Borderline Personality Disorder

The Hon. T.A. FRANKS (16:25): I move:

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.

I note that this motion was seconded by the Hon. Ms Vincent. The Hon. Ms Vincent and I are actually moving this motion together today, and we were hoping to get the support of all members of this council, but certainly I am moving this motion in conjunction with the Hon. Ms Vincent. We move this motion to draw the attention of not only this parliament but also this government to borderline personality disorder. Many of us would have heard the term but may not have a deeper understanding of what that term means.

It is a term that was first proposed in the 1930s to describe a group of people who—and I quote Adolph Stern of the United States in 1938—'fit frankly neither into the psychotic nor into the psychoneurotic group' and thus bordered on other conditions. The term was certainly one that was a recognition of this illness, and understanding of this illness has progressed over time.

Not only those who have this illness but also their loved ones and families do really struggle. The Hon. Kelly Vincent has dubbed this particular illness the 'Cinderella' of mental health labels, if you like. As we know, labels are for jars, not people, but certainly the Cinderella of borderline personality is waiting to come to the ball and we hope that this motion will ensure that borderline personality disorder is treated with the seriousness that it deserves.

People who have borderline personality disorder conditions really suffer a double stigma: there is the stigma of having a mental illness and then there is the stigma, even with the mental health professionals, of having a condition that is called borderline personality disorder. We know from Senate report after Senate report that this is an area where not only is there a great deal of work that needs to be done but there is hope. There is hope, not only for a recovery—a hope which in previous decades was thought to be an impossible hope, but indeed with dialectical behaviour therapy we know that people who have borderline personality disorder can actually recover and can get better.

We also know that this is a condition where those people who suffer that double stigma—the double whammy of being stigmatised not only by the general community but even by the mental health professionals who they have to deal with—can have a win-win. We know that the way this illness manifests itself leads to people unnecessarily coming into contact with emergency departments, and emergency departments are probably the last place that people should be in this state, particularly when they are having quite severe incidences of their illness.

We know that the state government has been looking into this issue, and a report was finally released that was prepared and presented in June 2014, and I draw members' attention to that report. It is called Borderline personality disorder: an overview of current delivery of borderline personality disorder services in the public sector across South Australia and a proposed way forward. That is what we are here to discuss with this motion today: a proposed way forward.

In response to that report (which I note took some time to surface into the public realm, and that was quite disappointing for all concerned), I absolutely commend the work of Dr Martha Kent and also those who have lobbied us long and hard about this issue to get this report out into the public, and now let us get that proposed way forward actually moving forward, not just in the way that Julia Gillard in her campaign for prime ministership used that term but in the way that we are all working together on this.

One of the key recommendations in that state government report is for a statewide specialist BPD service to promote preventive approaches and focus specifically on early development and attachment disorder in at-risk groups as well as early intervention services for early and late teenage clients. It was also the case that we need effective treatment pathways from primary care, emergency and rural and remote, as well as drug and alcohol settings.

As I say, this has been the subject of several Senate inquiries, and there is another document that I would like to draw members' attention to, and that is the financial argument for the establishment of a statewide specialised borderline personal disorder service in South Australia. It is based on the strengths of the Spectrum personality disorder service in Victoria but, certainly, with a relevance to South Australia and tailored to South Australian needs.

That particular report points to the fact that in our South Australian population there are likely to be in the order of 84,000 to 336,000 people who are ultimately affected in some way because of a diagnosis of BPD. That is an estimate of some small number of those directly affected but with the extrapolation for those families and loved ones and others who are around those with that deep diagnosis. That is some 20 per cent of the South Australian population.

The report argues, and quite rightly so, that for an investment of something a little over $1 million a year we could actually see significant savings, most evidently through the alleviation of pressures on our emergency departments but, obviously, as we know in this place and we have come to learn in 2014, early intervention is certainly better than allowing a situation to get to the stage where you need acute intervention.

It is as simple as a stitch in time saves nine. It is as simple as an apple a day keeps the doctor at bay. It is as simple as you do not put the ambulance at the bottom of the cliff: you put a fence at the top of the cliff with a sign. You do some community education and you help people before it gets to a situation where they have jumped and they need that acute care.

In one case alone, and this is a case that has taken place in South Australia, we have seen one particular consumer who had had 97 emergency department presentations in the 12 months prior to his engaging in dialectical behavioural therapy. He had had multiple physical health problems, he had sabotaged his medical treatments, he lacked suitable accommodation, he had lost his friends and his family because of his behaviours, and he had lost his possessions due to his behaviours as well.

He had had alcohol abuse in his life from the age of 13 and he had had substance abuse with amphetamines, THC and heroin, and so on, from those teen years. He had been self harming since the age of 18, and he actually had not had any contact with his family for many years. He had a forensic history and had been assessed as being in persistent danger of harming himself. In 2006, case management was recommended for him as a consumer. However, not a single worker in the South Australian mental health services was willing to manage him.

After DBT he has continued to abstain from alcohol and other substances, he has reunited with his family, he has moved out of supported accommodation and into independent housing, he has not self-harmed for approximately 18 months and has had no suicide ideation either. He has had zero presentations to the emergency department for approximately two years.

This case study shows that recovery is possible, that hope is possible, and that with a small investment we could see not only lives changed and lives saved but, of course, that budget bottom line. The cost of reductions in this case study are based solely on emergency department bed days and that would be an estimated cost of on average $850 per day. With 97 bed days that would be some $82,450 in one single year that we would save by that small investment in not only this person's future but in our community's future.

We know that he now has a life worth living, a life that is not in chaos, and that that particular course of treatment has allowed him to engage fully. Indeed, he is even now talking about going on to study computer science, he is living in rented accommodation, and he has very much moved along that path to recovery.

That man's story could be replicated across the board for those in our community who suffer from borderline personality disorder, for those who love and support them, and for those who they have lost. This motion before us today hopes to draw attention to the issues around borderline personality disorder, and certainly we hope that we can work across this parliament, across party divides, to see a service unit in this state, along the lines of what currently exists in Victoria with the Spectrum unit, a reality by next year.

Next year we hope that this Legislative Council will have recognised, as is called for in this motion, Borderline Personality Disorder Awareness Week, and wouldn't it be fantastic if we could be standing, not just Kelly Vincent and myself, as part of the Mental Health Week celebrations and commemorations and we could all be commemorating and seeing the opening of a service for Borderline Personality Awareness Week next October 2015. That is also something that is not just a dream; that is possible. This parliament can make it happen.

The Hon. K.L. VINCENT (16:37): I speak today as the seconder and co-mover of this motion. As a passionate advocate not only for the content of this motion but mental health and mental health awareness more broadly, I want to start by acknowledging that I am in a privileged position to be able to be here in this chamber talking about Mental Health Awareness Week and talking about World Mental Health Day which we have just had, but for many people, especially those with a stigmatised disorder like borderline personality disorder, every day is Mental Health Awareness Day and every week is Mental Health Awareness Week.

Every day people with borderline personality disorder (BPD) face the discrimination, the stigma, the trauma and pain of borderline personality disorder, so I am very proud to move this motion, together with the Hon. Tammy Franks. Dignity for Disability has been working on this issue for quite some time. It is very pleasing to be joined by a parliamentary colleague and, hopefully, as the Hon. Ms Franks alluded, more and more colleagues as time goes on.

As my honourable colleague, the Hon. Tammy Franks, has said, borderline personality disorder has been ignored, sidelined and kept on the borders for far too long. It is, as I believe the wonderful Dr Martha Kent labelled it, the Cinderella of mental illness, and it is time that South Australia provided appropriate services for people with this particular mental illness. Certainly it is arguable that the name of the condition does not help. The fact that it is called borderline personality disorder often seems to imply to people that it is something that you almost have, or that you are on the borderline of having.

For years it has also been seen as the mental illness that is too hard to treat. People with BPD are often presenting at emergency departments with varying health issues that they then find to be ignored, mistreated, stigmatised and put down on the basis that the person has a diagnosis of borderline personality disorder and, therefore, can sometimes exhibit symptoms that do not manifest physically or that the patient is somehow otherwise considered untrustworthy, or even crazy.

Needless to say this does not help people who already feel misunderstood, ignored, rejected, dejected, hurt and mistreated by those around them, by society more generally and by the family members and even the friends who do try to help them. Like those with what could arguably be called other invisible disabilities such as stoma, fibromyalgia, chronic fatigue, HIV/AIDS, chronic pain, acquired brain injury, or other psychiatric disabilities or illnesses, accepting that someone has BPD and that this is a reality for them and one that needs support and treatment has proved a challenge for our community, our health system and even for our mental health services.

We used to have a day service at the Glenside campus of the Royal Adelaide Hospital here in South Australia called The Willows. This provided services to people with borderline personality disorder but, unfortunately, tragically, this service was closed back in the mid-90s. Nothing replaced this day service. We have dialectic behavioural therapy, or DBT, that is highly regarded as an effective treatment for people with borderline personality disorder. However, there are significant waiting lists for this treatment, and services for people with BPD in rural and regional areas of our state are virtually non-existent.

I attended the first ever national Borderline Personality Disorder Awareness Day at the Mental Illness Fellowship of South Australia in Wayville, back in October 2011. Since that time, I have become increasingly aware of just how much suffering due to lack of appropriate support and services there is for people living with BPD and their friends and families in the South Australian community.

Sadly I have seen young members of our community with a BPD diagnosis commit suicide. They were in contact with both public and private South Australian mental health services but that did not prevent these tragic deaths. Young lives lost. Dignity for Disability has asked questions without notice of both the previous and current health ministers about BPD and we are yet to receive a single answer to any question on this matter. I have been asking these questions for the past three years. I have also delivered a matters of interest speech on BPD and the response I receive is always from people with a BPD diagnosis and their family carers, thanking me for raising this ignored mental illness with the government.

I want to take the time to thank them as well for the information that they have shared with me that has allowed me and now my parliamentary colleague, the Hon. Tammy Franks, to continue this important fight. As this motion states, 1 to 4 four per cent of South Australians are experiencing borderline personality disorder at any one time but, as Ms Franks suggested, the numbers are actually greater than that when we consider the severe suffering and loss of family connection that family members and friends of people with a borderline personality disorder diagnosis can also experience.

It is high time and it is past time and we are obliged to acknowledge this and establish a specialised specific borderline personality disorder support and treatment service in this state, similar to the one in Victoria known as Spectrum. We have the model, the economic and societal savings have been proven, and we in South Australia are running out of time to meet our long-ignored obligation to people living and suffering every day with the stigma and mistreatment of borderline personality disorder in our communities. It is time to accept that, while borderline personality disorder can be life changing, and there is no doubt of that, it does not have to be a life sentence. I commend this motion to the chamber.

Debate adjourned on motion of Hon. G.A. Kandelaars.