1. The Availability of Dialectical Behavior Therapy in Partial Hospitalization and Residential Services for Borderline Personality Disorder: An Exploratory Longitudinal Study of the National Mental Health Services Survey From 2014 to 2021.
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Spina, Daniel S. and Levy, Kenneth N.
- Subjects
DIALECTICAL behavior therapy ,MENTAL health services ,MENTAL health surveys ,BORDERLINE personality disorder ,HEALTH equity ,BEHAVIOR therapy - Abstract
Objective: Treatment guidelines on borderline personality disorder (BPD) recommend day-hospital or residential treatments for patients with BPD who cannot tolerate outpatient treatment (American Psychiatric Association, 2010; National Health & Medical Research Council, 2013). However, the current literature suggests that evidence-based treatment for BPD may be difficult to access (Lohman et al., 2017). The present study aims to characterize the accessibility of dialectical behavioral therapy (DBT) in day-treatment and residential programs in the United States in the last 7 years and examines whether day-treatment and residential programs that accept state benefits (i.e., Medicaid) are significantly less likely to offer DBT. Method: Using mixed logistic regression, we examined trends in the National Mental Health Services Survey data from 2014 to 2021, a survey of U.S. mental health facilities which tracks whether facilities provide DBT. Results: We found that the likelihood that a residential or day-hospital facility offers DBT has been growing over time at the national level (OR
day-treatment = 1.07, SE =.03, z = 1.90, p =.05; ORresidential = 1.08, SE =.05, z = 1.77, p =.08). We also found significant variability in these trends at the state level. In addition, we found that facilities accepting state benefits were less likely to offer DBT (ORday-treatment =.66, SE =.021, z = −1.93, p =.05; ORresidential =.67, SE =.21, z = −1.91, p =.06). Conclusion: Consistent with previous literature, our study suggests that these programs are very scarce across the United States and difficult to access for those with Medicaid. What is the public health significance of this article?: The present study is the first to evaluate whether residential and day-hospital programs in the United States have become more likely to provide evidence-based treatment for borderline personality disorder (BPD) over time. Our findings suggest that the likelihood that residential and day-hospital programs provide dialectical behavioral therapy (DBT) has grown nationally since 2014. However, some states show significantly less growth relative to other states in the likelihood of residential and day-hospital programs to provide DBT, suggesting areas of disparity for patients with BPD needing a higher level of care. Our findings also suggest that residential and day-treatment programs which accept state benefits (i.e., Medicaid) tend to be significantly less likely to offer DBT. Targeting states with slower growth rates in these programs and states which have a greater number of consumers with Medicaid may increase access and reduce treatment disparities. [ABSTRACT FROM AUTHOR]- Published
- 2024
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