A Randomized-Controlled Trial of Mentalization-Based Treatment Compared With Structured Case Management for Borderline Personality Disorder in a Mainstream Public Health Service.

Dave Carlyle,Richard Porter,Marie Crowe,Roger Mulder,Maree Inder,Chris Frampton,Robert Green

doi:10.3389/fpsyt.2020.561916

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Open Access

https://doi.org/10.3389/fpsyt.2020.561916

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Abstract

Background: Treatment of borderline personality disorder (BPD) in publicly funded mental health services generally use approaches based on medical interventions and generic case management. Specific psychological therapies developed for BPD may be more effective but have rarely been evaluated in routine clinical practice.Aim: To examine the effectiveness of Mentalization Based Treatment (MBT) in adults with an established diagnosis of BPD under the care of a publicly funded Mental Health Service (MHS), on rates of non-suicidal self-harm (NSSH) and attempted suicide (SA).Methods: A randomized, controlled trial (RCT) comparing 18 months of MBT with Enhanced Therapeutic Case Management (ETCM), a form of Structured Clinical Case Management (ICTRP: ACTRN12612000951853). Participants were adults recruited from a patient population under the care of a publicly funded mental health service (MHS) with a confirmed diagnosis of BPD. The primary outcome measures were the incidence of non-suicidal self-harm or suicide attempt over 18 months of treatment.Results: 72 participants (71 females, 1 male) were randomized to MBT (n = 38) or ETCM (n = 34). Both groups showed a significant reduction in the overall incident rate of SA and NSSH. Between groups, SA rates were higher in the MBT group and conversely NSSH rates were higher in the ECTM group.Conclusions: The introduction of a structured service that delivered a structured psychotherapy (MBT) and an effective case management approach (ETCM) both resulted in a reduction in SA and NSSH. The differences in improvements found between groups within this study setting will require further research.

Highlights

borderline personality disorder (BPD) is a serious disorder affecting 1–2% of the general population, up to 10% of psychiatric outpatients and 20% of in-patients [1]
Evidence suggests that Dialectical Behavior Therapy, Mentalization-Based Treatment, Transference-Focussed Therapy and SchemaFocussed Therapy are effective in reducing BPD symptoms including self-mutilation, suicide attempts, anxiety and depression, hospitalization and impaired social functioning [5, 6]
Ninety-three outpatients of the community mental health service, with a possible diagnosis of BPD were identified for screening for inclusion

Summary

Introduction

BPD is a serious disorder affecting 1–2% of the general population, up to 10% of psychiatric outpatients and 20% of in-patients [1]. Non-suicidal self-harm is a feature which is distressing to patients and their families, results in significant morbidity and has high costs to the health service [4]. A widening range of treatment approaches demonstrate efficacy in addressing key features of the disorder (selfharm, suicidality, high service use, etc.). Evidence suggests that Dialectical Behavior Therapy, Mentalization-Based Treatment, Transference-Focussed Therapy and SchemaFocussed Therapy are effective in reducing BPD symptoms including self-mutilation, suicide attempts, anxiety and depression, hospitalization and impaired social functioning [5, 6]. Well-structured clinical care that is sympathetic to the unique interpersonal problems of people with BPD (MBT and DBT) has been shown to be effective in reducing symptom distress [7, 8]. Treatment of borderline personality disorder (BPD) in publicly funded mental health services generally use approaches based on medical interventions and generic case management. Specific psychological therapies developed for BPD may be more effective but have rarely been evaluated in routine clinical practice

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