Using Project Air treatment guidelines for personality disorders

Use the links below to access the key information from the guidelines and all other resources you need at the click of a button.

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Assessment 

Watch a young person speak about their experience with borderline personality disorder, diagnosis, and ongoing care.

1. Develop trust with the young person by taking their experience seriously, managing your own emotions. Be aware of transference and countertransference issues that may arise and maintain clear boundaries. See Dr. Mary Emeleus speaking about transference and countertransference in primary care.
2. Confirm the diagnosis - Diagnosis of borderline personality disorder is appropriate in young people under 18 years old if the symptoms cause significant interference with their daily functioning for at least 1 year, a diagnosis of Borderline Personality Disorder should only be made by specialist mental health professionals. If in doubt refer on or consult a specialist. More information about the evidence for assessing and treating BPD in adolescents.
3. Be aware of symptoms indicating possible borderline personality disorder. Watch a young person speak about their experience.
4. The SCID-5 can be used to guide a conversation about Borderline Personality Disorder symptoms to identify whether referral for a comprehensive assessment by an experienced mental health clinician is needed. Assess risk to self and others.
5. Assess and treat co-occurring symptoms and note that substance use is often a co-occurring issue.
6. Develop a BPD management plan including referral pathways that involve improvement of the young person’s social, occupational, interpersonal and psychological functioning. What do I do if I identify a high acute risk of suicide?
7. Never assume a young person has borderline personality disorder based on self-harm.
8. Be mindful of history-taking where trauma is present as it can be re-traumatising -be sensitive to whether obtaining details about adverse past experiences is necessary or appropriate at this point. Watch Dr Sandra Radovini speaking about taking a clinical history where trauma is suspected.
9. Where there isn’t access to an experienced mental health clinician, seek psychiatric advice (use telepsychiatry if needed)
10. Include family and friends – provide information about diagnosis and treatment pathways and if risk is identified, develop a shared safety plan. Guidelines for developing a care plan, and a template of a care plan are available in the Project Air Strategy Guidelines.

Management 

Evidence for assessing and treating BPD in adolescents

1. Psychoeducation around BPD should only be provided following a diagnosis and a diagnosis should always be supported by psychoeducation.
2. GPs have a key role in helping a young person navigate the healthcare system.
3. Where appropriate, and with consent, advise family and friends about helpful ways to interact with the young person. 
4. Develop a safety management plan with young person and review it regularly.
5. Ensure consistent messaging across care provision and check with young person when and with whom to share their BPD diagnosis (e.g. it may not be appropriate to include this information in a standard referral letter for a minor surgical procedure). Stigma by health professionals around BPD has been identified as a major issue affecting the care given to people with BPD and may need to be discussed with young person and their family.

Continuing Care

See Borderline Personality Disorder management plans.

Monitoring

Risk assessment should be undertaken at the following instances:

1. when the person first contacts a health service
2. when the person begins a course of structured psychological therapy
3. when there is a clear change in mental state
4. if the person develops another mental illness (e.g. a substance use disorder, depression or psychosis)
5. if the person’s psychosocial status changes
6. at transitions between services or discharge from a treatment plan
7. when important relationships have broken down for the young person
8. when the BPD management plan is being reviewed or altered

And should include:

1. Assessment of risk of self-harm or suicide
2. Assessment of risk-taking behaviour, including sexual behaviour
3. Assessment of risk to others
4. Risk assessment should aim to identify changes in:
   1. Patterns of suicidal or self-harm behaviours
   2. Co-occuring mental illness or substance use
   3. The person’s sources of psychosocial support
   4. The person’s mental state (identify depression, hopelessness and suicidal thoughts).
5. Safety planning – see Project Air Guidelines for working with people in crisis and conducting risk assessment
   
   

What to do if the young person is resistant to safety planning?

Watch this video and see the section on ‘Working with resistance’ on p31 of the Project Air Guidelines.

Further information about caring for people with Borderline Personality Disorder can be found in the Project Air Guidelines: Treatment Guidelines for Personality Disorders. 

For Clients 

• I want to know more about borderline personality disorder - Watch a young person share their experience
• I want to better regulate or manage my mood 
• I want to know more about getting help.
• What do I need to know about seeing a GP?
• I want to better manage my feelings of anger or get more information on anger
• I want to know more about eating better: information from headspace and Reach Out
• I want to sleep better
• I want to be more active
• I want to stop or reduce use of alcohol and or other drugs. More information is available at headspace.

For Family and Friends 

• I want to know more about borderline personality disorder. See Project Air Strategy, Your Health in Mind, Spectrum (Victoria based) and Orygen
• Watch a young person speak about their experience with borderline personality disorder.
• How will my child/friend’s borderline personality disorder impact me? Information from NEABPD
• I want to find out about recognising mental health issues in young people.
• Information about self-harm is available from headspace (Self Harm Mythbuster and Self Harm fact sheet) and ReachOut
• Information about suicide in young people is available from headspace and ReachOut
• I want more information about depression in young people
• How can I better look after myself? Self care for family