The five challenges preventing young people with personality disorders from accessing quality care

The five challenges preventing young people with personality disorders from accessing quality care

6 April 2021

The five challenges preventing young people with personality disorders from accessing quality care

Many young people living with personality disorders would experience better clinical and functional outcomes if five key challenges to their access to care were addressed, Orygen researchers have said.

Professor Andrew Chanen, director of clinical programs and services and head of personality disorder research at Orygen, and Dr Katie Nicol, a research fellow with Orygen’s Helping Young People Early (HYPE) program, said overcoming these challenges could support early interventions and better outcomes for young people with mental disorders.

Professor Chanen said personality disorder was a treatable mental disorder, with adverse and severe personal, social and economic consequences. “It’s associated with a near two-decade reduction in life expectancy,” Professor Chanen said.

“In spite of this, and advances in understanding and treatment, early intervention has not delivered for the vast majority of young people experiencing personality disorder.

“A shift from niche programs in specialist services to mainstream primary care and specialist youth mental health services must take place to ensure prevention and early intervention for personality disorder in young people,” he said.

Professor Chanen and Dr Nicol, writing in the journal Current Opinion in Psychology, said the five key challenges impeding young people’s access to adequate and timely care were:

Failure of identification: Though young people with personality disorder are frequently engaged with health services, non-diagnosis or delay in diagnosis is the norm. 

Access failure: Even when identified, referrals to specialist personality disorder care are uncommon and late, with client engagement poor and treatment inconsistent.

Research translation failure: The delay between treatment innovations and their implementation in mental health services can be up to 17 years. Evidence-based therapies for personality disorder have been difficult to embed due to time commitment, staff and financial resource availability, and lack of organisational support.

Innovation failure: Psychosocial treatments for personality disorder have remained largely unchanged for 40 years. These are limited to office-based, individual or group psychotherapies that have rigid and/or restrictive entry criteria, are technically complex, and require lengthy training.

Functional recovery failure: Existing interventions have limited impact on social connectedness, employment or quality of life – the most disabling and costly aspects of personality disorder, and the most valued goal for young people and their families.  

Professor Chanen said researchers and service providers must work with young people, their families and friends to address these challenges to ensure effective innovation and implementation of early intervention for personality disorder at all levels of health systems. 

“Services must be engaging and easy to access, focusing on the needs and wants of those who utilise them, and be appropriate to the stage of illness,” he said.

“Improving the effectiveness of early intervention for a personality disorder is a matter of urgency, given the disproportionate adverse effects the COVID-19 recession will have on young people with personality disorders. 

Orygen’s HYPE research and clinical teams work collaboratively to conduct innovative, world-first research with young people experiencing personality disorder. Current projects include the trial of an antipsychotic medication for those who experience auditory verbal hallucinations (the Verbatim study), and a vocational intervention for young people who have become disengaged with employment or education (the INVEST study).