Managing borderline personality disorder within the NDIS: challenges and opportunities

Objectives

This paper describes a case of borderline personality disorder (BPD) receiving National Disability Insurance Scheme (NDIS) services and managed by an Area Mental Health Services (AMHS). It aims to explore the challenges encountered and identify useful principles of shared management.

Conclusions

Mental health guidelines for BPD highlight the importance of using an explicit and integrated theoretical approach and adequate clinician training. NDIS has a strong consumer-led focus, putting individuals in charge of their own care including choosing their providers and how workers address their needs. Disability support workers are not required to have any mental health training and are not provided with supervision. Initially an escalating cycle of affective instability, crisis, reduced self-agency and increasing NDIS support was observed. The support workers were placed in a vulnerable position. Integrated care required the intervention of a state-wide service.

The provision of psychosocial support under the NDIS, especially for those with BPD, is in a process of development and an argument for more specific and specialised NDIS services can easily be made. Currently, at the very least, mental health clinicians need to consider whether more support is always better when considering the role of the NDIS in individuals with BPD.