The following guidance is based on the best available evidence. The full guideline gives details of the methods and evidence used to develop the guidance. People have the right to be involved in discussions and make informed decisions about their care, as described in your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
1.1.1 Access to services
People with borderline personality disorder should not be excluded from any health or social care service because of their diagnosis or because they have self-harmed.
Young people with a diagnosis of borderline personality disorder, or symptoms and behaviour that suggest it, should have access to the full range of treatments and services recommended in this guideline, but within CAMHS.
Ensure that people with borderline personality disorder from black and minority ethnic groups have equal access to culturally appropriate services based on clinical need.
When language is a barrier to accessing or engaging with services for people with borderline personality disorder, provide them with:
- information in their preferred language and in an accessible format
- psychological or other interventions in their preferred language
- independent interpreters.
1.1.2 Borderline personality disorder and learning disabilities
When a person with a mild learning disability presents with symptoms and behaviour that suggest borderline personality disorder, assessment and diagnosis should take place in consultation with a specialist in learning disabilities services.
When a person with a mild learning disability has a diagnosis of borderline personality disorder, they should have access to the same services as other people with borderline personality disorder.
When care planning for people with a mild learning disability and borderline personality disorder, follow the Care Programme Approach (CPA). Consider consulting a specialist in learning disabilities services when developing care plans and strategies for managing behaviour that challenges.
People with a moderate or severe learning disability should not normally be diagnosed with borderline personality disorder. If they show behaviour and symptoms that suggest borderline personality disorder, refer for assessment and treatment by a specialist in learning disabilities services.
1.1.3 Autonomy and choice
Work in partnership with people with borderline personality disorder to develop their autonomy and promote choice by:
- ensuring they remain actively involved in finding solutions to their problems, including during crises
- encouraging them to consider the different treatment options and life choices available to them, and the consequences of the choices they make.
1.1.4 Developing an optimistic and trusting relationship
When working with people with borderline personality disorder:
- explore treatment options in an atmosphere of hope and optimism, explaining that recovery is possible and attainable
- build a trusting relationship, work in an open, engaging and non-judgemental manner, and be consistent and reliable
- bear in mind when providing services that many people will have experienced rejection, abuse and trauma, and encountered stigma often associated with self-harm and borderline personality disorder.
1.1.5 Involving families or carers
Ask directly whether the person with borderline personality disorder wants their family or carers to be involved in their care, and, subject to the person’s consent and rights to confidentiality:
- encourage family or carers to be involved
- ensure that the involvement of families or carers does not lead to withdrawal of, or lack of access to, services
- inform families or carers about local support groups for families or carers, if these exist.
CAMHS professionals working with young people with borderline personality disorder should:
- balance the developing autonomy and capacity of the young person with the responsibilities of parents or carers
- be familiar with the legal framework that applies to young people, including the Mental Capacity Act, the Children Acts and the Mental Health Act.
1.1.6 Principles for assessment
When assessing a person with borderline personality disorder:
- explain clearly the process of assessment
- use non-technical language whenever possible
- explain the diagnosis and the use and meaning of the term borderline personality disorder
- offer post-assessment support, particularly if sensitive issues, such as childhood trauma, have been discussed.
1.1.7 Managing endings and supporting transitions
Anticipate that withdrawal and ending of treatments or services, and transition from one service to another, may evoke strong emotions and reactions in people with borderline personality disorder. Ensure that:
- such changes are discussed carefully beforehand with the person (and their family or carers if appropriate) and are structured and phased
- the care plan supports effective collaboration with other care providers during endings and transitions, and includes the opportunity to access services in times of crisis
- when referring a person for assessment in other services (including for psychological treatment), they are supported during the referral period and arrangements for support are agreed beforehand with them.
CAMHS and adult healthcare professionals should work collaboratively to minimise any potential negative effect of transferring young people from CAMHS to adult services. They should:
- time the transfer to suit the young person, even if it takes place after they have reached the age of 18 years
- continue treatment in CAMHS beyond 18 years if there is a realistic possibility that this may avoid the need for referral to adult mental health services.
1.1.8 Managing self-harm and attempted suicide
Follow the recommendations in ‘Self-harm‘ (NICE clinical guideline 16) to manage episodes of self-harm or attempted suicide.
1.1.9 Training, supervision and support
Mental health professionals working in secondary care services, including community-based services and teams, CAMHS and inpatient services, should be trained to diagnose borderline personality disorder, assess risk and need, and provide treatment and management in accordance with this guideline. Training should also be provided for primary care healthcare professionals who have significant involvement in the assessment and early treatment of people with borderline personality disorder. Training should be provided by specialist personality disorder teams based in mental health trusts (see recommendation 126.96.36.199).
Mental health professionals working with people with borderline personality disorder should have routine access to supervision and staff support.
© NICE (2009) Borderline personality disorder: recognition and management
Clinical guideline [CG78]. Available from whttps://www.nice.org.uk/guidance/cg78. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.