Mental health experts call for specialised training for emergency first responders on borderline personality disorder

Mental health experts call for specialised training for emergency first responders on borderline personality disorder
  • PublishedOctober 6, 2023

The 33-year-old peer support worker from Perth recalled she would have intense emotional swings, often swamped by outburst of distress, sometimes with suicidal ideation.

During this time, Carissa often interacted with mental health emergency first responders: triple zero and mental health hotline callers, police, paramedics, and staff at the emergency department.

But often, instead of finding them helpful, Carissa would feel more devastated.

A young woman looking at the camera, holding arms.
Carissa Wright, who’s gone through the recovery of Borderline Personality Disorder, wants to see more compassionate support for people from emergency first responders. (Supplied: Emelia Peet )

On one occasion, Carissa was advised by the police officers who conducted a welfare check on her, to “drink a glass of water and go home” when she was having an episode of BPD and psychosis in a local park, and was mentally “in a suicidal space”.

“I don’t think all the first responders were like awful people or anything,” says Carissa. “I just think the system is designed to not always cater for the need and care that an unregulated person might need.

“I just know from my own experience, I feel quite suffocated.”

The WA Police told the ABC that a mental health co-response team would be deployed to a scene that has been triaged as requiring mental health support.

Like Carissa, many people living with BPD often find themselves unable to receive the exact support they need from emergency and healthcare services when they are triggered.

In 2019, 20-year-old Kobee Huddy, who lived with BPD, called a mental health hotline in South Australia as he had ideation of self harm, four hours before he was fatally shot by the police.

A coronial inquest was held to investigate the incident, and the counsel assisting said the call operator from the mental health hotline could not be held responsible for Kobee’s later interactions with police.

However, psychologists and advocates are now calling for more funding and specialised training for emergency first responders on the mental disorder, as stigma continues to prevent people with BPD from accessing appropriate emergency care.

‘People desperately seek help’

BPD is the most common personality disorder in Australia, with government data showing one to four of every 100 Australians experience BPD at some stage in their life.

It’s common in young women — its symptoms usually appear in teenage years and early adulthood, and more women are diagnosed with BPD than men.

People with BPD also face high risks of self harm and suicides. Research in 2020 has found that 181 out of 2,870 suicides in Victoria between 2009 and 2013 had a record with BPD diagnosis — that’s 6.8 per cent of the total suicide cases.

It also found almost all these cases had contacted emergency and mental health services within 12 months of death, and 88 per cent of them reached out to the services within six weeks of death.

Professor Sathya Rao in suits smiles at camera.
Professor Sathya Rao says the intensive emotions that people with BPD experience may push them to use self-harm as coping mechanism. (Supplied)

Professor Sathya Rao is the executive clinical director at Spectrum, a Victoria-based mental health organisation specialised in BPD and complex trauma.

“People with borderline personality disorder tend to experience a lot of emotional crises, and when they’re in crisis, they may feel suicidal, they may hurt themselves, or they might take an overdose,” he said.

BPD is curable through long-term psychological therapeutic treatments such as Dialectical Behaviour Therapy which help people with BPD master skills of emotional control.

But the duration for recovery varies between individuals, and it’s still possible that people experience intense episodes during this period.

However, there are limited resources and access to treatments to support people with BPD to go through the episodes, meaning they have to turn to emergency services to keep themselves safe, according to Professor Rao.

“These people [with BPD] are desperately trying to get some help. They literally stand on the rooftop and say ‘help me’,” he said.

Being seen as ‘bad’ person, rather than being ill

A survey by SANE Australia in 2019 shows BPD was the most common personality disorder seen by mental health professionals, with 97.3 per cent of them having worked with someone with BPD at least once in their life.

Despite the strong demand for professional mental health care, a large amount of research in the past two decades have found people with BPD constantly face stigma from the very people they desperately seek help from.

One common stigma is that some healthcare professionals consider people with BPD as “bad”, while they see people with other mental illness diagnoses as being “ill”.

And for many young people living with BPD, including Natasha Swingler, the stigma against BPD makes them hesitant to call emergency services, even if they are at risk of life.

Natasha, diagnosed with BPD at 17, described her experience with first responders and emergency services in her early 20s “traumatising” and awful”.

Natasha Swingler headshot
Natasha Swingler has lived with BPD from a young age.(Supplied:  RCVMHS)

“[There is a stigma that] once you’ve got a BPD diagnosis, you must be inherently manipulative or attention seeking,” she said. “Those messages really hit home in those emergency department environments.

“You’re given this notion that everyone else here [in the emergency departments] needs to be here, whereas yours is your own fault.”

Rita Brown, president of the Australian BPD Foundation, says while she notices a growing awareness of BPD in Australian healthcare settings, stigma is still a major issue that the BPD community has to tackle.

“We still certainly hear of too many occasions where people are being denied appropriate and compassionate treatment, even for medical concerns,” Brown said.

She is worried the continuous stigmatisation will prevent people with BPD from actively seeking treatment and support “because they know that they’re just going to be turned away from a service”.

Training for first responders can save life

The issues of inappropriate care by first responders and emergency services also extends beyond the BPD community.

In 2022, a research by Melbourne-based mental health organisation Orygen found the healthcare system is “failing to meet the needs of people who present to the emergency department following self-harm”.

It states many patients find their experience with emergency departments “lacking in compassion and empathy”, and feel they are blamed for being “time wasters”.

If you or anyone you know needs help:

And when it comes to BPD, the healthcare workforce’s lack of relevant knowledge and skills can lead to underestimation of the seriousness of the patient’s condition and inappropriate treatments, according to Professor Rao.

He says it’s time for the healthcare workforce and emergency services to learn more about what is BPD and how to assess and mitigate its risks. 

“These are people who have very painful psychological conditions,” Professor Rao said.

“They’re not choosing to be like this. In fact, they desperately want to seek help and be different and heal.”

An infographic from BPD Awareness Week.
The BPD Awareness Week from October 1 to 7 this year focuses on making a difference in care for people with BPD. (Supplied: BPD Awareness Week )

Both Natasha and Carissa want to see more resources made available outside emergency services for people with BPD.

After going through a 12-month intensive programs on Dialectical Behaviour Therapy funded by Western Australian Mental Health Commission (WAMHC), Carissa says she has farewelled the dark days full of suicidal ideation.

“That was a big game changer for me,” she said.

In a statement, the WAMHC says it provides about $1.1 billion to mental health services across Western Australia, including funding to five public health service providers.

“These health service providers use this funding to deliver a range of mental health services, which may include a Dialectical Behaviour Therapy program outlined in the Statewide Model of Care,” it said.

A spokesperson at the federal health department said it is state and territory governments’ responsibility for training first responders, including the delivery of specialised training for mental health emergency first responders.

“In addition, the Commonwealth and states have committed through the National Mental Healthand Suicide Prevention Agreement (National Agreement), to work together to reduce stigma and discrimination for people affected by mental ill-health,” she said.


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