BPD-related issues with a high cost to society:
Unemployment
- Even though many people with BPD are very intelligent, people with BPD may have more difficulty completing school, which limits their career options and income.
- Unemployed and underemployed people with BPD do not contribute to the economy as much as they could or should.
- The only stable income for many people with BPD comes from social assistance (Employment and Income Assistance).
- People with BPD often do not get along well with co-workers, supervisors, and customers, so it is hard for them to keep a job. They may have emotional outbreaks in public that result in immediate dismissal.
- Thus, people with BPD need to find understanding employers and the right work environment where they can thrive, find purpose, and contribute to the economy.
Homelessness
- The instability in relationships and emotions can make it challenging to maintain stable housing, especially when substance abuse is involved.
- Because of the behaviour of people with BPD, including outbursts, loud fights with friends/significant others, conflicts with neighbors and landlord, and inability to earn consistent income from a stable job leading to missed rent, people with BPD get evicted.
- Some older teenagers and young adults get kicked out of their house because of the conflicts with their parents or they run away. They need a safe place to stay until they can move back home or find stable and safe housing.
- Thus, people with BPD need supportive landlords and neighbors in housing that will help them live in a more stable place.
Sexual abuse
- Risky, unsafe sex is one symptom used to diagnose BPD.
- BPD leads to promiscuity in women and makes them more vulnerable to sexual assault and unplanned pregnancy.
- Addictions, impulsive binge drinking, and illicit drug use can leave women incapable of giving consent.
- Thus, police and victim services need to better understand and help people with BPD who have been abused.
Substance abuse and overdose
- There is a higher chance of substance abuse in people with BPD because some individuals with BPD turn to substances to cope with their emotional pain and impulsivity.
- Intentional overdose is one way to commit suicide, but risky use of non-prescription recreational drugs from unsafe sources can also lead to unintentional overdose.
- Addictions interfere with the ability to start and stay in treatment for BPD. Some doctors and therapists, and most in-patient programs, will not treat a patient who is currently addicted to drugs and alcohol.
- It’s hard to know how much of the symptoms are caused by BPD vs. the substance use.
- If the patient is frequently intoxicated, it is difficult for them to take personal accountability and follow-through with the work needed to complete the treatment and recovery.
- Thus, BPD patients with addictions often need special dual-diagnosis treatment that is hard to find and expensive.
Legal problems and imprisonment
- Because of the addictions, anger, and self-harming behaviour, BPD can lead to legal problems.
- Without proper training or without mental health professionals attending calls involving people with BPD, the police can make the situation much worse instead of de-escalating the situation.
- Unfortunately, in Manitoba, BPD is not deemed a “Tier A” mental illness and does not qualify the person for special consideration or diversion to Mental Health Court, even though BPD causes the criminal behaviour like any other serious mental illness.
- Women with BPD tend to get help more often (3 times as often as men), but the reason for that may be that men instead get involved in substance abuse, violence and crime and can end up in jail without ever being diagnosed with BPD. The proportion of men and women with BPD is roughly the same, but many men do not get diagnosed with BPD, so they aren’t getting treatment to prevent criminal behaviour ending in a jail sentence.
- Men with a poor self-image may find acceptance and an identity through organized crime gangs.
- Inmates with BPD (diagnosed or undiagnosed) may be more disruptive and cause more disturbances that could be reduced if they got specific treatment for BPD, such as DBT
- People with criminal charges will not be accepted into the STAT program in Winnipeg.
- Thus, the criminal justice system needs to change to recognize, accommodate, and treat DBT like other mental illnesses and disorders.
Clinical treatment limitations
- People with BPD have long waiting lists to access publicly-funded therapy, if they can get a referral, and only the most serious mental illness patients get referred to a psychiatrist.
- The cost of private DBT therapy is more than most people can afford.
- People with BPD can get kicked out of a therapy program for things like being late, not doing homework, or being verbally “abusive”, which can be caused by the condition they need treated.
- Thus, the healthcare system needs to hire more doctors, nurses & therapists trained to provide treatment to people with BPD or provide funding to cover the cost of private treatment.
- Also, alternative treatments that cost less to provide should be brought into Manitoba and funded by the government.
- Please click here for more information about the difficulties treating BPD.
Other social costs
- Unfortunately, no one is keeping Canadian statistics about the numbers of people diagnosed with BPD, the outcomes of their treatment, or the number of people with BPD who are unemployed, homeless, sexually abused, addicted to substances, or in prison. Better data and statistics are needed to understand the magnitude of the societal costs and scope of impact related to BPD.
- More information is also needed about the effectiveness of current BPD treatment options and new therapies that are not yet available in Manitoba.
- The cost of emergency and crisis intervention related to people with BPD is very high. These costs come from:
- institutionalization/hospitalization for in-patient treatment,
- out-patient therapy under Provincial Medicare,
- visits to emergency rooms for self-harming behaviour or suicide attempts,
- police or ambulance being called after conflicts involving the person with BPD (violence, disturbing the peace, spousal abuse, sexual assault victim, property damage, or self-harming/suicide), and
- missed work by family-members dealing with crisis of their loved-one with BPD.
- Nurses and doctors have to deal with more abuse than ever and there is a zero-tolerance policy in most healthcare facilities. People with BPD can get turned away from medical help at emergency rooms or the mental health crisis center because of perceived “abusive” behaviour, which is a symptom of their condition.
- There are examples of people with BPD who have committed suicide after being refused proper care by crisis and emergency care. This statistic may not be tracked in Canada, but a documentary called “The Diagnosed” stated that this happened in the UK to more than 50 people in 8 years resulting in warning letters from the coroner. Please click here for a related article by CBC Winnipeg.
Without treatment, many people with BPD will struggle with the issues identified above.
The government investment in better treatment for people with BPD will more than pay for itself by reducing the costs identified above.