People with borderline personality disorder experiences of mental health services in an Australian context: Associated anxiety and structural stigma

Objective: The objective is to investigate associations between anxiety accessing mental health services and structural stigma as self-reported by people with borderline personality disorder. 

Methods: A retrospective cohort design was used to investigate data from the 2017 National Consumer Survey undertaken in Australia between June and July 2017. Analyses were performed using multivariate binary logistic regression models. 

Results: Data comprised 423 people with borderline personality disorder aged 18 years and above, where 384 (93.7%) were females. Associations were found between anxiety and stigma in relation to mental health service access for borderline personality disorder. Strikingly, most people with borderline personality disorder reported experiencing anxiety accessing mental health services irrespective of having anxiety disorder/s, indicative of stigma leading to anxiety rather than a by-product of anxiety disorder/s. People with borderline personality disorder and anxiety disorder/s were 9.8 times more likely to feel very anxious about not being taken seriously in mental health services, than respondents with no anxiety disorder/s. Contrastingly, people with borderline personality disorder and anxiety disorder/s were 79% less likely to feel anxious about cost of services, than respondents with no anxiety disorder/s. People with borderline personality disorder previously refused public hospital admission were 8.7 times more likely to feel very anxious about cost of services and 5.3 times more likely to feel very anxious about long wait lists for services than people with borderline personality disorder not refused hospital admission. 

Conclusion: Associations were observed for people with borderline personality disorder experiencing anxiety accessing mental health services, attributed to stigma in health systems. Findings provide nuanced understanding of structural mechanisms and system-level problems affecting services and advances knowledge on the impact of borderline personality disorder–related stigma in healthcare.