Lecture – Examining Stepped Care in Personality Disorder Treatment

Available with English captions.

Presented by Brin Grenyer, MSc, PhD, MAPS, MAICD, Project Air Strategy for Personality Disorders – Visiting Scholar Series lecture

Many people with personality disorders seek care from emergency and inpatient mental health services. Unfortunately, these approaches often focus on helping a person in crisis. In many cases, they do not offer access to the kind of long-term, evidence-based treatment that may be more effective.

In this presentation, Grenyer explains how a “stepped care” approach may be better suited to those with borderline personality disorder and related conditions. In a stepped care system, individuals receive what is considered the most effective and efficient care at the beginning of their treatment. Depending on the seriousness or intensity of the patient’s situation, care can be “stepped up” as appropriate.

Watch now to learn more about:

  • How stepped care models fit within a whole of service approach
  • How brief intervention can play a role between acute and long-term therapy
  • Cost benefits of a whole of service approach

Drawing on recent research and his own experiences at the Project Air Strategy for Personality Disorders in Australia, Grenyer shows how a stepped care approach can improve treatment in ways that benefit the patient and the health system.

For example, he details a Project Air study that examined whether implementing a stepped care model of psychological therapy could cut demand on hospital units by people with personality disorders. A randomized controlled trial found that a stepped approach led to shorter bed stays, a reduced likelihood to seek emergency treatment, and significant health cost savings.

Studies like these, Grenyer asserts, demonstrate the promise of increased stepped care in the treatment of personality disorders. Still, Grenyer states there is a need for more research. “We need to be much better at collecting good, reliable data,” he states. “At the moment, because of the stigma of the disorder, there’s often a reluctance to tell people what their diagnosis is and to properly record it, as well.”

Grenyer calls for a greater focus on personality disorders throughout the health care community.

“We now actually have very good treatments that work, but getting access to those is one of the key challenges,” he states. “Young people are showing up with emerging personality disorders and diagnosable personality disorders, and we need to work out ways of getting them help as early as possible.”