Bray, J.1, Heerebrand, S.2, Roberts, R. 2, Ulbrich,C.1 & Edwards, S. 2

1 Eastern Community Mental Health, CALHN, SA Health, 2Adelaide University

 

Objective: Borderline Personality Disorder (BPD) is a significant mental illness, associated with an increased risk of self-harming and suicidal behaviours. The prevalence of BPD in mental health settings is up to 23% in outpatient settings, and 43% in inpatient settings. The standard application of Dialectical Behavior Therapy (DBT) for the treatment of BPD has substantial evidence demonstrating efficacy. However, this treatment option is limited within SA Health. This study aimed to evaluate the effectiveness of an established, shorter and more available intervention, DBT skills training group (DBT-ST), in a publicly-funded community mental health setting.

Method: Participants (114 people with BPD) attended an 18-20 week DBT-ST in a community mental health setting between 2010 and 2016. The study utilised a quasi-experimental design with a within-persons waitlist control group. Primary outcomes were: BPD symptoms, general psychological distress, depression, and rate of Emergency Department (ED) presentations and psychiatric inpatient bed-days.

 

Results: Participants showed a clinically significant reduction in BPD symptoms, general psychological distress and depression. The waitlist control group showed no significant improvement in BPD symptoms. The rate of ED presentations was significantly reduced by approximately 50%. There was an emerging trend for a reduction in psychiatric inpatient bed-days however there was insufficient power to assess this.

Conclusion: Participation in DBT-ST has been shown to be an effective and accessible treatment for people with BPD, which can be life changing. Additionally, given the prevalence of BPD, DBT-ST can create substantial cost saving for SA Health as DBT-ST participants have decreased contacts with ED.


Jemma Bray

Jemma Bray is a Clinically Endorsed Psychologist and Board Approved Supervisor in Central Adelaide Local Health Network (CALHN), specializing in the area of Mental Health. Jemma is a Senior Clinical Psychologist in Community Mental Health and the inaugural CALHN Dialectical Behaviour Therapy (DBT) Coordinator. Jemma has many years’ experience working with people with chronic and complex mental illness in Community Mental Health and Acute Inpatient settings. Jemma is passionate about working with people with Borderline Personality Disorder and is a comprehensively trained DBT therapist with several years of experience providing group and individual therapy to this high risk population. Jemma has been actively involved with quality improvement activities in CALHN and provides education to SA Health staff to further their learning and development. Jemma has been published in the areas of trauma and DBT plus is involved with ongoing research of Community Mental Health psychological practice including the DBT Program.

Sharon Heerebrand

Sharon Heerebrand is a Clinically Endorsed Psychologist in Southern Adelaide Local Health Network (SALHN), specialising in comorbid Drug and Alcohol Use and Mental illness. Sharon is currently employed as a Clinical Psychologist at Drug and Alcohol Services of South Australia. Sharon has previously worked in both inpatient and community Mental Health settings providing both individual and group interventions to people with chronic and severe mental health diagnoses. Sharon completed her Masters in Clinical Psychology at the University of Adelaide where she completed a thesis titled “Effectiveness of brief dialectical behaviour therapy skills training for borderline personality disorder” which analysed 6.5 years of retrospective data collected by the Eastern Community Mental Health service’s DBT Skills Training program. Sharon is interested in working with people with complex mental health presentations, including consumers with personality disorder diagnoses. Sharon has been published in the area of DBT and maintains a strong interest in ongoing research.

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