McLean Hospital 115 Mill Street Belmont, MA 02478
Borderline personality disorder (BPD) is a complex mental illness characterized by emotional hypersensitivity and unstable behaviors that is often misdiagnosed. Some clinicians avoid patients with BPD, believing they are difficult to work with and have poor outcomes. And the most effective evidence-based treatments are highly specialized, time-consuming, and expensive; leaving them inaccessible to most patients.
This picture is changing, however, thanks in large part to an anonymous $600,000 grant to the McLean Borderline Personality Disorder Training Institute from a grateful family. The gift provides funding to train clinicians, including primary care providers, across the country to recognize and treat BPD using a straightforward, evidence-based treatment called general (a.k.a. good) psychiatric management (GPM). Free training is delivered in under-resourced areas where treatment for BPD is scant or nonexistent. The gift—structured as a challenge grant—inspired an additional $100,000 in contributions from other grateful families wanting to expand options for underserved areas.
Thus far, the institute, led by Lois W. Choi-Kain, MEd, MD, medical and program director at McLean’s Gunderson Residence, and John G. Gunderson, MD, director of the Personality and Psychosocial Research Program at McLean, has hosted popular, one-day GPM workshops in Massachusetts, Maine, New Orleans, and abroad, with many more planned. Dr. Choi-Kain’s collaborators, Drs. Karen Adler and Claire Brickell, have delivered talks on GPM to primary care physicians and to college mental health centers. Meanwhile, Dr. Gunderson teaches train-the-trainer workshops for faculty at several leading medical schools. Dr. Sara Masland, a post-doctoral research fellow, is studying the outcomes of these efforts.
Psychiatrist Dan Price, MD, residency director at Maine Medical Center, says it’s thanks to McLean’s training and ongoing mentoring that his health system has been able to open a new BPD specialty clinic. “Like other areas of the country, many of our clinicians felt unable to treat this illness, and were, frankly, reluctant to make the diagnosis,” said Price.
“Physicians feel that they lack the tools to treat BPD and have nowhere to refer patients,” he explained. “With GPM training from McLean, we can now start addressing this widespread disorder instead of pretending, or hoping, it doesn’t exist.”
GPM is based on the work of Dr. Gunderson, who is a pioneer in BPD research and treatment. Unlike specialized treatments requiring costly and lengthy trainings, GPM can be learned in a day-long workshop and effectively practiced by non-specialists including nurses, social workers, and primary care physicians.
It also departs from other gold-standard treatments, like dialectical behavioral therapy (DBT) and mentalization-based therapy (MBT), in its deceptively simple approach: clinicians teach patients about the illness—called psychoeducation—prescribe medications conservatively, and encourage patient employment. A 2009 study published in the American Journal of Psychiatry showed that GPM was as effective as DBT. Dr. Choi-Kain points out, however, that not everyone will respond to GPM and some will need to step up to more specialized treatments.
Dr. Choi-Kain hopes that she and her colleagues will do such a good job spreading GPM that eventually they’ll put McLean’s expensive specialized treatments out of business. “Our goal is ambitious,” she conceded, “to change clinicians’ minds about diagnosing this disorder and to proliferate GPM across the country as a model of BPD care delivered by generalist mental health professionals so more patients have access to care that will help them get better.”