Objective To define a comprehensive model of care that improves accessibility of treatments across primary, private and public mental health care sectors for people with borderline personality disorder (BPD) in Australia. Methods This Model describes a staged/tiered approach utilising brief, short- and long-term psychological treatments in individual or group therapy settings. These treatments utilise generalist (common factors) and specialist approaches, enhancing the capacity of healthcare providers to offer care, thereby improving access to appropriate evidence-based psychological treatments. Findings People experiencing milder symptoms of BPD may benefit from brief treatments employing a generalist psychotherapy approach. People with moderate to severe BPD may benefit from generalist/specialist approaches within the private and public sectors. People experiencing complex and high-risk BPD may require longer-term specialist psychotherapy and multidisciplinary care. Treatment type and duration should be tailored to the person’s presentation and needs, with clear pathways for escalation of care when required. Conclusions This model of care proposes that psychological treatment be delivered at a level and within a timeframe appropriate to each person’s needs and proximal to where they live. A Core Competency Framework, based on evidence-based common factors psychological treatment, can facilitate delivery of these services in a holistic, equitable, and streamlined manner.
Queensland has recently allowed general practitioners (GPs) to diagnose and manage adult attention deficit hyperactivity disorder (ADHD), aiming to relieve pressure on specialist services. However, adult ADHD assessment is complex and requires multi-session evaluation, collateral information and differential diagnosis. Most GPs report limited time and training, and Medicare rebates favour brief over comprehensive consultations, making it difficult to deliver this level of care. As a result, the reforms may work paradoxically, increasing misdiagnosis risk and placing further strain on services. This viewpoint outlines these risks and proposes ways to implement reforms that enable guideline-level GP ADHD care.
Objective To explore the views of South Australian psychiatrists regarding rational suicide, their views and experiences of voluntary assisted dying (VAD) and their reported willingness in discussing end-of-life issues with patients and expressing their views regarding VAD with their colleagues. Method An online qualitative survey was designed, piloted and sent via email to all members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in South Australia and responses were subject to qualitative content analysis. Results A range of views were identified, from agreement with the concept of rational suicide and support for VAD citing respect for autonomy and dignity, through to misunderstanding of the psychiatrist’s role, ambivalence and a rejection of VAD, grounded in discomfort in assisting death. Not all those in support of the legislation were willing to be involved in the VAD process and some only wanted very limited involvement. Conclusions This study highlights that psychiatrists do not have equal understanding of South Australian VAD legislation. We recommend that a learning module for psychiatrists be designed and delivered by the RANZCP.
