Matter of Interest | Borderline Personality Disorder
20/03/2013
The Hon. K.L. VINCENT (15:54): This week in ABC news reports and in other media, we have heard about the ongoing crisis in mental health and the lack of acute mental health beds in the state’s public hospitals, particularly down at the Flinders public hospital with the closure of beds within the Margaret Tobin Unit. It is absolutely unacceptable that people with mental illness are being held in an emergency department for a number of days, rather than hours, and that in some cases, for both their own safety and that of those around them, this results in the shackling of patients to the bed. This is a complete violation of human rights and not what we should expect to be happening in 2013 in the health system of a First World country.
Unfortunately this government continues to ignore the overall crisis in mental health and the needs of people with borderline personality disorder. I find it somewhat timely that on Monday, when Adelaide’s mental health patients were spending their days in an inappropriate environment of emergency departments rather than in mental health beds around Adelaide, the National Health and Medical Research Council of Australia released the Clinical Practice Guidelines for the Management of Borderline Personality Disorder.
I am very pleased to see these released, as borderline personality disorder (BPD) is a much maligned disorder and is often difficult to treat. There is also a complete dearth of appropriate treatment facilities in South Australia in metropolitan and rural and regional areas. I would like to highlight some of the issues raised in the stated need for this clinical guideline:
The care of people with BPD is very challenging for health professionals and for the health system. Australians with BPD experience difficulties gaining access to effective treatment and support services. In 2005, consultation by the Mental Health Council of Australia and the Brain and Mind Research Institute in association with the Human Rights and Equal Opportunity Commission, reported that people with BPD, carers and service providers throughout Australian mental health services expressed concern that the availability of BPD therapies is extremely limited, particularly for psychological therapies.
The urgent need for accessible appropriate treatment for people with BPD has been acknowledged by an Australian Parliament Senate Select Committee on Mental Health and an Australian Parliament Senate Standing Committee on Community Affairs. These committees identified several areas in which the Australian health system must be improved to provide better care and support options for people with BPD, and reported the following findings:
•BPD is under-recognised.
•Health professionals are often not aware of the most effective treatments for BPD, and these are not being offered to people who need them.
•Due to lack of appropriate services, people with BPD often present to emergency departments or are admitted to secure inpatient units. These treatment settings are not therapeutic for people with BPD and can contribute to the cycle of admission, self-destructive and other maladaptive behaviours, and readmission.
•Consumers and carers have commonly reported discrimination by mental health professionals against people with BPD…
•Access to BPD services within the criminal justice system is limited, despite the relatively high rates of BPD among prison populations.
Many things that I harp on about in this chamber can both prevent poor outcomes and improve the lives of South Australians if we follow the reports and guidelines regularly presented to us by experts. BPD is one of these issues: a mental health matter with at least a 1 to 2 per cent prevalence rate in the community, and we need to ensure that our state Labor government implements these recommendations with some vigour and purpose.
At present we are a long way off, to say the least. We have no specialist education, information or treatment services. People with BPD are often on long waiting lists for the accepted best outpatient treatment—dialectical behaviour therapy. Our health professionals do not get enough training. Carers of people with BPD find themselves in a quagmire with a lack of support and services. It is a mess. The sooner the government admits we urgently need a specialist facility, such as the Spectrum service in Victoria, which I have mentioned in this place before, the better off we will all be.
