long waiting lists, and specialist services are not an affordable option for many people with a diagnosis of borderline personality disorder and their families,” says Ms. Klein.
“Similarly, health professionals reported experiencing challenges navigating health services and referral pathways, due to the limited services and supports available.”
The research further suggests that there is a pervasive culture of stigmatization, particularly in emergency and acute mental health services, that perpetuates misconceptions about the legitimacy of the diagnosis of borderline personality disorder, as well as its treatability and prospects for recovery. , leading to reticence among some health professionals. to diagnose or treat people with this mental health condition.
“Alarmingly, there are consistent reports in the literature that when experiencing a suicidal crisis, people with a diagnosis of borderline personality disorder and their carers are treated disrespectfully and are denied treatment when they present to some health services. , which leads to them not being offered support. these patients at a crucial time when crisis intervention is needed,” says Ms. Klein.
“The Clinical Practice Guidelines for the Management of Borderline Personality Disorderdeveloped in 2012, affirm that treatment of this disorder is a legitimate use of health care resources and that having a diagnosis of borderline personality disorder is never a reason to deny a person health care.
“These stigmatizing experiences cause patients and their caregivers to face discrimination and high levels of anxiety when seeking treatment because their condition is not taken seriously, which undermines patient care and can re-traumatize and exacerbate behavior. self-destructive of patients.
The authors say the review’s findings echo existing structural problems plaguing other areas of the health system and provide further evidence of the critical need for health reform.
“This should serve as a call to action for governments to prioritize and address these important public health issues,” says Ms Klein.
“We need a system-wide approach that includes providing health professionals working with people with borderline personality disorder ongoing access to education, training and supervision to better support them in their role.”
See also
Money: The research was funded by the Suicide Prevention Research Fund, established by the Federal Government to support research on suicide prevention. The purpose of the fund is to support world-class Australian research and to facilitate the rapid translation of knowledge into more effective services for individuals, families and communities. Suicide Prevention Australia administers the fund on behalf of the Federal Government. We also acknowledge our partner organization, Lived Experience Australia.
About this research news on mental health and BPD
Author: annika dean
Font: Flinders University
Contact: Annika Dean – Flinders University
Image: The image is in the public domain.
original research: Open access.
“Structural stigma and its impact on health care for borderline personality disorder: a scoping review.” by Pauline Klein et al. International Journal of Mental Health Systems
Summary
Structural stigma and its impact on health care for borderline personality disorder: a scoping review.
Background
People with Borderline Personality Disorder (BPD) and their caregivers/relatives continue to experience structural stigma when accessing health services. Structural stigma involves societal conditions, cultural norms, and organizational policies that inhibit the opportunities, resources, and well-being of people who live with stigmatized attributes. BPD is a serious mental illness characterized by pervasive psychosocial dysfunction that includes problems regulating emotions and suicidal tendencies. This scoping review aimed to identify, map, and explore the international literature on the structural stigma associated with BPD and its impact on health care for consumers with BPD, their caregivers/families, and health professionals.
Methods
A comprehensive literature search spanned the evidence-based databases of MEDLINE, CINAHL, PsycINFO, Scopus, the Cochrane Library, and JBI (from inception to February 28, 2022). The search strategy also included gray literature searches and handsearching of the references of included studies. Eligibility criteria included citations relevant to structural stigma associated with BPD and health care and crisis services. Quality assessment of included citations was completed using the Mixed Methods Assessment Tool version 2018 (MMAT v.18), the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews, and the Research Synthesis Tool, and AGREE II: progress in the development of guidelines, reports and evaluation in the health care tool. Thematic analysis was used to inform data extraction, analysis, interpretation, and data synthesis.
Results
A total of 57 citations were included in the review comprising peer-reviewed empirical articles (n = 55) and reports (n = 2). Studies included quantitative, qualitative, mixed methods, and systematic review designs. The review findings identified several existing macro- and micro-level structural mechanisms, challenges, and barriers that contribute to BPD-related stigma in health systems. These structural factors have a substantial impact on access to health services and care for BPD. Key themes that emerged from the data included: structural stigma and BPD diagnosis and BPD-related stigma around health care and crisis services.
conclusion
The narrative synthesis of the findings provides evidence on the impact of structural stigma on medical care for BPD. It is anticipated that the results of this review will inform future research, policy, and practice to address BPD-related stigma in health systems, as well as approaches to improve responsive health service delivery and care for consumers with BPD and their caregivers/families. .
