Borderline Personality Disorder,  DBT,  Emotions,  Suicide,  Treatment

A system that fails troubled teens

Teens whose multiple diagnoses meant that her see-saw emotions were extremely challenging to treat, especially in a mental health system that is over-burdened and difficult for desperate families to navigate.

A system that fails troubled teens

From Friday’s Globe and Mail – with correction
Published Thursday, Jun. 27 2013, 9:00 PM EDT
Last updated Thursday, Jul. 04 2013, 10:09 AM EDT

Katherine Duff is 16. She comes from a close-knit Toronto family. She has a part-time-job and gets straight As. She loves poetry, watching movies with her younger sister, and going out with friends for dinner or to the mall. She adores animals, especially dogs. And she wants desperately to go to university and become a lawyer. Like her dad.


But for two years, Katherine was locked in a downward spiral of angry, self-destructive thoughts. She heard voices. She cut herself (she has multiple scars on her arms and legs). Diagnosed as bipolar with borderline personality disorder (BPD), she tried twice in the past year to take her own life, both times overdosing on Seroquel, one of six anti-psychotic drugs she takes to regulate violent mood swings. On good days – which for a while were rare – she went to school, worked at a doggy daycare, and baked cupcakes with her mom. On bad days, she shut herself off from society, curled up in bed weeping.

Last winter, Katherine’s parents, Cameron and Doris Duff, never left her side. They locked away knives and carefully meted out her medications. And they tried to get their middle child the help she desperately needed, taking her to mental health clinics such as Ontario Shores and Toronto’s Oolagen Mental Health Centre and Hincks-Dellcrest Centre for Children and Families. They saw child psychiatrists. They admitted Katherine four times to Sunnybrook’s outpatient adolescent centre, where she stayed a week to 10 days at a time. When she’d return home, the vicious cycle would start all over again.

Katherine is one of many Canadian teens whose multiple diagnoses meant that her see-saw emotions were extremely challenging to treat, especially in a mental health system that is over-burdened and difficult for desperate families to navigate.

“The underlying stress of not knowing, day to day, if she’s going to be alive, is terrifying,” Doris Duff says, her daughter at her side. “It’s been hard on our marriage. It’s been hard on her older brother and sister. We just wanted to make sure she sees her next birthday.”

Like others with children who have complex mental health needs, the Duffs have been on a heart-wrenching journey: long waits for services, shortages of child psychiatrists and a total lack of the kind of intense, residential treatment facilities Katherine needed.

After her second suicide attempt last February, the Duffs followed the advice of a psychologist at Hincks-Dellcrest and admitted her to McLean Hospital outside Boston, at a cost of more than $70,000 (it was not covered by OHIP). The Harvard-affiliated institution offers a treatment called dialectical behaviour therapy, or DBT. Incredibly, she has been home more than a month now, and Mr. Duff, his voice shaking with relief, says she is “doing amazing these days. It’s like she’s a different kid.”

DBT psychotherapy for teens has been getting increasingly good reviews in the United States and Europe, where the therapy, supported by Buddhist meditative techniques, is more widespread. Mr. Duff says many psychologists here have not even heard of the treatment, which University of Washington psychology researcher Marsha Linehan developed to help people with borderline personality disorder by combining cognitive behavioural therapy techniques and concepts of stress tolerance and mindful awareness. It trains the mind to think differently so that patients can learn to cope with strong emotions, explains Joanna Henderson, a scientist at the Centre for Addiction and Mental Health’s child, youth and family program in Toronto.

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