Borderline personality disorder : the attitudes of mental health clinicians

According to the literature, borderline personality disorder (BPD) is often viewed negatively by mental health clinicians. The primary aim of this research was to assess the attitudes of clinicians working in mental health continuing care teams (CCTs) in Melbourne . A purpose-designed questionnaire, Attitudes to Borderline Personality Disorder Scale (BPD-APS), was used to gather demographic information from a sample of 91 participants and to assess clinicians' attitudes. Participants were from four main disciplines: 22 nurses (24%), 16 psychologists (18%), 17 social workers (19%), 12 consultant psychiatrists (13%), 11 psychiatric registrars (12%). Clinicians' discipline, years of practice, consultation and training with a specialised service (Spectrum) and level of burnout, measured by the Maslach Burnout Inventory (MBl-HSS), were all factors expected to influence clinicians' attitude towards BPD patients. Fifty-eight per cent of the participants had positive attitudes to BPD patients but a substantial proportion ( 42%) had negative attitudes. Years of experience in mental health impacted on clinicians' levels of interest in working with BPD patients but were not associated with their attitudes towards such patients. Significant statistical differences were found between the four main disciplines: psychiatrists/registrars and psychiatric nurses had more negative attitudes to patients with BPD. Social workers and clinical psychologists were more positive. Analyses indicated that clinicians (58%) experienced moderate to high levels of emotional exhaustion. Thirty eight per cent of the clinicians reported moderate to high levels of depersonalisation, while 61 per cent rated low to moderate levels of personal accomplishment on the MBl-HSS. The attitudes of the clinicians were correlated with depersonalisation but not with emotional exhaustion. Consistent with recent literature, clinicians with access to consultation and training had more positive attitudes. The findings of this study clearly indicate the need for clinicians working in mental health services to receive specific training, supervision and support for working with BPD patients.