Ambulance attendances involving personality disorder

Spectrum’s Research Centre, in collaboration with Turning Point’s National Addiction and Mental Health Surveillance Unit (NAMHSU), has published an investigation into ambulance attendances for Victorians who experience personality disorder. 

For an estimated 6.5% of the community, personality disorder-related psychological distress may precipitate mental health crises. This is a prominent clinical feature of borderline personality disorder. This distress may result in suicidality and self-harming behaviours, including drug overdose.

First responders, including paramedics, are not mental health experts. Mental health-related crisis presentations may be a source of anxiety and frustration, particularly during frequent ambulance re-attendances. We investigated the utilization of Victorian ambulance services that involved of personality disorder. These were for presentations related to mental health, drug & alcohol harms, suicidality and self-harm.

Victorian paramedic records from 2012 to 2019 were extracted from the National Ambulance Surveillance System (NASS).

• There were 76,929 ambulance attendances for 9,632 people with borderline and/or other personality disorder (4.1% of the total).
• 8.3% (798 service users; 20+ attendances each) accounted for half of these ambulance call-outs, requiring ambulance services on 38,167 occasions over a 6.5 year period.
• 75% of service users were female, with 65% aged 34 years or younger. By contrast, the ‘all other mental disorders’ group were less likely to be female (55%) and older, with 42% younger than 34 years.
• The prevalence of suicidal and self-harm presentations in service users with personality disorder was substantially greater than among people with other mental disorders.
• 88% of ambulance attendances resulted in transport to the emergency department

These findings highlight the prevalence and recurrence of emergency service utilisation by a sub-group of people who experience complex and severe personality disorder.

These findings point to the need for evidence-based alternatives that will reduce the incidence of mental health crises and reliance on emergency services. These could include increasing the use of co-response teams when responding to mental health crises in the community, in tandem with implementing effective and appropriate treatment and support strategies to provide the help that people need after they have experienced mental health crises.

Funding for this study was generously provided by The Eastern Health Foundation.