Designing an intervention to support carers of people diagnosed with borderline personality disorder

Abstract

Background: Borderline personality disorder (BPD) is a highly disabling and enduring mental health condition, which is estimated to affect 1.6% of the general population. Family and carers often play a vital role in supporting a person with BPD. However, despite the United Kingdom (UK) carer support policies, evidence indicates there is a lack of services, support, and effective interventions for this population of carers. This study aims to explore the experiences and needs of carers supporting people with BPD and work with them to co-design an evidence-based supportive intervention tailored specifically for them.

Methods: This is a qualitative study utilising Facet Methodology. Semi-structured interviews were conducted with 20 carers and to co-design the intervention focus groups with 14 professional or carer stakeholders. Framework analysis was used to analyse the data, thereafter a socioecological model was developed to understand the social contexts in which carers’ experiences occurred. The Six-Step Quality Intervention Development (6SQuID) framework guided the intervention design, involving carers and professional stakeholders throughout the process. Thereafter, the Template for Intervention Description and Replication (Tidier) supported the development of a comprehensive and accurate implementation plan.

Findings: Four overarching themes were identified from the analysis of carers’ experiences and needs: i) Trauma by association; ii) Social and emotional isolation; ii) Beyond coping, and iii) Carers are people who need support too. The socioecological model showed the main focus for intervention should be social and emotional support and information and education about BPD. This informed the co-design of a multi-component intervention called Calm and Connected, consisting of an educational website, skills course, and peer support group.

Conclusion: This thesis makes a significant contribution to knowledge concerning the experiences and needs of carers of people with BPD. The studies generate an evidence base that has implications for policy and practice, presenting credible theories to support the future development of interventions for carers.