Borderline Personality Disorder

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

That this council—

1. Recognises that the first week of October each year has been declared as the Borderline Personality Disorder Awareness Week; and

2. Acknowledges that the Australian Borderline Personality Disorder Foundation, through ongoing advocacy from Ms Janne McMahon OAM, Dr Martha Kent and Associate Professor Andrew Chanen has been fundamental in promoting understanding of the disorder in the community and working towards better treatment options and quality of life for those affected by the disorder.

(Continued from 9 December 2015.)

The Hon. S.G. WADE (21:09): I rise on behalf of the Liberal team to support this motion in recognition of Borderline Personality Disorder Awareness Week and in particular the work of the Australian Borderline Personality Disorder Foundation, and I would like to acknowledge our distinguished guests in the gallery. Borderline personality disorder is the most common of all personality disorders, affecting between 1 per cent and 4 per cent of South Australians. Those experiencing BPD have extreme difficulties regulating their emotions and often experience periods of great highs and periods of intense emotional distress, impulsiveness and self-doubt.

BPD puts a lot of pressure on state agencies and service providers, such as hospitals, drug and alcohol services, ambulance services, housing services, police and correctional services. As shadow minister for health, I am aware of the pressure, for example, in our emergency departments. Emergency department dashboards show that in the past three months there have been up to 16 mental health patients waiting for a bed in emergency departments at one time across Adelaide, with at least four waiting longer than 24 hours. A number of these people would have been people who were experiencing BPD.

Improving access to BPD treatment would help avoid presentations to emergency departments by people with BPD and ease the distress on patients and the pressure on hospitals. In the past, people living with BPD have often met with misunderstanding. There is a strong need for a broader awareness of BPD, action to address the stigma surrounding BPD and greater recognition that it is a treatable mental illness.

The development of new approaches to psychotherapy and evidence-based therapies have demonstrated that people living with BPD can achieve recovery, with low relapse rates. Studies by the New South Wales Centre for Health Economics Research and Evaluation show that up to $18,000 per patient can be saved through providing proper treatment and therapy. Most of this saving relates to reduced hospital admissions and reduced pressure on emergency departments. In the light of this situation, the deafness of the government to community concerns has been very frustrating for the sector.

I am mindful of the delay in the release of the 2012 report in relation to the overview of current BPD services. Only earlier today, this house reflected on the fact that of the 24 questions asked in relation to BPD in the last four years only two have been answered. We had the confusion in relation to the social impact tender in relation to BPD services. In this context, it was pleasing to see a recent initiative which is much more positive. I refer there to the borderline personality disorder action plan work.

On 17 March 2016, the Minister for Mental Health and Substance Abuse, the Hon. Leesa Vlahos, announced that the first task of the Mental Health Commission would be to explore an action plan to assist people living with borderline personality disorder. The opposition welcomes that reference.

A consultation paper, entitled South Australian Action Plan for People Living with Borderline Personality 2017-2020, has been released for public comment. The draft paper recommends a collaborative approach on information and education, workforce development, early identification and referral, access treatment, care and support and governance and partnerships.

I appreciate that a number of members will pick up on different aspects of that report. The feedback that I am getting from stakeholders is that the plan, while it is robust in terms of policy, needs to have clarity on a number of issues and on the priorities and funding. The draft is still a consultation draft. Feedback was due by 7 September. The draft itself indicated that a final document would be released in October 2016. As soon as I read that, it flashed to me that that was a reference to Mental Health Week, but of course early October is also the period when we celebrate Borderline Personality Disorder Awareness Week.

Both those weeks came and went and the final plan has not been released. I understand that the final draft is still on the minister's desk. I share the anticipation of many in the sector looking forward to the release of the final plan. I urge the government to be clear on the plan, its priorities and its funding. People with borderline personality disorder and those who care for them have waited for too long for such a plan. It would be tragic if their expectations were being raised without foundation. I thank the Hon. Tammy Franks for moving this motion, and on behalf of the Liberal team I indicate our support for it.

The Hon. G.E. GAGO (21:15): I rise on behalf of the government to support this motion in an amended way. I moved to amend the motion as follows:

In paragraph 2: delete the word 'and' before 'Associate Professor Andrew Chanen', and insert the words 'people living with (and recovered from) borderline personality disorder and their loved ones' after 'Associate Professor Andrew Chanen'.

This amendment seeks to broaden the recognition and acknowledgement of those suffering with borderline personality disorder and their friends and families in the advocacy role they play through their life experience.

The new South Australian Mental Health Commissioner, Chris Burns, commenced in July 2016 and was asked to further explore the issues of better treatment options and improving the quality of life for people living with borderline personality disorder (BPD). BPD is a significant mental illness, where people experience difficulties in regulating emotion. Everyone struggles with their emotions from time to time, but people living with BPD experience emotions more intensely and have extreme difficulties with regulating those emotions. The National Health and Medical Research Council clinical guideline states:

BPD is a common mental illness…associated with severe and persistent impairment of psychosocial function, high risk for self-harm and suicide, a poor prognosis for co-existing mental health illness, and heavy use of healthcare resources.

This disorder causes a great deal of mental and physical anguish for those suffering from the disorder and of course their friends and families and loved ones who try to support them. The guideline continues:

International data show that the suicide rate among people with BPD is higher than that of the general population. Estimated suicide rates among people with BPD range from 3% to 10%.

The development of BPD is thought to involve a combination of biological factors, such as genetics, and experiences that happen to a person while growing up, such as trauma early in life. Over 80 per cent of people living with BPD report a history of trauma, with many also having a diagnosis of post-traumatic stress disorder. For most people living with BPD, symptoms begin to emerge during adolescence or as a young adult. Left untreated, BPD has a significant impact on the life of that individual and, as I said, their family and other loved ones.

People living with BPD have historically met with widespread misunderstanding and blatant stigma. However, evidence-based treatments have emerged over the past two decades which reveal that it is a highly treatable illness, bringing hope to those diagnosed with the disorder and to their friends and family. Due to the difficult life circumstances caused by their illness, people with this disorder often have greater contact with a number of agencies and service providers, including emergency departments, general hospitals and mental health services, drug and alcohol services, ambulance services, police, correctional services, general practitioners, NGO community services and housing services.

Therefore, the responsibility for early identification, referral, assessment, treatment and support for people living with this disorder in South Australia is shared across the community by the primary healthcare system, the public and private mental health systems, hospitals, Correctional Services, forensic services, schools and other government and non-government agencies. While I understand there has been an earlier commitment by SA Health to improve systems of mental health care for people living with BPD, long-term collaborations and partnerships are required as a foundation for building an effective statewide approach to support people living with BPD.

The SA Health Mental Health Commission has built on this work and is currently completing South Australia's first statewide Action Plan for People Living with Borderline Personality Disorder, which describes a collaborative approach to reducing the impact of living with BPD as a health priority and facilitating the integration, teamwork and goodwill needed to construct systems that are responsive to people living with this disorder.

The action plan has been developed by a project steering group chaired very capably by Ms Karyn O'Keefe, a lived experience consultant/educator who has recovered from BPD herself. This group has involved representatives from SA Health and across a number of government departments, NGOs, consumers, carers and expert clinicians. I would like to take the opportunity to commend all the participants who engaged in the planning and consultation process, which I understand included consulting with over 400 people, particularly those people living with (and recovered from) BPD.

The South Australian government is committed to working with all relevant parties to continue getting the best outcomes for people living with this disorder, and their friends and family. We support these two points but propose the amendment to point 2 to include reference to all people who have been involved in advocacy on this issue—people living with and recovered from borderline personality disorder, and their loved ones. The final motion would read:

2. Acknowledges that the Australian Borderline Personality Disorder Foundation, through ongoing advocacy from Ms Janne McMahon, OAM, Dr Martha Kent and Associate Professor Andrew Chanen, people living with (and recovered from borderline personality disorder) and their loved ones, has been fundamental in promoting understanding of the disorder in the community and working towards better treatment options and quality of life for those affected by the disorder.

The Hon. K.L. VINCENT (21:22): Dignity for Disability speaks yet again today in strong support of the Hon. Ms Tammy Franks' motion recognising Borderline Personality Disorder Awareness Week as the first week in October. Borderline personality disorder, or BPD as it is more commonly known, is a mental health condition that is experienced by an estimated 1 to 4 per cent of the South Australian population, as has been pointed out by my colleagues. Yet this state, to date, has had no plan, specialist service or cohesive strategy in place to support people with borderline personality disorder and their family carers.

Indeed, as the Hon. Ms Gago pointed out, it is important that we also recognise the families of people with BPD, some of whom have joined us in the gallery here tonight. I am very happy that the supporters have joined us in the gallery here tonight, and I am very pleased to see them. I would also like to take a moment to recognise the work of Bob Burke in particular—who I do not think is here—who has just been awarded the Dr Margaret Tobin Award for his work with Sanctuary, a support group for families impacted by BPD. Certainly, families and other support networks have a big role to play in supporting people in recovering from BPD.

The lack of action to date from this government is a complete disgrace. While the government sat idly by on its hands, many mainly young South Australians who have had a BPD diagnosis have self-harmed, have lost jobs and, in the worst possible circumstances, have even died by suicide.

On 5 October 2011, I attended the first ever BPD Awareness Day held here at the Mental Illness Fellowship of South Australia, where I met Bob Burke, who is an MC, and his wife, Judy, who together, are family carers of their daughter who has a BPD diagnosis. I also met psychiatrist Dr Martha Kent and irrepressible mental health advocate Janne McMahon.

Since that time, five years ago—although I cannot believe it has been five years—either myself or my staff has attended many BPD-related meetings and conferences and have, together with the Hon. Tammy Franks, hosted briefings for MPs and staff to help them understand the impact of BPD and, more importantly, what the impact does not necessarily have to be with the right support.

I have spoken in this place on more than a dozen occasions about BPD and the need for a better response from all levels of our healthcare system. Since then, I have also been very pleased that the Hon. Ms Franks and I have been joined by our parliamentary colleague, the Hon. Stephen Wade, and, particularly given that he is the shadow health minister, his support for this issue means a great deal, I am sure.

We have advocated on behalf of people with BPD and their families, and I have put out media releases, including some jointly with colleagues, as I have said, demanding, nay begging, the government to do something. I am relieved that finally there appears to be something happening in this space, thanks in no small part to the advocacy of people like Janne McMahon, many people living with BPD or family members who have a loved one impacted by BPD. They are all waiting patiently, or not so patiently, yet again in the gallery, hoping we are finally to see some action soon.

I commend this motion to the chamber and look forward to the Mental Health Commission and mental health minister, the Hon. Leesa Vlahos in the other place, realising a plan for people with BPD. Now we need action. Not words, but action. People living with BPD, and their families and those who love them, have been given very little, in fact nothing but words for far too long. We will be doing all that we can within Dignity for Disability to ensure that we see genuine, tangible, holistic action.

I would love to see some swift answers to those questions I asked earlier today in this place relating to the borderline personality disorder action plan, and most importantly, including whether it is envisaged that the BPD hub will be a bricks and mortar service, such as that which these amazing advocates behind me have been advocating for for a very long time, or whether it is simply to be a virtual information-sharing type service.

It is clear that a specialist service is what we need; it is what these very knowledgeable and passionate advocates have been pushing for for a very long time. Let me preface that by saying that I completely agree that in an ideal world people with BPD may well be able to get their support through the general health system. However, the fact is that we simply do not live in an ideal world and, given the maligned nature and complex nature of presentations like BPD, I firmly believe that if we can invest in people early enough to get them over the hurdle and give them that sense of purpose and connection to themselves and to others, give them that sense of identity, then maybe they can move into getting support through more mainstream services.

In the meantime, it is clear that this very much forgotten group of people requires specialist support and intervention around them, so that they can reach the point of recovery. Unfortunately, it is clear from a meeting I had with a peak medical body just a few weeks ago, that there are far too many people, including in the health sector, who still do not believe that recovery from borderline personality disorder is possible.

Well, I can tell you from the people that I have met, and these people behind me can tell you, from the lives of the people that they love, that it is possible, and that even someone who has attempted suicide no less than 14 times in their life now no longer meets the diagnostic criteria for BPD. So it is possible, but it is only possible with the right supports around us, and that includes this government having the guts and the compassion to commit resources and funding to tangible supports.

I am sure I speak for my colleagues here today when I say that we will band together and we will not forget these people. We will continue to push until we see these supports in the South Australian society and economy. Let us not forget how enormously expensive it is to have someone spend years of their life cycling in and out of emergency departments when they are living from crisis to crisis and their families are giving up work and giving up the things that give them economic and social freedom because their loved one is lurching from crisis to crisis. For the good of the South Australian community, including the economy, we will not forget those living with BPD or their families, and we will continue to fight.

The Hon. T.A. FRANKS (21:30): I rise to thank those speakers who have made a contribution today, in particular the Hon. Stephen Wade and the Hon. Kelly Vincent, who have been long-time advocates for better services and a dedicated unit, hub, whatever you want to call it—a dedicated service that actually provides both for those living with borderline personality disorders and for those caring and supporting them. I absolutely welcome the amendment by the government to this motion. I note that it is a quantum leap. It is a quantum leap not least because the motion did not seek to deny the existence of Borderline Personality Awareness Week this time.

Previously, the Weatherill government's position has actually been to oppose the recognition of the week, something that flew in the face of logic, given that it is on the federal health calendar and given that it has been nominated by the organisations involved in this area themselves. It was beyond belief that the government previously refused to acknowledge the week. I have to say, they may not have acknowledged the week itself in the past, but I welcome their acknowledgement now. It has gone from strength to strength so far without the Weatherill government, but I look forward to the Weatherill government's involvement in seeking a solution.

The other part of the amendment made by the government today which I really welcome is the inclusion of the words 'and people living with (and recovered from) borderline personality disorder and their loved ones', because this is a recognition that people can recover from borderline personality disorder, something that has been very long in the coming. Indeed, we know that in this day and age people can recover from BPD and should be recovering. They should not be facing what is a double dose of stigma.

On top of the mental health and mental illness stigma, BPD sufferers face that double dose because the condition is not well understood. We look forward to a dedicated BPD service, ensuring that there is pressure taken off the emergency departments of our hospitals and saving money, but more importantly saving lives, and not just the lives of those who suffer, but the lives of those around them who love them and support them.

We do need an action plan. I am very pleased to see a different attitude from the current minister charged with responsibility for this area. I look forward to an announcement imminently, and I note that while the mental health budget is stretched, this is something that we cannot let lie. There are health economics arguments in support of taking action sooner rather than later, so if the budget bottom line is all you care about, then focus on that.

I care about the lives lost, I care about the families who need the support, and so I would say: whatever the cost we should be doing this. However, the reality is that we will save money as we save these lives, so what argument can you possibly have against taking action and ensuring a dedicated unit or hub or service, whatever you want to call it. I do not care about the name, as long as we actually take that action that we hear is imminent.

I want to thank those who have put so much effort into getting to this stage. I welcome the government's words tonight. They are a quantum leap from previous speeches in this place. I look forward to this being very much a cross-party celebration in the future, of having made those great gains, and look forward with hope to that.

I also want to acknowledge the Margaret Tobin awards. One of the Margaret Tobin awards this year was awarded to Bob Burke for his facilitation of Sanctuary, which is known to many who have made a contribution tonight. For those of you who are not aware of that work, I am sure if you wanted to go and visit a Sanctuary meeting, those wonderful people doing so much in this space would welcome your interest and it would raise your awareness.

I will not talk too long because the hour is late, but I am heartened by the support for this motion and, indeed, that acknowledgement not only of the week itself but of the fact that people can recover. I believe there is hope and I believe we should be giving people hope, but that hope should not have to wait any longer than it already has. It has already been an inordinate amount of time.

We have women in our gaols who are there because of borderline personality disorder, we have people in emergency departments who are there because of borderline personality disorder, we have people making a reasonable go of it but who are still having a lesser life than they should have because of borderline personality disorder, and we have people who have died needlessly because of borderline personality disorder. There is something we can do, and we should get on with an action plan and actually put it into action.

Amendment carried; motion as amended carried.