Ambulance attendances involving personality disorder – investigation of crisis-driven re-attendances for mental health, alcohol and other drug, and suicide-related events

Abstract

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.