I Can't Help You If You're a Borderline: A Qualitative Exploration of Provider Based Stigma with Social Workers Who Provide Care to Those Living with Borderline Personality Disorder in Ontario, Canada

Background: Borderline Personality Disorder (BPD) is a serious mental illness characterized by instability in interpersonal relationships and self-image, emotional and behavioral deregulation stemming from past trauma and/or biological aetiologies, with high morbidity and mortality. Provider based stigmatization is associated with poor healthcare delivery, inadequate screening, diagnosis, and treatment, leading to early mortality. This presentation addresses a gap in the literature about how social workers describe their experiences of providing care to people living with BPD across the continuum of care.

Methods: We conducted semi-structured interviews with social workers recruited in the Canadian province of Ontario. Interviews were conducted between April 2020 and January 2021 and lasted between 50 and 60 minutes. Interviews were audio recorded and professionally transcribed verbatim and imported into NVivo 12 qualitative data management software. The transcribed data were coded, and major themes were identified using a Critical Realist Analysis. Standard research ethics protocols were followed, and participants were provided with a $25 CAD honorarium.

Results: We interviewed N=41 social workers (CisFemale 33, CisMale 7, Gender Queer = 1; 80% white, 7% South Asian, 7% Chinese, 2% Middle Eastern, 2% Indigenous) employed across the continuum of care: hospital, community and private practice as well as, child welfare, and social and legal services. Years in practice ranged from 1 to 44, with an average of 11 years post accreditation. The age of participants ranged from 27 to 72 years old. Interviews were conducted remotely. Recruitment occurred using purposive and snowball sampling, and email recruitment.

Key themes: 1) Provider Based Stigma: all participants interviewed described witnessing social workers stigmatizing behaviours towards someone diagnosed with BPD in the workplace at some point in their careers. Many reported that these stigmatizing behaviours have been decreasing over time because of a general increase in awareness about BPD, 2) Interprofessional stigma: all those who were interviewed reported working alongside other professionals (e.g., physicians, nurses, occupational therapists) who had interacted with someone living with BPD in a stigmatizing manner (e.g., blaming them for hospital admissions), 3) Lack of specific training and education about BPD: participants report they feel ill equipped to support those living with BPD because they don’t understand the illness and they do not have the right therapeutic “tools” to support them and, 4) Participants called for trauma informed care principles to the integrated into and taught during their education and within their workplaces through access to professional development activities.

Conclusions: Participants expressed that stigma towards those living with BPD is still a significant problem within the mental healthcare system in Ontario. The implementation of trauma informed care principles may help towards increasing empathy and compassion towards those living with BPD. Understanding the extent of these themes not only highlights the need for BPD to be destigmatised but also the need to approach this work through a multifaceted approach which may include more targeted education for social workers, advocacy and leadership in policy development, along with greater inclusion of those living with BPD in these processes.