« Good Psychiatric Management » pour le trouble de la personnalité borderline dans le cadre du soutien à l’emploi : étude de cas multiples sur l’expérience des clients

Context

People with borderline personality disorder (BPD) often present occupational issues, such as impulsivity, conflicts in the workplace, dismissals and unemployment. Several psychosocial programs have been recently developed to tackle this issue but need more evidence for their value, and require rather a lot of resources for implementation. The Individual Placement and Support (IPS) model of supported employment has shown its international effectiveness in professionally reintegrating people with severe mental illness, and is well established throughout the world. This model responds to a principle of zero exclusion regarding any kind of disorders if they are being treated. However, its value for individuals with BPD remains largely understudied. IPS job coaches find it difficult to deal with people with this disorder and could benefit from an additional feature to help them in this sense. Good Psychiatric Management (GPM) for BPD, an evidence-based therapeutic method, applicable in any psychiatric setting, could be a solution for easing job coaches’ practices and reaching more satisfying results for clients. A one-day training is enough to show a change in healthcare attitudes towards BPD. In a previous study, IPS teams seemed to find this additional feature valuable and feasible.

Objectives

The aim of this multiple case study was to explore clients’ experiences of the IPS intervention with GPM-trained job coaches.

Material and Methods

IPS practitioners of the RESSORT unit of the Community Psychiatry Ward of Lausanne University Hospital and the Nant Foundation, Vaud, Switzerland, were trained in GPM in January 2022. Six of their BPD clients took part in research interviews, around 9 months later, addressing their experience and opinion about the intervention. An abductive content analysis was conducted, using the characteristics of an efficient GPM intervention as a theoretical background to classify elements that were or were not fitting GPM success. In parallel, quantitative data from these clients, including their professional path during the intervention, and questionnaires for non-vocational outcomes, were collected at three time points, when they entered the study, 3 months and 9 months later. Their evolution through time was analysed descriptively and linked to their discourse.

Results

Service users were globally satisfied with the intervention, built a certain level of stability and an alliance with their job coach, and would recommend participating in the program. Job coaches seem to have adopted the main GPM principles. Judging by the discourse and evolution of the participants, the intervention seemed to help them in their recovery and professional goals. Most of them had a stable or improving symptoms level and found an activity at post-test.

Discussion

These results also suggest some additional improvements: more clarity about the intervention framework, a BPD specialised treatment outside of IPS, and continued applications of IPS principles to potentiate the positive effects of combining both interventions. The integration of GPM in IPS is appreciated not only by the providers but also by the users.

Conclusions

These first results seem promising for the professional reintegration of people living with BPD. The present conclusions should be confirmed through larger-scale controlled studies, and compared to other specialised rehabilitation programs for BPD.