Assessing the efficacy of a stepped care treatment program for Borderline Personality Disorder

INTERVENTION: The intervention is a stepped care group treatment program. Following diagnostic assessment confirming trial eligibility, all participants will receive three sessions of individual treatment to plan care and reinforce safety. These consultations will be provided as 1 ‐ 2,, 1 hour sessions per week facilitated by a mental health worker, e.g. psychologist, registered nurse, or social worker. Participants will then be randomised to either stepped care group treatment or tailored individual treatment. The stepped care group treatment will involve two phases: an initial 12 week phase, followed by an extended 16 week phase. Not all participants will proceed from the initial to the extended phase. Criteria for continuing to the extended phase is continuing to meet diagnostic criteria for BPD (> 4 criteria) or severity on GAF < 65 at completion of the initial phase. The group intervention is a skills training (GST) program. The first phase of group treatment will involve 12 consecutive weekly, 2 hour sessions. The second phase of group treatment will provide 1 x 2 hour sessions for 16 consecutive weeks. The groups will be facilitated by 2 psychologists. The GST program is a skills based therapy that includes four modules: mindfulness (focusing on the 'here and now'), crisis coping skills, skills in how to identify and manage emotions and skills for improving interpersonal communication and relationship building. CONDITION: Borderline Personality Disorder PRIMARY OUTCOME: Change in duration of admissions collected through data linkage to medical records Change in number of presentations to the emergency department collected through data linkage to medical records. ; Severity of BPD assessed by number of criteria meet of the structured Clinical Interview for DSM‐5 Disorders for Personality Disorders (SCID‐5‐PD). SECONDARY OUTCOME: Change in overall functioning measured by the Global Assessment of Functioning (GAF). INCLUSION CRITERIA: Formal diagnosis of Borderline Personality Disorder