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Borderline Personality Disorder (BPD) is a common mental illness impacting around 1 to 4% of the Australian population (National Health and Medical Research Council (NHMRC) 2012).


People with BPD often have difficulties in regulating emotions and impulses and are at a high risk of suicide and self-harm. The rates of death by suicide are between 3 and 10% for people living with BPD (NHMRC 2012). A rate higher than the general population (NHMRC 2012).

Reviewing the literature on carer perspectives for a person with BPD when seeking emergency care responses, identified that the emergency department (ED) was where most carers and consumers present in a crisis related to BPD.

Carers, often a parent or spouse go the ED when their loved one is in crisis as this is the only viewed option of where to go. However, the emergency care and management of BPD is complex and resource intensive due to suicidal ideation (Acres, Loughhead & Procter 2018).

ED nursing staff are an early contact point, they are tasked with maintaining safety and reducing the impact of the crisis. Despite taking on this role, many nurses have not received training in responding to and managing people with BPD which becomes a barrier to the consumers’ recovery (Morphet et al. 2012).

Carers have experienced medical discrimination based on diagnostic label (Lawn & Mcmahon 2015). Many have reported that support and information was not provided by healthcare professionals when requested. Despite the lack of communication carers are often relied upon to make treatment decisions with a lack of information which impacts their ability to make an informed decision (Dunne et al. 2013). Collaborative relationships and improved communication between nursing staff, healthcare professionals and carers on how to manage crisis and high-risk situations is one way to keep carers informed.

In addition, maintaining a trauma informed approach is vital in the recovery process for the carer and the consumer. By practicing kindness, empathy and developing trust with nursing staff, carers and consumers are encouraged to engage in the recovery process which can lead to improved outcomes (Acres, Loughhead & Procter 2018).

References
Acres, K., Loughhead, M., & Procter, N. 2018 (In press). Perspectives of family carers for people diagnosed with borderline personality disorder: A scoping review on the emergency care responses of nurses and other health professionals. Australasian Emergency Care.
Dunne, E. & Rogers, B. 2013, It’s us that have to deal with it seven days a week: Carers and borderline personality disorder, Community Mental Health Journal, vol. 49, no. 6, pp. 643-648.
Lawn, S. & Mcmahon, J. 2015. Experiences of care by Australians with a diagnosis of borderline personality disorder, Journal of Psychiatric and Mental Health Nursing, vol. 22, no. 7, pp. 510-521.
Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M. & Bohus, M. 2004. Borderline personality disorder, The Lancet, vol. 364, no. 9432, pp. 453-461.
Morphet, J., Innes, K., Munro, I., O’Brien, A., Gaskin, C.J., Reed, F. et al. 2012. Managing people with mental health presentations in emergency departments: A service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective, Australasian Emergency Nursing Journal, vol. 15, no. 3, pp. 148-155.
National Health and Medical Research Council. 2012. Clinical practice guidelines for the management of borderline personality disorder, Available from nhmrc.gov.au/guidelinespublications/mh25 (5 February 2019).

Authors

Kristy Acres RN, BN, ADip MNGT, ADip HR, Cert MH, Cert AOD, Honours Candidate, School of Nursing & Midwifery, University of South Australia
Mark Loughhead PhD, Lecturer: Lived Experience,* School of Nursing & Midwifery, University of South Australia * A position jointly supported by UniSA and Mind Australia Ltd.
Nicholas Procter PhD, MBA, RN, Chair, Mental Health Nursing, School of Nursing & Midwifery, University of South Australia

For more Focus stories on Mental Health head to ANMJ’s Apr-Jun issue here