Challenging therapeutic pessimism: borderline personality disorder and co-morbid substance abuse1

The challenges encountered within public mental health services in New South Wales, Australia, have been well described in recent review documents. New South Wales and Federal government policies clearly outline expectations of evidence-based service delivery. Achieving these expectations in urban settings remains a somewhat haphazard process, while service delivery in rural and remote areas often falls markedly short of satisfactory. This article describes the almost overwhelming challenges encountered by a mental health team and drug and alcohol service confronted with a consumer with co-morbid borderline personality disorder (BPD) and a multiple substance abuse disorder. While successful evidence-based treatments for BPD have been described in the literature, therapeutic pessimism remains pervasive in many settings. When a consumer presents with a co-morbid substance abuse disorder, clinicians from both mental health and Drug and Alcohol services at times struggle to develop an effective and collaborat...