Background: Historically, many public mental health services in Australia have fallen short of ‘best practice’ in the treatment of individuals with a diagnosis of Borderline Personality Disorder. Negative attitudes and clinicians anxiety has led to consumers being refused community services on the basis of this diagnosis. Through lack of alternative treatments, these consumers have received lengthy hospital admissions, which have proven ineffective in providing long-term safety or symptom reduction. Carers and family members of people with this diagnosis have also been ignored. Lack of support and education has failed to alleviate extreme distress and feelings of helpless.

Plan: This symposium will review the experience and outcomes following the implementation of a Dialectical Behaviour Therapy (DBT) approach to the treatment of Borderline Personality Disorder. The authors will describe the implementation of DBT across several clinical settings. The symposium will demonstrate that a shift in treatment focus has resulted in a better quality of care for consumers. The symposium will highlight data which shows: symptom reduction for consumers involved, reduced hospital admissions, a positive change in clinician’s attitude to working with these consumers and better access to support and education for carers.


Paper 1: Reduction in Hospital Admission Days and Symptoms of Borderline Perosnality Disorder following Involvement in a Community DBT Program.

The Liverpool/Fairfield Dialectical Behaviour Therapy (DBT) Program was established as an initiative to offer an evidenced-based treatment to a population of people who have historically experienced difficulty gaining access to appropriate services. Our aim has been to target consumers with a diagnosis of Borderline Personality Disorder who also present as a particularly high risk and/or tend to be frequent users of mental health emergency services. Some evidence suggests that consumers with these characteristics may benefit most from DBT (Linehan et. al., 2006). We also aimed to move towards best practice treatment guidelines which suggest that inpatient admissions should be avoided, in preference of community-based interventions (NCCMH, 2009). This paper examines hospital admission data which shows that, for completers of the program, hospital admission days were significantly reduced during the time of DBT involvement. This reduction in admission days was also maintained during the year following discharge. We also examine preliminary self-report data which shows a reduction in symptoms of Borderline Personality Disorder.


Paper 2: The Implementation of an Eight Week Group Program for Family and Carers of Consumers Participating in the Liverpool and Fairfield DBT program.

The NSW Carers Strategy 2014-2019 identifies carer engagement and carer health and wellbeing as key area of focus given the important role that carer’s and family members play in the lives of consumers. The carer role can have a detrimental impact on the physical and emotional wellbeing of the carer including fatigue, anxiety, depression and isolation. A key feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships. This pattern of interactions can impact on family members and carer’s health and ability to meet the demands of their roles. This presentation highlights an initiative by The Liverpool and Fairfield DBT program to implement an 8 week carer’s group as an adjunct to the DBT program. The program aims to provide the carer’s of consumers attending the Liverpool and Fairfield Dialectical Behaviour Therapy (DBT) Program with education about Borderline Personality Disorder and the DBT program. The program teaches skills that carer’s can use to manage their own emotions, improve relationships and develop a sense of support and connection with other carer’s. The implementation and outcomes of the group will be reviewed.

Paper 3: Qualitative investigations of effects on the DBT clinicians and the effect of an inpatient DBT program

One important aim of DBT is to modify staff attitudes towards working with borderline clients. The DBT assumptions (about clients and staff) and the staff consult group are attempts to decrease negativity, pessimism and hopelessness in the staff group. We carried out two focus groups with the team members in Liverpool and in Campbelltown. We used a semi structured interview and recorded the responses. The interviewers were clinical psychologists who did not work in that DBT team. Staff were asked about their perception of the training program, of the experience of carrying out the therapy, of the consult team and how their feelings about working with borderline clients had changed since being involved in DBT. The results were transcribed and then analysed independently by two raters using Thematic Analysis. The results will be presented. A DBT program has been set up on a young-persons ward as a development of the program. This is largely based on Swenson and colleagues (2001) report on inpatient DBT. We describe the ward program as implemented in Birunji ward and report an Interpretative Phenomenological Analysis of an interview of clients experience of being in the program.