Borderline Personality Disorder,  DBT,  Self-Injury,  Suicide

Learning that there is a better way than self-harm

A new programme is being rolled out across the country to teach people who are severely suicidal and who repeatedly self-harm that there is a less destructive way to manage their emotional pain.

Those who repeatedly self- harm are often diagnosed with borderline personality disorder (BPD), which is characterised by difficulties in managing emotions, in suicidality and continual self-harm.

Dr Marsha Linehan, a psychologist at the University of Washington, has led a crusade to find an effective treatment approach for BPD and has been credited internationally with developing the most effective treatment to date – dialectical behaviour therapy (DBT).

Linehan spent a week in Ireland at the start of the year training health practitioners in her techniques.

For people with BDP – which is also known as emotionally unstable personality disorder or emotional intensity disorder – standard DBT cuts suicide in half, cuts emergency department visits in half and cuts inpatient admission by 73 per cent when compared with other expert non-behavioural treatments.

“Dialectical behaviour therapy – DBT – is a trans-diagnostic intervention that has varying levels of intensity depending on the person’s level of disorder,” Linehan says. “You must match the intervention to the individual’s needs, and highly suicidal individuals need the full standard treatment.”

Daniel Flynn, principal psychology manager with Cork Mental Health Services, is coordinating a national research and implementation programme for DBT. He says suicidality and self-harm are significant problems in Ireland, which has a higher incidence of male self-harm than the international average.

Suicidality and repeated self- harm account for 8 per cent of all emergency department self- harm attendances. The most common forms of deliberate self-harm in Ireland are overdosing, cutting and burning.

“We are lucky in Ireland to have such detailed data on deliberate self-harm available [through the National Registry of Deliberate Self-Harm],” Flynn says. “However, we know that the 10,000 presentations to our emergency departments nationally is not fully representative of the problem. It’s like an iceberg. Those attending the EDs [emergency departments] is what you see above the water, but there is a huge mass under the water that we don’t see – people in quiet desperation hiding their suicidality and self-harm and not learning there is another way of managing their emotional pain.”

Flynn and the National Office for Suicide Prevention are training 16 teams to deliver Linehan’s treatment.

The first DBT programme run by Flynn and his team was in the North Lee Adult Mental Health Service in Cork, an area with one of the highest rates of deliberate self-harm in Ireland.

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