None listed
Conditions
Brief summary
Mentalization based therapy (MBT) is a psychological treatment to develop a person’s capacity to focus their attention on, and understand thoughts and emotions, and to help with more accurate interpretation of their and other people’s behaviour, and in turn improve interaction with other people. This study’s aim is to determine whether taking a MBT approach in conjunction with a recovery-based model of care (‘Strengths’ model: a model of care that emphasizes and supports a person’s potential for recovery) is of benefit to patients of St Vincent’s Mental Health (SVMH) who have a history of recurrent, self-harm and who suffer with Borderline Personality Disorder. The benefits that will be looked for include whether there are reduced episodes of significant self-harm (that is requiring consultation by a medical practitioner) and suicidal behaviour in participants of the study and also, whether there are reduced presentations to/attendances at the Emergency Department or psychiatric inpatient admissions and the impact on the length of any admission to a psychiatric inpatient unit . In addition, there will be assessment of participants day to day psychological functioning based on questionnaires completed by participants as well as assessment by the study’s investigators. Participating case managers working at SVMH will use the MBT approach in patients under their care and with their patient’s consent, and at a frequency determined by the case manager in consultation and agreement with the patient according to their mental state and level of distress or stress. Any discordance between the case manager and patient regarding the frequency of contact will be respectfully discussed and considered by the case manager in the context of the professional relationship. This could involve several meetings per week at times of crisis. The treatment would be focused on helping the patient reinstate a mentalizing approach during crises. Telephone contacts would be employed and active follow-up occur if participants (patients) were not able to attend appointments. The frequency of contacts and meetings will be recorded. A crisis plan (that is a mutually agreed approach between case manager and patient regarding how the patient (participant) would cope during a time of significant distress or stress) would be developed by the patient and the case manager. Participating case managers using the MBT approach will be supervised fortnightly by a MBT trained therapist. The training for case managers using the MBT approach would be two half days training by SPECTRUM (Victorian statewide personality disorders service) staff prior to study commencement. There would be an additional two hour training for participating case managers, two months into the study. Participating case managers will also be invited to attend a focus group, 3 monthly for a duration of 12 months, discussing their experience of using a MBT approach in combination with the ‘Strengths’ model of care; these focus groups will be de-identified in terms of individual, patient details, to preserve their confidentiality and privacy.
Interventions
This is a proof of concept study to determine whether a mentalization-based intervention in a metropolitan community mental health service, when added to a recovery-based model of care (Strengths model) is of clinical benefit to patients at St Vincent’s Mental Health with a history of recurrent, deliberate self-harm who meet DSM-IV criteria for BPD and at least 8 of the DIB-R rating scale criteria for BPD. The hypothesised clinical benefits are reduced episodes of significant self-harm and suici
This is a proof of concept study to determine whether a mentalization-based intervention in a metropolitan community mental health service, when added to a recovery-based model of care (Strengths model) is of clinical benefit to patients at St Vincent’s Mental Health with a history of recurrent, deliberate self-harm who meet DSM-IV criteria for BPD and at least 8 of the DIB-R rating scale criteria for BPD. The hypothesised clinical benefits are reduced episodes of significant self-harm and suicidal behaviour and reduced acute presentations to the Emergency Department, acute psychiatric inpatient admissions and length of inpatient stay, in tandem with improved subjective and objective functioning over a 12 month period. This study will be conducted with collaborative support and training in MBT from senior SPECTRUM (Victorian Statewide Personality Disorders Service) clinicians. Mentalization-based therapy (MBT), is a psychological treatment for Borderline Personality Disorder (BPD) , whose aim is to develop a person’s capacity to focus attention on and understand thoughts and emotions, to help with more accurate interpretation of their and others’ behaviour, and in turn improve interpersonal functioning Case managers using the MBT approach would see their patients at a frequency determined by the case manager in consultation and agreement with the patient according to their mental state and level of distress or stress. Any discordance between the case manager and patient regarding the frequency of contact will be respectfully discussed and considered by the case manager in the context of the professional relationship. This could involve several meetings per week at times of crisis. The treatment would be focussed on helping the patient reinstate mentalizing during crises. Telephone contacts would be employed and active follow-up occur if patients failed to attend appointments. The frequency of contact and meetings will be recorded. A crisis plan would be developed by the patient and the case manager. Case managers employing the MBT approach would be supervised fortnightly by a MBT trained therapist. The training for case managers employing MBT would be two half days training by SPECTRUM staff prior to study commencement. There would be an additional two hour training module, two months into the study. The total, additional time commitment of 40 hours for case managers will be 26 hours of supervision, 10 hours of training, and up to 4 hours in focus groups over the 12 month duration of the study. The case managers’ attendance in these study-related activities will be back-filled by duty and, or additional staff.
Sponsors
St Vincent's Mental Health
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to 64 Years
Healthy volunteers
No
Inclusion criteria
i) For Patients: Patients with likely/established BPD, irrespective of Axis I comorbidity. Recurrent deliberate self-harm. i) For Case managers: Employed at St Vincent’s Mental Health . Currently providing care and case management to patients of St Vincent’s Mental Health who are suffering with likely/established BPD, irrespective of Axis I comorbidity.
Exclusion criteria
i) For patients: Do not suffer with likely/established BPD.. Currently being treated with MBT. ii) For case managers: Not currently providing care and case management to patients of St Vincent’s Mental Health who are suffering with likely/established BPD.
Outcome results
None listed