Family Systemic Approaches for Borderline Personality Disorder in Acute Adult Mental Health Care Settings

2018 ◽  
Vol 39 (2) ◽  
pp. 155-173
Author(s):  
Hyounjung Choi
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Care ◽  
Borderline Personality ◽  
Health Care Settings ◽  
Adult Mental Health

Cost of borderline personality disorder in Catalonia (Spain)

2014 ◽  
Vol 29 (8) ◽  
pp. 490-497 ◽  
Author(s):  
L. Salvador-Carulla ◽  
M. Bendeck ◽  
M. Ferrer ◽  
Ó. Andión ◽  
E. Aragonès ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Care ◽  
Addiction Treatment ◽  
Health Resources ◽  
Indirect Costs ◽  
Borderline Personality ◽  
The Cost

AbstractIntroductionThe available information on the cost of illness of Borderline Personality Disorder (BPD) is overtly insufficient for policy planning. Our aim was to estimate the costs of illness for BPD in Catalonia (Spain) for 2006.MethodsThis is a multilevel cross-design synthesis study combining a qualitative nominal approach, quantitative ‘top-down’ analysis of multiple health databases, and ‘bottom-up’ data of local surveys. Both direct and indirect costs have been estimated from a governmental and societal perspective.ResultsEstimated year-prevalence of BPD was 0.7% (41,921 cases), but only 9.6% of these cases were treated in the mental health system (4033 cases). The baseline of the total cost of BPD in Catalonia was 45.6 million €, of which 15.8 million € (34.7%) were direct costs related to mental health care. The cost distribution was 0.4% in primary care; 4% in outpatient mental health care; 4.7% in hospitalisation; 0.7% in emergency care; and 24.9% in pharmacotherapy. Additionally, the cost of drug addiction treatment for persons with BPD was 11.2%; costs associated with sheltered employment were 23.9% and those of crime and justice were 9.7%. Indirect costs – including temporary sick leave and premature death (suicide) – represented 20.5% of total costs. The average annual cost per patient was 11,308 €.ConclusionsAn under-reporting of BPD was identified by the experts in all health databases and official registries. Most of the BPD costs were not related to mental health care. Amongst the direct cost categories, pharmacotherapy had the largest proportion despite the lack of specificity for BPD. This distribution of costs reinforces the idea of BPD complexity related to an inadequate and inefficient use of health resources.

scholarly journals Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study

10.2196/13479 ◽  
2019 ◽  
Vol 7 (10) ◽  
pp. e13479 ◽  
Author(s):  
Youri PMJ Derks ◽  
Randy Klaassen ◽  
Gerben J Westerhof ◽  
Ernst T Bohlmeijer ◽  
Matthijs L Noordzij
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Care ◽  
Emotional Awareness ◽  
Borderline Personality ◽  
Average Score ◽  
Multiple User ◽  
User Groups

Background Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. Objective The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. Methods Using several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). Results The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. Conclusions mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.

scholarly journals Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study (Preprint)

2019 ◽  
Author(s):  
Youri PMJ Derks ◽  
Randy Klaassen ◽  
Gerben J Westerhof ◽  
Ernst T Bohlmeijer ◽  
Matthijs L Noordzij
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Care ◽  
Emotional Awareness ◽  
Borderline Personality ◽  
Average Score ◽  
Multiple User ◽  
User Groups

BACKGROUND Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. OBJECTIVE The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. METHODS Using several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). RESULTS The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. CONCLUSIONS mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.

scholarly journals Characteristics of Psychiatric Patient's Use of One Emergency Department and Crisis Services and Comparison of Models of Care for Patients with Borderline Personality Disorder in the Frequency of Use of Emergency Services

2019 ◽  
Author(s):  
Ramamohan Veluri ◽  
Stacey Roles ◽  
Roberta Heale ◽  
Vicky P. K. H. Nguyen ◽  
M. Elizabeth Renouf
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Emergency Department ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Urgent Care ◽  
Frequent Users ◽  
Care Services ◽  
Ed Visits

Abstract Background: The cost of urgent mental health care services is high, both to the system as well as the individual and strategies that prevent these visits are paramount. Frequent users of the emergency department (ED) are a small percentage of ED patients but account for a large percent of visits. In particular, studies show that those patients with borderline personality disorder commonly present to urgent care. Given the rising number of ED visits and the corresponding cost to the health care system, it is important to explore strategies for avoidable or preventable visits to the ED, coupled with directing resources that ensure access to appropriate quality care. Methods: This research was a prospective chart review of the population of frequent users diagnosed with psychiatric illness in the (ED) and crisis (CRI) services at one hospital. Detailed analysis revealed characteristics of the patients who presented to the ED and CRI with a mental health diagnosis. Additional analysis of the subgroup of these patients with borderline personality disorder and/or self-harming behaviour was completed to determine the impact of the model of psychiatric care on subsequent crisis or ED visits in the year after the index visit. Results: The majority of patients presenting for mental health issues did so once. The mean number of subsequent presentations to the ED was 5.00 demonstrating that a small number of patients presented many times. Male patients were trending toward significance for number of ED and CRI visits. Patients with borderline personality disorder and/or self-harming behaviours in a model of care that offered increased access to services were less likely to visit the ED and CRI. Conclusions: Unstable or complex patients with psychiatric issues often present at the ED and CRI. Accessibility to community care services has the potential to reduce the number of ED and CRI visits and is a critical factor when considering this less stable group.

scholarly journals Towards a Program Theory for Family-Focused Practice in Adult Mental Health Care Settings: An International Interview Study With Program Leaders

2021 ◽  
Vol 12 ◽  
Author(s):  
Annette Bauer ◽  
Stephanie Best ◽  
Juliette Malley ◽  
Hanna Christiansen ◽  
Melinda Goodyear ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Health Problems ◽  
Program Theory ◽  
Health Care Settings ◽  
Adult Mental Health ◽  
Family Focused Practice

Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts.Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study.Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem.Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice.

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