Adult Borderline Center and Training Institute, McLean Hospital, Belmont, Massachusetts (Iliakis, Ilagan, Choi-Kain); Center for Addiction and Mental Health, University of Toronto, Toronto (Sonley); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain).
Psychiatr Serv. 2019 Sep 1;70(9):772-781. doi: 10.1176/appi.ps.201900073. Epub 2019 May 29.
This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide.
The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized.
The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country.
Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.
本研究旨在评估边缘型人格障碍（BPD）的治疗供给和需求，以了解全球范围内现有资源背景下的当前护理和培训标准。
通过使用公开来源和培训计划的数据，估计了 22 个国家的精神卫生专业人员和专门从事 BPD 循证治疗的精神卫生专业人员的总供给。BPD 的患病率和治疗寻求率取自大规模的国家流行病学研究。计算了寻求治疗的患者与可获得的提供者的比例，以评估当前系统是否能够满足需求。总结了培训和认证要求。
有 BPD 治疗需求的患者与精神卫生专业人员（无论其治疗 BPD 的兴趣或培训如何）的比例，在澳大利亚、荷兰和挪威约为 4:1，而在新加坡则为 192:1。寻求接受循证护理的患者与经认证的临床医生的比例，在挪威为 49:1，而在墨西哥则为 148,215:1。治疗和国家的认证要求不同。
在研究的 22 个国家中，大多数国家都存在可用于治疗 BPD 的提供者以及专门治疗 BPD 的提供者短缺的情况。在资源充足的国家，培训临床医生提供针对 BPD 的一般或简化治疗，除了专门治疗外，还可以帮助解决当前的实施差距。在人员不足的国家，必须考虑更节省资源的替代方案，即使是实施一般治疗也需要足够的人员。对实际护理分配的考虑可能会影响未来 BPD 治疗的指南和标准，而不仅仅是强化的循证心理治疗。
