Thursday, October 11, 2012

Temporary Treatment Options for BPD

Earlier this week I was talking to someone on Twitter (whom has a great website for Borderline Personality Disorder) whom was feeling triggered, used her DBT skills and then went to Intensive Outpatient Program (IOP.)  Many people on Twitter then had questions as well as discussed some opinions to those with BPD and pro/cons of hospitalizations.  After reading a ton of research articles here are some options and pro/cons of each.  I understand those without insurance may not have many options and some depend on your area:

Inpatient:  Simply put admitting yourself into the hospital for a period of time.  First off as a counselor who has done this with clients I have run into a few problems; 1) the psychiatric unit is full 2) the client needs to be in "immediate risk of hurting themselves and others" and one time since it was self injury and not suicide they were essentially rejected at the front door.  The other issues particular to those with Borderline PD is that hospitalizations are sometimes too "cushy."  In Kiera Van Gelder's book, The Buddha and the Borderline," she explains her hospitalizations in this way, "when I climb into bed, the white hospital sheets feel as cool ans fresh as peppermint." Kiera find her hospitalizations difficult as she feels too comfortable/attached and the discharges feel like yet another rejection.  Hospitalizations also rarely provide any skills or groups specific to BPD and is mostly a quick stabilization for some people. Inpatient likely won't keep those who aren't at immediate risk for longer than a few days.

*The exception to the issue with Inpatient and BPD is that there are a few specific inpatient programs for those with Borderline Personality Disorder.  There is a thorough list here and as always if you have money you will get the best care*

Intensive Outpatient/Partitial Psychiatric Hospitalization: These programs provide more services than most inpatient programs.  For instance DBT and mindfulness groups for 3 hours a day, 3 days a week is a typical format for BPD-specific IOP programs.  There are more programs that are available for BPD here and because it's short (read: cheaper) insurance is more likely to cover it.  In Buddha and the Borderline, Kiera talks about MAP, a mood and anxiety program utilizing Cognitive Behavioral Therapy (MAP), she attends everyday from 7:30am-4pm.  The group at her clinic includes "cognitive behavioral skills, assertive communication skills, depression and anxiety, behavioral scheduling, relapse prevention, impulse control. There is also stress management, self-assessment, mood regulation, positive events scheduling, family issues, life transition, community meetings, treatment planning and contract writing." This is a less comfortable options, plus as a counselor I like the idea of how "real world" sleeping in your own bed, and continuing to handle your life, albeit part-time. It is harder to get attached to this kind of program and it focuses on long-term goals rather than temporary medication management and nightly fever checks from nurses. IOP can vary from a week to a few months.

Respite: This option is the lowest intensity of all and not available everywhere.  Respite is known as the place where caregivers for elderly or children with physical or mental health issues essentially go to "get a break." When I worked in Portland, Oregon there was a respite in some of the larger counties for mental health issues.  Essentially mental health respites are typically in large houses where 6-10 clients live temporarily, it's a toss up if you share a room or not (think low-end bed and breakfast) but it is always same-sex rooms.  There is typically a shared space like a living room/sitting area where people chat, read and watch TV.  There is typically one case manager and sometimes (often depending on who is working) there might be a group a day, there is an open space and people can leave during the day, but need to return by curfew.  The residents are typically de-escalating from a mental health issue and are looking to relax for a bit.  I had a client tell me she liked respite because they made her peppermint tea when she couldn't sleep.  From the respites I know they do not specialize in BPD or do any skills group- but it might be a good place if you need some "head space" to think, figure things out and a safe place to be.  Respite stays vary but typically 3-7 days and include meals.

As always the first goal of any intensive treatment is safety, and if you are thinking of hurting yourself or someone else go immediately to the hospital to get well.  The above options are for non-life threatening situations only.

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