Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events
Background: Mental health crises experienced by people with personality disorder often necessitate emergency service involvement. Ambulance services are frequently first responders. Acute crisis presentations of people experiencing personality disorder can be a source of anxiety and frustration for...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-04-01
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| Series: | Journal of Affective Disorders Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666915325000125 |
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| author | JH Broadbear RP Ogeil M McGrath DS Scott Z Nehme F Moayeri D Lubman S Rao |
| author_facet | JH Broadbear RP Ogeil M McGrath DS Scott Z Nehme F Moayeri D Lubman S Rao |
| author_sort | JH Broadbear |
| collection | DOAJ |
| description | Background: Mental health crises experienced by people with personality disorder often necessitate emergency service involvement. Ambulance services are frequently first responders. Acute crisis presentations of people experiencing personality disorder can be a source of anxiety and frustration for emergency workers, especially when they recur frequently. This study evaluated the utilisation of ambulance services for mental health, alcohol and other drug, and suicide-related events in association with personality disorder, to understand how system responses can be improved. Methods: We conducted a retrospective study of coded electronic patient care records from the Victorian-arm of the National Ambulance Surveillance System between January 2012 and May 2019. Records where ‘borderline personality disorder’ or ‘other personality disorders’ was noted were assessed using patient demographics, presentation, outcome, and re-presentation frequency, in comparison with attendances for ‘other mental health conditions’. Results: 76,929 attendances for 9,632 people with borderline and/or other personality disorder were identified. Most presentations involved suicide attempts, suicidal ideation, non-suicidal self-injury, and drug and alcohol harms. Most attendances (87.9%) were transported to emergency departments. Re-attendance was common; 8.3% of people accounted for 49.6% of all attendances involving personality disorder. Limitations: The study data likely underrepresent the prevalence of personality disorder in ambulance attendances, as a diagnosis was noted by paramedics only if it was considered relevant to the attendance and volunteered at the scene. Conclusions: Two-thirds of service users noted to have personality disorder required ambulance services three or more times per year, highlighting the need for evidence-based alternatives to reduce the incidence of mental health crises and reliance on emergency services. These findings are a valuable reminder to emergency clinicians that they are primarily seeing service users who have the most severe presentations, and may serve as a bulwark against therapeutic nihilism. |
| format | Article |
| id | doaj-art-e284dc75367f424ea2f9eef56c6d3e85 |
| institution | Kabale University |
| issn | 2666-9153 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Affective Disorders Reports |
| spelling | doaj-art-e284dc75367f424ea2f9eef56c6d3e852025-02-06T05:12:58ZengElsevierJournal of Affective Disorders Reports2666-91532025-04-0120100882Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related eventsJH Broadbear0RP Ogeil1M McGrath2DS Scott3Z Nehme4F Moayeri5D Lubman6S Rao7Spectrum Personality Disorder and Complex Trauma Service, 110 Church St, Richmond, Australia; Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia; Corresponding author at: Spectrum Personality Disorder and Complex Trauma Service, 110 Church St, Richmond, Australia.Turning Point Drug and Alcohol Service, 110 Church St, Richmond, Australia; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, AustraliaTurning Point Drug and Alcohol Service, 110 Church St, Richmond, Australia; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, AustraliaTurning Point Drug and Alcohol Service, 110 Church St, Richmond, Australia; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, AustraliaEastern Health Clinical School, Monash University, Clayton, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, AustraliaTurning Point Drug and Alcohol Service, 110 Church St, Richmond, Australia; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, AustraliaTurning Point Drug and Alcohol Service, 110 Church St, Richmond, Australia; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, AustraliaSpectrum Personality Disorder and Complex Trauma Service, 110 Church St, Richmond, Australia; School of Clinical Sciences, Monash University, Clayton, Victoria, AustraliaBackground: Mental health crises experienced by people with personality disorder often necessitate emergency service involvement. Ambulance services are frequently first responders. Acute crisis presentations of people experiencing personality disorder can be a source of anxiety and frustration for emergency workers, especially when they recur frequently. This study evaluated the utilisation of ambulance services for mental health, alcohol and other drug, and suicide-related events in association with personality disorder, to understand how system responses can be improved. Methods: We conducted a retrospective study of coded electronic patient care records from the Victorian-arm of the National Ambulance Surveillance System between January 2012 and May 2019. Records where ‘borderline personality disorder’ or ‘other personality disorders’ was noted were assessed using patient demographics, presentation, outcome, and re-presentation frequency, in comparison with attendances for ‘other mental health conditions’. Results: 76,929 attendances for 9,632 people with borderline and/or other personality disorder were identified. Most presentations involved suicide attempts, suicidal ideation, non-suicidal self-injury, and drug and alcohol harms. Most attendances (87.9%) were transported to emergency departments. Re-attendance was common; 8.3% of people accounted for 49.6% of all attendances involving personality disorder. Limitations: The study data likely underrepresent the prevalence of personality disorder in ambulance attendances, as a diagnosis was noted by paramedics only if it was considered relevant to the attendance and volunteered at the scene. Conclusions: Two-thirds of service users noted to have personality disorder required ambulance services three or more times per year, highlighting the need for evidence-based alternatives to reduce the incidence of mental health crises and reliance on emergency services. These findings are a valuable reminder to emergency clinicians that they are primarily seeing service users who have the most severe presentations, and may serve as a bulwark against therapeutic nihilism.http://www.sciencedirect.com/science/article/pii/S2666915325000125Personality disorderMental health crisisEmergency responseAmbulance presentations |
| spellingShingle | JH Broadbear RP Ogeil M McGrath DS Scott Z Nehme F Moayeri D Lubman S Rao Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events Journal of Affective Disorders Reports Personality disorder Mental health crisis Emergency response Ambulance presentations |
| title | Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events |
| title_full | Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events |
| title_fullStr | Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events |
| title_full_unstemmed | Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events |
| title_short | Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events |
| title_sort | ambulance attendances involving personality disorder investigation of crisis driven re attendances for mental health alcohol and other drug and suicide related events |
| topic | Personality disorder Mental health crisis Emergency response Ambulance presentations |
| url | http://www.sciencedirect.com/science/article/pii/S2666915325000125 |
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