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Psychiatr Serv. 2019 Sep 1;70(9):772-781. doi: 10.1176/appi.ps.201900073. Epub 2019 May 29.

Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?

Author information

1
Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain).

Abstract

OBJECTIVES:

This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide.

METHODS:

The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized.

RESULTS:

The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country.

CONCLUSIONS:

Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.

KEYWORDS:

Access to care; Borderline personality disorder; Evidence-based treatments; Generalist treatments; Implementation; Training requirements

PMID:
31138059
DOI:
10.1176/appi.ps.201900073

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