Borderline personality disorder (BPD) is a highly stigmatised mental health diagnosis. People living with BPD can experience overwhelming psychological distress, self-harm, and suicidality. Dialectical Behaviour Therapy (DBT) is an intensive, evidenced-based treatment for BPD. It provides group and individual therapy, typically delivered face-to-face.
In Murrumbidgee Local Health District (MLHD), DBT has historically not been accessible to all of our communities. Previous programs have proved unsustainable for individual site based mental health, drug and alcohol and MyStep to Mental Wellbeing teams to provide. Traditionally, DBT is only offered from fixed locations and is only accessible to people who can travel to the location twice a week for both group and individual therapy.
Delivering group dialectical behaviour therapy via telehealth
Our innovation is a district wide, hybrid telehealth and face-to-face implementation of DBT, removing the need for the group facilitators and participants to be in the same location. By developing this hybrid model, and collaborating with clinicians across the district, we have been able to offer DBT to people who would not otherwise have been able to participate in this therapy.
While DBT is a well-established therapeutic modality, our program introduces a novel integration of telehealth for skills group training with in-person individual therapy, tailored to the unique needs of this diverse population. We have also applied telehealth to the weekly consultation group. Engaging in the DBT consultation group offers professional supervision, skill development, and case consultation, leading to decreased burnout among staff yielding a significant cost benefit by reducing turnover and enhancing overall productivity.
Therapists can reach a broader patient population without increasing travel, an efficient use of resources while maintaining a high standard of care. The use of enabling technologies promotes a sustainable service model by reducing geographic barriers and enhancing treatment accessibility. Our program represents a transformative shift in mental health service delivery, paving the way for scalable and sustainable models of care that prioritise patient-centred outcomes and equitable access to other evidence-based treatments.
Increased consumer participation and treatment adherence
We piloted this model between December 2022 and November 2023 in a collaborative research project with Hunter New England Local Health District; A pilot effectiveness – implementation study utilising telehealth to increase access to Dialectical Behaviour Therapy for consumers in rural areas diagnosed with borderline personality disorder.
Evaluation of the pilot included implementation outcomes, quantitative outcomes benchmarked at baseline and every four months for consumers and clinicians, qualitative outcomes for consumers, clinicians, and managers at three and tweleve months and economic analysis. Preliminary results are promising with qualitative data demonstrating:
- increased consumer participation
- improved treatment adherence
- strong engagement and satisfaction reported by both participants and clinicians
- better clinical outcomes and quality of life for participants
- improved job satisfaction for clinicians
- clinicians report feeling more confident and skilfull.
Data is still being analysed, however preliminary data analysis indicates a sustained reduction in suicidal and non-suicidal self-injury and improvement in patient identified problems over the course of the programme. While the sample size was small (12 participants at the two sites) statistical analysis of outcomes for the Beck Depression Inventory and the Borderline Personality Symptom Inventory show results to be non-inferior to those of DBT participants in a previous randomised control trial conducted at the specialised service.
