Accessing psychological treatment

It may be very challenging to access psychological treatment for borderline personality disorder in the mental health system. Wait times and costs can vary, and it is common for most people to try more than one clinician in order to find the person who feels like the best fit for them.

It can be helpful to have someone to support us during this process. This could be our general practitioner (GP), a supportive friend or family member, a community support worker, an area mental health clinician, or just someone who can support us in the way we need.

To access psychological treatment through the public health system (services covered by Medicare), you can make an appointment with a general practitioner (GP) or primary care provider and ask them to help you access mental health care as a public patient. They can arrange for you to receive a Mental Health Care Plan, which allows you to claim a rebate for a set number of sessions with a mental health professional every 12 months. The GP can also write a referral for you to consult with a mental health clinician, such as a social worker, psychologist or psychiatrist.

A person is considered a 'public patient' when they aren’t using private health insurance to pay for services.

To access psychological treatment through the private health system, you would typically have private health insurance, which partly covers the costs of accessing private mental health services and clinicians. If you have private health insurance or can afford to pay the costs associated with private providers, you can ask your GP for a referral to a private mental health clinic, as well as a private mental health clinician.

Psychologists:

Psychologists are experts in human behaviour and mental processes. Many psychologists are trained in various types of psychotherapy. Psychologist services in the community can be funded by Medicare but sometimes there is an additional 'gap' charge to the service user. A psychologist providing treatment for borderline personality disorder (BPD) should be skilled in a type of psychotherapy that has been shown to be effective for people living with BPD. Usually psychologists providing psychotherapy will be endorsed by the Australian Psychological Society (APS), College of Clinical Psychologists, or College of Counselling Psychologists. Most psychologists require you to provide them with a referral from a GP. Psychologists are listed on the Australian Psychological Society website.

Psychiatrists:

Psychiatrists are medical doctors who have trained as medical specialists in mental health practice. They specialise in diagnosing and treating people with mental health conditions, including the prescribing of medications used for such treatment. Psychiatrist services in the community are funded by Medicare but sometimes there is an additional 'gap' charge to the patient. A psychiatrist who is providing treatment for BPD should be skilled in a type of psychotherapy that has been shown to be effective for supporting people living with BPD. All fully qualified psychiatrists in Australia are members of the Royal Australia New Zealand College of Psychiatrists (RANZCP) and are listed on the RANZCP’s website (find a psychiatrist). A list of psychiatrists is also available on the Your Health in Mind website. Most psychiatrists will accept referrals from a GP.

Credentialed Mental Health Nurses:

Credentialed Mental Health Nurses (CMHN) are registered nurses who have completed an accreditation process with the College of Mental Health Nurses that ensures they have advanced expertise in treating mental health conditions. They are listed on the Australian College of Mental Health Nurses website. CMHN most often work as part of a GP or private psychiatrist practice with their role funded by Medicare. There is usually no gap charge for a credentialed mental health nurse employed within a GP or private psychiatrist practice. A CMHN who is providing treatment for people living with BPD should be skilled in a type of psychotherapy that has been shown to be effective for people living with BPD.

Nurse Practitioners:

Nurse Practitioners (NPs) suited to working with people living with BPD are advanced nurses who are specially qualified and registered in Australia to provide an expanded scope of practice in mental health. Mental health NP services in the community are funded by Medicare but sometimes there is an additional 'gap' charge to the service user. Similar to a GP or psychiatrist, a mental health NP is able to diagnose and provide treatment for people living with mental health conditions, including prescribing medications used for such treatment. A mental health NP who is providing treatment for people living with BPD should be skilled in a type of psychotherapy that has been shown to be effective for a BPD diagnosis. NP can receive referrals from a GP or a psychiatrist.

Accredited Mental Health Social Workers:

Usually a social worker who is providing treatment for people living with BPD will be an Accredited Mental Health Social Worker who has been assessed by Australian Association of Social Workers (AASW) as having specialist mental health expertise. Accredited mental health social worker services in the community are funded by Medicare but sometimes there is an additional 'gap' charge to the service user. An Accredited Mental Health Social Worker who is providing treatment for people living with BPD should be skilled using a type of psychotherapy that has been shown to be effective for a BPD diagnosis. Most Accredited Mental Health Social Workers require a referral from a GP.

Mental Health Endorsed Occupational Therapists:

Usually an occupational therapist (OT) who is providing treatment for BPD will be a Mental Health Endorsed OT who has been assessed by Occupational Therapy Australia as having specialist mental health expertise. Mental health endorsed OT services in the community are funded by Medicare but sometimes there is an additional 'gap' charge to the service user. A mental health endorsed OT who is providing treatment for BPD should be skilled using a type of occupational therapy practice that aligns well to psychotherapeutic approaches shown to be effective for people with BPD. Most OT’s require a referral from a GP.

Finding a therapist that feels right for you can be a challenging process, however there are various resources to support navigating through this process. The various professions listed above all have their own professional bodies and directories for locating their members. These are:

• Royal Australian College of Psychiatrists (RANZCP)

• Australian Psychological Society (APS)

• Australian College of Mental Health Nurses (ACMHS)

• Australian Association of Social Workers (AASW)

• Occupational Therapy Australia (OTA).

In relation to the professional therapists described above, the Australian Health Practitioner Regulation Agency (AHPRA) registers all doctors (including psychiatrists), nurses (including nurse practitioners), occupational therapists, and psychologists (but not social workers at this stage). The AHPRA website allows you to check that your doctor, nurse, occupational therapist or psychologist is currently registered to practise in Australia.

We recognise that it is very common for us to try a few different practitioners until we find one that feels best for us, and at the time that is right for us too.

Finding a therapist you feel comfortable with is important. It is very common for people to meet with a number of different therapists before finding one that feels like the best fit. The therapeutic relationship between us and our therapist is very important — therapy will be the most helpful if we have a good relationship with the therapist.

We’ve had a think about what we consider 'green flags' when looking for a good therapist. A good therapist will be skilled in:

• validation, compassion, and empathy

• curiosity and using a ‘not knowing’ stance (open-minded)

• acceptance

• change oriented approaches

• trauma sensitive care

• collaboration and cooperation

• recovery oriented, person centred, strengths based care

• being non-judgmental

• being an actively engaged clinician

• focusing on emotions and experiences

• focussing on the therapeutic relationship

• having a clear and structured treatment framework

• focussing on personal recovery, and 

• working with the person’s individuality and identity