Supporting young people with Borderline Personality Disorder: Sarah Maxwell’s Story
Published: 5 Apr 2019
Psychiatrist Sarah Maxwell travelled to Australia in 2016 to research treatment for young people with Borderline Personality Disorder. Her findings have influenced the development of a programme that will help young people with Borderline Personality Disorder to be identified and treated earlier.
Borderline Personality Disorder (BPD) is a severe mental disorder which first presents in adolescence or young adulthood. It affects 1-3% of the UK population. It has a negative impact on how an individual thinks about themselves, others and the world, and is characterised by unstable relationships, self-image and mood, as well as impulsive behaviour which often leads to risk-taking and self-injury.
Sarah has worked in the NHS since 2005 and during this time she has seen how difficult it can be for young people to access services and treatment when they are presenting with the early features of BPD. This is a big problem because if BPD is not recognised and treated early, the long-term consequences can be profound. People who suffer from it may be debilitated by its symptoms for the rest of their lives, and in many cases die young, while a high burden of care is often placed on families.
In 2016, Sarah travelled to Australia on a Churchill Fellowship to observe a specialist service called HYPE (Helping Young People Early) developed by ORYGEN Youth Health, a world-leading youth mental health programme based in Melbourne. HYPE’s services are specifically targeted at assessing, diagnosing and treating BPD early.
Sarah was particularly impressed by the rigorous assessments provided by HYPE to determine whether a young person has BPD, or whether the symptoms can be explained by a different condition such as depression. Once it has been determined that someone has BPD, the HYPE team are then able to rapidly offer appropriate treatment.
Following her return to the UK, Sarah helped to develop a more thorough assessment process for young people at Norfolk NHS’ Youth Service, where she works. The process uses many of the features of HYPE’s model.
While this was a welcome step, Sarah felt that to more effectively tackle the onset of BPD in young people, such complex, resource-intensive treatment in specialist settings should be replaced by briefer interventions that can be delivered by non-specialists in accessible settings familiar to the recipients, such as schools and colleges.
“Schools and colleges play an important role in the emotional health and wellbeing of young people and are well placed to identify those with mental health problems. However, these institutions do not receive adequate support to meet young people’s needs, even though education staff regularly report that they would like to be able to use mental health interventions to support students.” – Sarah Maxwell
Sarah and her team have now been awarded £350,000 from the National Institute for Health Research to run a pilot project that will see non-specialist staff within colleges and schools deliver a programme of mental health support for young people. The programme, called Brief Education Supported Treatment for BPD (BEST), will include interventions modelled on HYPE’s treatments.
BEST is now up and running. It will involve training staff from around eight schools and colleges in Norfolk to work with mental health professionals to deliver a treatment package to more than 60 teenagers. Sarah hopes the programme will help staff at schools and colleges to feel confident in spotting the early signs of BPD and to offer support that may ultimately reduce the symptoms of BPD.
Sarah credits her Fellowship with boosting her confidence and equipping her to push for improvements in support for young people with BPD. It enabled her to make connections with field-leading experts, overseas and in the UK, whose insights will benefit the development of BEST.