Borderline Personality Disorder 1

Wednesday November 19, 2014

Adjourned debate on motion of Hon. T.A. Franks:

That this council notes that—

1. At any one point in time, between 1 and 4 per cent of the general population experiences borderline personality disorder;

2. This illness can be characterised by overwhelming emotions, relationship problems, impulsive and risk-taking behaviour and a fragile sense of self;

3. A history of trauma, abuse or deprivation is common among those with the illness;

4. Despite its prevalence, enormous public health costs and devastating toll on individuals and families, recovery from borderline personality disorder is possible;

5. Borderline personality disorder is a leading cause of suicide, with an estimated 10 per cent of individuals with this diagnosis taking their own lives;

6. An increased understanding of borderline personality disorder is required among health professionals and the general public by promoting education, research, funding, early detection and effective treatments; and

7. With the aim of promoting understanding of the illness in the community and working towards better treatment options and quality of life for those affected by the disorder in South Australia, Ms Janne McMahon OAM, Dr Martha Kent, Professor Andrew Chanen and the Australian Borderline Personality Disorder Foundation request the South Australian Legislative Council to acknowledge the first week of October each year as Borderline Personality Disorder Awareness Week and a statewide specialised borderline personality disorder service (unit) for South Australia be established.

(Continued from 15 October 2014.)

The Hon. J.M. GAZZOLA ( 17:44 :21 ): In giving the government's response to the Hon.  Ms  Franks' motion regarding borderline personality disorder, I move the following amendment:

Leave out paragraph 5 .

L eave out paragraph 7, and insert—

7. The state government supports the proposal to increase the awareness of borderline personality disorder. However, this should be built into existing Mental Health Week activities. The government will also be exploring ways for improving networking of South Australian borderline personality disorder experts.

In regard to paragraph 5 of the motion, borderline personality disorder is a serious mental disorder with significant morbidity and mortality. It has been estimated that between 3 and 10 per cent of persons with BPD take their own lives (Clinical Practice Guidelines for the Management of Borderline Personality Disorder—National Health and Medical Research Council—2012). Suicide has complex social, cultural and health components. The assertion that BPD is a leading cause of suicide is not evidence-based and should be deleted.

In the past, BPD has struggled to find acceptability, respect and compassion within the arena of mental health. Historically, this has been due in part to limited effective treatment options. Now that a range of psychological therapies has been demonstrated to be effective for borderline personality disorder, the situation has radically changed. The Borderline Personality Disorder Work Group was established in June 2010 by the statewide Mental Health Clinical Network to obtain reliable information regarding the current status of borderline personality disorder service provision within the public mental health service and to make recommendations to SA Health regarding a workable, multidimensional, statewide service delivery model for patients with borderline personality disorder in South Australia.

A report was produced by the statewide Mental Health Clinical Network titled 'Borderline personality disorder: an overview of current delivery of borderline personality disorder services in the public service across South Australia and a proposed way forward' (the report) which describes the current service delivery to consumers with a diagnosis of borderline personality disorder within the state mental health system, along with the impact on their families and carers.

The statewide strategic mental health committee has considered the report and the feedback from public consultation which ran from June 2014 to July 2014, and is working with the statewide Mental Health Clinical Network on next steps. The report offers a way forward to build on current service provision, taking into consideration the key components of a future service model based on the NHMRC's clinical practice guidelines and international best practice guidelines.

The Australian government National Health and Medical Research Council's 'Clinical practice guidelines for the management of borderline personality disorder', released in March 2013, examined the efficacy of specialised services for people with borderline personality disorder. It was determined that '…there was insufficient evidence to formulate evidence-based recommendations on the role of specialised BPD services'.

SA Health will be exploring ways for improving networking of South Australian borderline personality disorder experts but, at this stage, will not embark on establishing a specialised borderline personality disorder service. Opportunities exist to build on existing pathways by including early intervention strategies, training, supervision and support around non-dialectical behavioural therapies.

Policy development identifying borderline personality disorder as core business and enhanced services providing coordinated care will ensure a reduction in the stigma associated with this diagnosis for both consumers and their families. It will also assist in the reduction of the number of adverse outcomes for this consumer group, with direct savings to public health services through a decline in hospital presentations.

In addition, all South Australian mental health services are able to support people experiencing the symptoms of serious mental illness, including borderline personality disorder, through the SA Health Mental Health Services Pathways to Care policy directive. This directive ensures that, wherever a person presents to public mental health services, their symptoms and issues, not simply their diagnoses, are addressed and appropriate support is provided. I urge honourable members to support the government's amendments.

The Hon. J.A. DARLEY ( 17:49 :34 ): I rise to indicate my support for this motion and to commend the Hon. Tammy Franks and the Hon. Kelly Vincent for their work in this space. I note that in a recent letter to the Editor, published in The Advertiser , Dr Michelle Atchison flagged the support of the South Australian Branch of the Royal Australian and New Zealand College of Psychiatrists. In that letter she stated:

The college welcomes Kelly Vincent's comments on the importance of a dedicated mental health service for persons living with the difficulties brought about by borderline personality disorder. A dedicated service, with a group of experts who can deliver timely care, is strongly supported. We will be discussing this with the Minister of Health, Jack Snelling, in the coming weeks to support the proposed plan for a specific service for the patient group.


I have also received correspondence from other stakeholders working in this area strongly in support of the motion, including Ms Janne McMahon, OAM, mental health consumer advocate. According to Ms McMahon, people with BPD experience the worst prejudice, discrimination and stigma than do others with mental illness. This appears in the main to be as a result of a lack of recognition of BPD as a mental disorder, and as such people with the diagnosis are actively excluded from the mental health system.

Because admission to psychiatric care or mental health services is often refused, general practitioners who lack the appropriate skills and training are left to manage patients with BPD. It also impacts on our emergency departments and generally our health system as a whole. My limited understanding of this disorder is that self harm, including suicide attempts, is also very common amongst those people suffering from it.

According to Ms McMahon, in Adelaide alone there have been five BPD-related deaths known of over the last 12 months. It is also estimated that one-third of young people who die by suicide have the diagnosis or traits of BPD. The fact that we do not have a state-wide policy dealing with the issues and needs of people with borderline personality disorder is something that needs urgent attention, particularly given the alarming suicide rate that is attributable to this disorder.

In supporting this motion I urge the government, and the Minister for Health in particular, to carefully consider the devastating effect that this disorder is having on our community, and to work with advocacy and stakeholder groups on this very important issue.

The Hon. S.G. WADE ( 17:52 :15 ): I rise to speak on this motion to indicate the Liberal Party's support for it. Also, up front I indicate that the Liberal Party will not support the government's amendment on two grounds: first, on my understanding the government's objection to clause 5 is that the suggested prevalence of 10 per cent is not evidence based. My recollection is that the SA Health work group, the borderline personality work group, does quote studies that show that the rate of completed suicide and people with BPD has been estimated to be approximately 10 per cent, and on that basis we are happy for clause 5 to stand. In relation to the proposed amendment to clause 7, we always read this motion as being focused on a statewide borderline personality service rather than the issue of the week, so in that regard we certainly prefer the original clause 7 than the proposed alternative.

In supporting the motion, the Liberal Party commends the Hon. Kelly Vincent and the Hon. Tammy Franks for bringing the motion to the council. According to parliamentary procedure one motion can only have one mover, but the two honourable members have formed a tag team on this issue, and a formidable team at that. The motion is structured in three parts, as I see it: first, the motion recognises the impact of the illness; secondly, the motion highlights a lack of understanding of the illness, even amongst service providers; and, thirdly, the motion highlights the need for a service.

Given the shortness of time and the fact that other honourable members want to make a contribution, I will not take the opportunity to highlight all the issues as I had intended to do, but I am duty bound to indicate to the council that I have received a large number of contacts from members of the public conveying their personal stories of living with borderline personality disorder, either personally or with a member of their family or someone they care for. I thank them for their courage in telling their story. That is a powerful contribution to raising awareness and it certainly has been helpful to me and other members of the Liberal Party in considering the need for a service.

I found it interesting that the shared experience was that the services generally do not understand borderline personality disorders and do not properly engage with the disorder. The SA Health Borderline Personality Work Group chaired by Dr Martha Kent and Dr Prue McEvoy referred to that misunderstanding in the following terms:

[BPD] is a serious mental disorder with significant morbidity and mortality, but has struggled to find acceptability, respect and compassion within the arena of mental health. Historically this has been due in part to limited effective treatment options. Now that a range of psychological therapies [have] been demonstrated to be effective for BPD, the situation is radically changed.

And their report goes on. Thirdly, the motion addresses the need for a service and I believe the SA Health Borderline Personality Work Group very comprehensively goes through a range of issues. Their conclusion is quite clear:

The preferred model is a statewide specialist BPD service that has an educational and service development focus with a highly specialised clinical component. A statewide specialist BPD service such as this would coordinate services and would significantly improve staff morale and patient flow through acute services.

The Liberal team looks to the experiences of the Victorian jurisdiction and what has been learnt from the work of the work group and the feedback we have had from consumers and those who care for them, and we are persuaded of the need for a statewide service. We hope that the government, having had the foresight to establish that working group, will now follow through on its conclusions.

The Hon. R.L. BROKENSHIRE ( 17:56 :50 ): I will be brief so that this can go through before six. Family First strongly supports this. We commend the Hon. Tammy Franks and the Hon. Kelly Vincent. We thank the huge number of people who sent detailed, sad and tragic emails to us. It needs to be supported and, with that, I just say, let's get on with it, let's make it statewide and let's see some action.

The Hon. T.A. FRANKS ( 17:57 :17 ): I rise to close this debate. While the time is growing short, I note that the majority of the members of this council are in support of this motion and we will debate it until its end. I rise on behalf of both myself and the Hon. Kelly Vincent of Dignity for Disability. As co-movers of this motion, parliamentary procedure does not allow her to also make concluding remarks, so I read her words for this council and for those who have a keen interest in this area. Ms Vincent notes:

[I speak today] as co-mover of this motion, as a passionate advocate for people with borderline personality disorder and the family and friends who care for them. Since I first became aware of this mental health issue more than three years ago, I have repeatedly asked questions of this health minister and his predecessor calling on improved services to support people with BPD and, in particular, the establishment of a specialist mental health service for people with borderline personality disorders, their family carers, and professionals who work with them.

This week is the one-year anniversary of the death of a young Adelaide woman with a borderline personality disorder diagnosis. She took her own life after our health system dismally failed her. A woman, younger than me, died last year because we, the South Australian community, could not provide adequate support and treatment through our health system. This death, like every suicide, leaves a trail of carnage, of depression, of sadness , of despair through the family and friends who surround that person. It is tragic and it should not happen.

Reports at both state and commonwealth level have recommended changes to the way we support people with borderline personality disorders in both the clinical and community settings. The state government, the mental health minister, have paid no heed. It is not good enough. Dignity for Disability is tired of reports being written and ignored. Promises of 'we'll look into this, we'll investigate that, we might do this' are not acceptable.

Let' s say you have no humanity and it worries you not a bit about this tragic loss of life and the wasted years that occur when people with borderline personality disorder are not given adequate treatment through our health system. Well, let's look at the economic argument—this is just one case study.

This male, with a BPD diagnosis, presented 97 times to the Emergency Department before he had received Dialectical Behaviour Therapy, or DBT. He had a history of self-har m, alcohol a nd substance abuse, physical health problems and lacked suitable accommodation. After receiving D B T (and I remind the chamber that there are long waiting lists for DBT programs), he was reunited with his family and moved into independent accommodation. He had no self-harming behaviour for 18 months and no presentation to EDs for two years. The cost saving to our health system by this man not presenting to EDs is $82,450.

Given BPD has a prevalence of 1 to 4 per cent of our population, and this group ha s among the highest level of unmet need, it is not hard to explain how an investment of $1.4 million in a SPECTRUM style [resource service] could result in savings of $100 million per year to our health and mental health budget bottom line.

It is time for parliament and this government to take action—we don't wan t to hear weasel words and empt y promises—we want a funded, resourced statewide specialist unit for Borderline Personality Disor d e r . Lives are being lost, families are under enormous stress, and we are not doing our job as a community to provide support to people with mental illness. It is time to get on with it.

Dignity for Disability commend the motion to the chamber.

The PRESIDENT: Any further—

The Hon. T.A. FRANKS: I have further comments, Mr President. I now speak on behalf of the Greens and sum up this debate. I thank those speakers who made a contribution, particularly the Hon. Kelly Vincent, who cosponsored this motion with me, and indeed the Hon. Stephen Wade, the Hon. Robert Brokenshire, the Hon. John Darley, and the Hon. John Gazzola, whose speech, I think did not do him justice. I suspect it was written by a West Wing wannabe rather than by somebody who had actually gone and done the research.

For a start, I indicate that the Greens will oppose the government amendment to this motion. I point out to the government that this motion we debate today is, in essence, the exact same motion that the federal Senate passed, with a few slight wording changes. In that place, it was cosponsored by the Labor senator for Queensland, Jan McLucas, and the Greens senator for South Australia, Penny Wright.

Clearly, the federal and state Labor parliamentary position on this issue seems to be different. I point to their particular concern about their recommendation that instead of recognising Borderline Personality Disorder Awareness Week in the first week of October, as was done in the federal motion and as is done in the health calendar—the federal calendar on health events—they suggest that perhaps this issue should be hidden within Mental Health Week in the following week, totally missing the point that this has actually been declared by the appropriate organisations and recognised at a federal level as the appropriate week.

It does not want to be subsumed within Mental Health Week. The whole idea of having an awareness-raising week is to raise awareness. Lumping it in with another week does it no justice and shows that this government's contribution was not well researched. The government also baulks at the statistics around suicide. If they have quibbles around the wording—and I suspect their quibbles are around the term 'leading cause of suicide'—they should have spoken to us about that. If they want to redefine a motion and insert their own words, those words should be done in consultation, not just with the members of this council but of course with the communities they purport to serve.

Given they did not even know that this was their own motion at a federal level, given they do not even know the health calendar date for Borderline Personality Disorder Awareness Week is already set for the first week of October (as we are simply recognising here), given they had not paid heed to the annual report of the Australian BPD Foundation and seem to have very little awareness of the recommendations of that foundation, I suggest they go away and read up. When Borderline Personality Disorder Awareness Week occurs in the first week of October next year, they are invited, as members of parliament, to Borderline Personality Disorder Awareness Week.

I do hope they attend those events. Perhaps they will not be doing it as the state Labor Party representatives. They will have to come as a conscience vote because, of course, their party does not support that week, but I hope they raise their own awareness and, in turn, that of their party. With those few words I commend this motion to the council.

Amendment negatived; motion carried.

Sitting suspended from 18:05 to 19:45 .


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