About Borderline Personality Disorder
What are the diagnostic procedures for BPD?
Personality disorders are diagnosed based on: Thorough interview with your doctor or mental health provider · Psychological evaluation · Complete clinical history · Signs and symptoms To be diagnosed with borderline personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published and updated by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. For borderline personality disorder to be diagnosed, at least five of the following signs and symptoms must be present: · Intense fear of abandonment · Pattern of unstable relationships · Unstable self-image or sense of identity · Impulsive and self-destructive behaviors · Suicidal behavior or self-injury · Wide mood swings · Chronic feelings of emptiness Anger-related problems, such as frequently losing your temper or having physical fights Periods of paranoia and loss of contact with reality A diagnosis of borderline personality disorder is usually made in adults, not in children or teenagers. That's because what appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature. |
What are treatment options for BPD?
Borderline personality disorder treatment may include psychotherapy, medications or hospitalization. Psychotherapy Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Types of psychotherapy that have been found effective include: · Dialectical behavior therapy (DBT). DBT was designed specifically to treat borderline personality disorder. Generally done through individual, group and phone counseling, DBT uses a skills-based approach combined with physical and meditation-like exercises to teach you how to regulate your emotions, tolerate distress and improve relationships. · Cognitive behavioral therapy (CBT). With CBT, you work with a mental health counselor (therapist) to become aware of inaccurate, negative or ineffective thinking; view challenging situations more clearly and objectively; and search for and put into practice alternative solution strategies. · Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify and separate your own thoughts and feelings from those of people around you. MBT emphasizes thinking before reacting. · Schema-focused therapy (SFT). SFT combines therapy approaches to help you evaluate repetitive life patterns and life themes (schema) so that you can identify positive patterns and change negative ones. · Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations. Medications Medications can't cure borderline personality disorder, but they can help associated co-occurring clinical problems, such as depression, impulsiveness and anxiety. Medications may include antidepressants, antipsychotics and anti-anxiety drugs. Medications must be appropriately prescribed by your doctor, in adequate doses, and with consistent supervision through scheduled follow-up visits. Hospitalization At times, you may need more intense treatment in a psychiatric hospital or clinic. Hospitalization can also keep you safe from self-injury or suicidal thoughts or behaviors. Because treatment can be intense and long term, you have the best chance for success when you consult mental health providers who have experience treating borderline personality disorder. |
What are the laws and policies regarding BPD?
The ADA - Americans with Disabilities Act
What is the intent of the ADA?
The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities in employment; state and local government activities; public accommodations; public transportation; telecommunications; and public services. It was signed into law by President George Bush on July 26, 1990.
Does the ADA protect people with severe mental illness?
The definition of disability in the ADA includes people with mental illness who meet one of these three definitions: "(1) a physical or mental impairment that substantially limits one or more major life activities of an individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment." A mental impairment is defined by the ADA as "any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities."
I. Employment (Title I of the ADA)
Do all employers have to comply with Title I of the ADA?
Private employers with 15 or more employees, state and local governments, employment agencies, labor organizations, and management committees are all subject to the ADA. The ADA does not apply to the federal government; however, discrimination by the federal government or federally assisted programs is prohibited under Title V of the Rehabilitation Act of 1973.
Who is protected by Title I?
The ADA prohibits discrimination against "qualified individuals with disabilities" who are individuals with disabilities who meet the skill, experience, education, and other job-related requirements of a position held or desired and who, with or without reasonable accommodation, can perform the essential functions of a job.
To offer ADA protection, does the employer have to be aware of the disability?
Yes. Employers are obligated to make reasonable accommodation only if they are aware of a person’s disability. Thus, employers do not have to accommodate disabilities that they are unaware of. If an employee with a known disability is having difficulty performing his or her job, an employer may inquire whether the employee is in need of a reasonable accommodation. In addition, if the employer has reason to know that the employee has a disability, they may have an obligation to discuss reasonable accommodation. In general, however, it is the responsibility of the individual with the disability to inform the employer that an accommodation is needed.
Does the ADA forbid blanket inquiries into your medical and psychiatric history during the hiring process?
Yes. However, an employer may ask you objective questions that help the employer decide whether you can perform essential duties of a job. An employer may ask you about your ability to meet the physical standards for jobs involving physical labor, your ability to get along with people, or your ability to finish tasks on time and to come to work every day.
The ADA requires employers who provide "reasonable accommodations" for qualified individuals with disabilities. What are "reasonable accommodations" for people with severe mental illness?
Examples of reasonable accommodations for people with severe mental illnesses included providing self-paced workloads and flexible hours, modifying job responsibilities, allowing leave (paid or unpaid) during periods of hospitalization or incapacity, assigning a supportive and understanding supervisor, modifying work hours to allow people to attend appointments with their psychiatrist, providing easy access to supervision and supports in the workplace, and providing frequent guidance and feedback about job performance.
What employment practices are covered?
All aspects of an employment relationship including recruitment, hiring, job assignments, pay, lay-off, firing, training, promotions, benefits, and leave.
Are there any exceptions to the requirements of Title I of the ADA?
Yes. There are two exceptions to the requirements of Title I of the ADA.
First, an employer is not required to provide an accommodation if it will impose an "undue hardship" on the operation of its business such as accommodations that are excessively costly, extensive, substantial, or disruptive, or would fundamentally alter the nature or operation of the business.
Second, an employer may refuse to employ or provide accommodations to an individual who poses a "direct threat" to the health or safety of him/herself or other employees in the workplace. The determination that an individual poses a direct threat to self or others cannot be made simply based on stereotypical generalizations about mental illness, but may be based only on objective evidence from a treatment provider or another credible source that the individual’s present condition makes him or her a direct threat to self or others.
How does one file a complaint under Title I of the ADA?
An individual who feels that he or she has been discriminated against in employment on the basis of disability can file a charge with the Equal Employment Opportunity Commission (EEOC) within 180 days of the alleged discriminatory act. (In certain states that have their own laws prohibiting employment discrimination based on disability this time limit may be extended to 300 days, but, as a general principle, the time limit is 180 days). The EEOC is authorized to mediate and negotiate a settlement between the individual who files the complaint and the employer. If this fails to resolve the matter, the EEOC has the option of either filing a lawsuit on behalf of the individual or issuing a "right to sue" letter. After a "right to sue" letter has been issued, the individual may file a lawsuit in a federal district court.
II. State and Local Governments (Title II of the ADA)
How does the ADA apply to state and local governments?
Title II of the ADA prohibits discrimination against qualified individuals with disabilities in all programs, activities, and services provided by state and local governments.
What are examples of state and local governmental activities covered under Title II of the ADA?
A state or local government must eliminate any eligibility criteria for participation in programs, activities, and services that screen out or tend to screen out or discriminate against persons with disabilities, unless it can establish that these requirements are necessary for the provision of the service, program, or activities. For example, a state may not refuse to grant a driver's license to someone merely because of their psychiatric diagnosis, unless the illness or medication taken for the illness interfere with the ability to drive. The ADA also requires that all new buildings constructed by a state or local government be accessible.
How does one go about filing a complaint under title II of the ADA?
Private individuals may file a complaint with the U.S. Department of Justice. To find out how this is done, call 1-800-541-0301. Alternatively, individuals may file lawsuits in a federal district court. Compensatory damages, including damages for pain and suffering may be awarded. Reasonable attorneys' fees may be awarded as well.
III. Public Accommodations (Title III of the ADA)
What is the purpose of Title III of the ADA?
No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodations by any person who owns, leases, or operates a place of public accommodation.
What are "places of public accommodations"?
Places of public accommodation include a wide range of entities such as restaurants, hotels, theaters, doctors' offices, pharmacies, retail stores, or museums.
How does one go about filing a complaint under title III of the ADA?
As with Title II, The U.S. department of justice is responsible for administering Title III of the ADA. An individual who believes he or she has been discriminated against in violation of Title III may either file an administrative complaint with the Department of Justice (1-800-541-0301) or file a private lawsuit in a federal district court.
IV. ADA Resource Guide
Who can I call if there is evidence of an ADA violation?
Resource
How to Contact
Private Attorney
Equal Employment Opportunity Commission (EEOC)
for Title I concerns
www.eeoc.gov
800-669-4000
U.S. Department of Justice
for Title II and Title III concerns
www.usdoj.gov
800-541-0301
Job Accommodation Network
janweb.icdi.wvu.edu
800-526-7234
State Protection & Advocacy Agency
www.ndrn.org
Legal services organization (legal aid) in your area
local phone directory
V. Additional Sources of Information
· A Technical Assistance Manual on the Employment Provision (Title I) of the ADA. A resource directory published by the U.S. Equal Employment Opportunities Commission. To order a copy, call 800-669-EEOC or visitwww.eeoc.gov/policy/docs/psych.html
· Opening Public Agency Doors: Title II of the Americans with Disabilities Act and People with Mental Illnesses: A Collaborative Approach for Ensuring Equal Access to State Benefit and Service Programs. Published by the Bazelon Center for Mental Health Law. To order a copy, call 202-467-5730
ESEA
ESEA is a large public education bill that includes funding for such things as Title I, school repairs, technology in the classroom, and charter schools. The reauthorization that passed in the Senate, includes an $11.5 billion increase in funding and a bipartisan commitment to full funding of IDEA (the Individual with Disabilities Education Act). Last month, the House passed a similar education bill. The bill will now go to a House-Senate conference that is anticipated to wrap up by the end of August. During the conference, several items will need to be reconciled, such as the cost of the education package and the full funding of IDEA, which was not contained in the House version.
For NAMI members, families, and children with severe mental illness key items in this legislation include provisions on school discipline, full funding of IDEA and an amendment to increase coordination of mental health services in schools. The discipline amendment that was introduced by Senator Jeff Session (R-AL) passed by a voice vote after a 50-50 tie last Thursday. The Sessions amendment will weaken the Individuals with Disabilities Education Act (IDEA) by eroding the protections for students with disabilities, including children with severe mental illnesses by allowing schools to cease education services for a school violation. Under the amendment, even if a school provides educational services to students who are suspended or expelled, it would not be required to provide a free appropriate public education to a student with a disability.
S 1 also includes an amendment introduced by Senators Pete Domenici (R-NM) and Edward Kennedy (D-MA). The amendment would establish a grant program to develop and enhance links between local education agencies and mental illness treatment programs. This marks an important step forward in helping communities establish agreements among the school districts and other education agencies and the systems that traditionally serve children and adolescents living with mental illness (e.g., mental health agencies and juvenile justice authorities).
NAMI applauds the efforts of Senators Domenici and Kennedy for introducing an amendment that would improve diagnostic, and treatment services available to students (through replication of evidence-based diagnostic screening tools such as the DISC). Expanding the use of the DISC, (Diagnostic Interview Schedule for Children) in schools and juvenile justice has been a priority for NAMI. This amendment would also provide crisis intervention services and appropriate referrals for students in need of treatment services and assist in educating teachers, principals, administrators, and other school personnel about available mental illness treatment services for children and adolescents.
The U.S Surgeon General reports that in the United States, 1 in 10 children and adolescents suffer from mental illness severe enough to cause impairment. Yet in any given year, fewer than 1 in 5 of these children receives needed treatment. The report also states that there is sweeping evidence that the nation lacks a unified infrastructure to help these children and many are falling through the cracks. Too often, children who are not identified as having mental health problems and who do not receive services end up in the juvenile justice system.
State Tech Act Programs
State Technology Act programs are statewide, technology-related assistance for individuals of all ages with disabilities. These programs provide training and technical assistance, assistive technology loans, provide advocacy and increase awareness. There are 56 projects, one in each state, the District of Columbia, and the U.S. territories.
For a list of state programs, visit http://resnaprojects.org/allcontacts/statewidecontacts.html.
IDEA/IDEIA
The Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities throughout the nation. IDEA governs how states and public agencies provide early intervention, special education and related services to more than 6.5 million eligible infants, toddlers, children and youth with disabilities.
Infants and toddlers with disabilities (birth-2) and their families receive early intervention services under IDEA Part C. Children and youth (ages 3-21) receive special education and related services under IDEA Part B.
The ADA - Americans with Disabilities Act
What is the intent of the ADA?
The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities in employment; state and local government activities; public accommodations; public transportation; telecommunications; and public services. It was signed into law by President George Bush on July 26, 1990.
Does the ADA protect people with severe mental illness?
The definition of disability in the ADA includes people with mental illness who meet one of these three definitions: "(1) a physical or mental impairment that substantially limits one or more major life activities of an individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment." A mental impairment is defined by the ADA as "any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities."
I. Employment (Title I of the ADA)
Do all employers have to comply with Title I of the ADA?
Private employers with 15 or more employees, state and local governments, employment agencies, labor organizations, and management committees are all subject to the ADA. The ADA does not apply to the federal government; however, discrimination by the federal government or federally assisted programs is prohibited under Title V of the Rehabilitation Act of 1973.
Who is protected by Title I?
The ADA prohibits discrimination against "qualified individuals with disabilities" who are individuals with disabilities who meet the skill, experience, education, and other job-related requirements of a position held or desired and who, with or without reasonable accommodation, can perform the essential functions of a job.
To offer ADA protection, does the employer have to be aware of the disability?
Yes. Employers are obligated to make reasonable accommodation only if they are aware of a person’s disability. Thus, employers do not have to accommodate disabilities that they are unaware of. If an employee with a known disability is having difficulty performing his or her job, an employer may inquire whether the employee is in need of a reasonable accommodation. In addition, if the employer has reason to know that the employee has a disability, they may have an obligation to discuss reasonable accommodation. In general, however, it is the responsibility of the individual with the disability to inform the employer that an accommodation is needed.
Does the ADA forbid blanket inquiries into your medical and psychiatric history during the hiring process?
Yes. However, an employer may ask you objective questions that help the employer decide whether you can perform essential duties of a job. An employer may ask you about your ability to meet the physical standards for jobs involving physical labor, your ability to get along with people, or your ability to finish tasks on time and to come to work every day.
The ADA requires employers who provide "reasonable accommodations" for qualified individuals with disabilities. What are "reasonable accommodations" for people with severe mental illness?
Examples of reasonable accommodations for people with severe mental illnesses included providing self-paced workloads and flexible hours, modifying job responsibilities, allowing leave (paid or unpaid) during periods of hospitalization or incapacity, assigning a supportive and understanding supervisor, modifying work hours to allow people to attend appointments with their psychiatrist, providing easy access to supervision and supports in the workplace, and providing frequent guidance and feedback about job performance.
What employment practices are covered?
All aspects of an employment relationship including recruitment, hiring, job assignments, pay, lay-off, firing, training, promotions, benefits, and leave.
Are there any exceptions to the requirements of Title I of the ADA?
Yes. There are two exceptions to the requirements of Title I of the ADA.
First, an employer is not required to provide an accommodation if it will impose an "undue hardship" on the operation of its business such as accommodations that are excessively costly, extensive, substantial, or disruptive, or would fundamentally alter the nature or operation of the business.
Second, an employer may refuse to employ or provide accommodations to an individual who poses a "direct threat" to the health or safety of him/herself or other employees in the workplace. The determination that an individual poses a direct threat to self or others cannot be made simply based on stereotypical generalizations about mental illness, but may be based only on objective evidence from a treatment provider or another credible source that the individual’s present condition makes him or her a direct threat to self or others.
How does one file a complaint under Title I of the ADA?
An individual who feels that he or she has been discriminated against in employment on the basis of disability can file a charge with the Equal Employment Opportunity Commission (EEOC) within 180 days of the alleged discriminatory act. (In certain states that have their own laws prohibiting employment discrimination based on disability this time limit may be extended to 300 days, but, as a general principle, the time limit is 180 days). The EEOC is authorized to mediate and negotiate a settlement between the individual who files the complaint and the employer. If this fails to resolve the matter, the EEOC has the option of either filing a lawsuit on behalf of the individual or issuing a "right to sue" letter. After a "right to sue" letter has been issued, the individual may file a lawsuit in a federal district court.
II. State and Local Governments (Title II of the ADA)
How does the ADA apply to state and local governments?
Title II of the ADA prohibits discrimination against qualified individuals with disabilities in all programs, activities, and services provided by state and local governments.
What are examples of state and local governmental activities covered under Title II of the ADA?
A state or local government must eliminate any eligibility criteria for participation in programs, activities, and services that screen out or tend to screen out or discriminate against persons with disabilities, unless it can establish that these requirements are necessary for the provision of the service, program, or activities. For example, a state may not refuse to grant a driver's license to someone merely because of their psychiatric diagnosis, unless the illness or medication taken for the illness interfere with the ability to drive. The ADA also requires that all new buildings constructed by a state or local government be accessible.
How does one go about filing a complaint under title II of the ADA?
Private individuals may file a complaint with the U.S. Department of Justice. To find out how this is done, call 1-800-541-0301. Alternatively, individuals may file lawsuits in a federal district court. Compensatory damages, including damages for pain and suffering may be awarded. Reasonable attorneys' fees may be awarded as well.
III. Public Accommodations (Title III of the ADA)
What is the purpose of Title III of the ADA?
No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodations by any person who owns, leases, or operates a place of public accommodation.
What are "places of public accommodations"?
Places of public accommodation include a wide range of entities such as restaurants, hotels, theaters, doctors' offices, pharmacies, retail stores, or museums.
How does one go about filing a complaint under title III of the ADA?
As with Title II, The U.S. department of justice is responsible for administering Title III of the ADA. An individual who believes he or she has been discriminated against in violation of Title III may either file an administrative complaint with the Department of Justice (1-800-541-0301) or file a private lawsuit in a federal district court.
IV. ADA Resource Guide
Who can I call if there is evidence of an ADA violation?
Resource
How to Contact
Private Attorney
Equal Employment Opportunity Commission (EEOC)
for Title I concerns
www.eeoc.gov
800-669-4000
U.S. Department of Justice
for Title II and Title III concerns
www.usdoj.gov
800-541-0301
Job Accommodation Network
janweb.icdi.wvu.edu
800-526-7234
State Protection & Advocacy Agency
www.ndrn.org
Legal services organization (legal aid) in your area
local phone directory
V. Additional Sources of Information
· A Technical Assistance Manual on the Employment Provision (Title I) of the ADA. A resource directory published by the U.S. Equal Employment Opportunities Commission. To order a copy, call 800-669-EEOC or visitwww.eeoc.gov/policy/docs/psych.html
· Opening Public Agency Doors: Title II of the Americans with Disabilities Act and People with Mental Illnesses: A Collaborative Approach for Ensuring Equal Access to State Benefit and Service Programs. Published by the Bazelon Center for Mental Health Law. To order a copy, call 202-467-5730
ESEA
ESEA is a large public education bill that includes funding for such things as Title I, school repairs, technology in the classroom, and charter schools. The reauthorization that passed in the Senate, includes an $11.5 billion increase in funding and a bipartisan commitment to full funding of IDEA (the Individual with Disabilities Education Act). Last month, the House passed a similar education bill. The bill will now go to a House-Senate conference that is anticipated to wrap up by the end of August. During the conference, several items will need to be reconciled, such as the cost of the education package and the full funding of IDEA, which was not contained in the House version.
For NAMI members, families, and children with severe mental illness key items in this legislation include provisions on school discipline, full funding of IDEA and an amendment to increase coordination of mental health services in schools. The discipline amendment that was introduced by Senator Jeff Session (R-AL) passed by a voice vote after a 50-50 tie last Thursday. The Sessions amendment will weaken the Individuals with Disabilities Education Act (IDEA) by eroding the protections for students with disabilities, including children with severe mental illnesses by allowing schools to cease education services for a school violation. Under the amendment, even if a school provides educational services to students who are suspended or expelled, it would not be required to provide a free appropriate public education to a student with a disability.
S 1 also includes an amendment introduced by Senators Pete Domenici (R-NM) and Edward Kennedy (D-MA). The amendment would establish a grant program to develop and enhance links between local education agencies and mental illness treatment programs. This marks an important step forward in helping communities establish agreements among the school districts and other education agencies and the systems that traditionally serve children and adolescents living with mental illness (e.g., mental health agencies and juvenile justice authorities).
NAMI applauds the efforts of Senators Domenici and Kennedy for introducing an amendment that would improve diagnostic, and treatment services available to students (through replication of evidence-based diagnostic screening tools such as the DISC). Expanding the use of the DISC, (Diagnostic Interview Schedule for Children) in schools and juvenile justice has been a priority for NAMI. This amendment would also provide crisis intervention services and appropriate referrals for students in need of treatment services and assist in educating teachers, principals, administrators, and other school personnel about available mental illness treatment services for children and adolescents.
The U.S Surgeon General reports that in the United States, 1 in 10 children and adolescents suffer from mental illness severe enough to cause impairment. Yet in any given year, fewer than 1 in 5 of these children receives needed treatment. The report also states that there is sweeping evidence that the nation lacks a unified infrastructure to help these children and many are falling through the cracks. Too often, children who are not identified as having mental health problems and who do not receive services end up in the juvenile justice system.
State Tech Act Programs
State Technology Act programs are statewide, technology-related assistance for individuals of all ages with disabilities. These programs provide training and technical assistance, assistive technology loans, provide advocacy and increase awareness. There are 56 projects, one in each state, the District of Columbia, and the U.S. territories.
For a list of state programs, visit http://resnaprojects.org/allcontacts/statewidecontacts.html.
IDEA/IDEIA
The Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities throughout the nation. IDEA governs how states and public agencies provide early intervention, special education and related services to more than 6.5 million eligible infants, toddlers, children and youth with disabilities.
Infants and toddlers with disabilities (birth-2) and their families receive early intervention services under IDEA Part C. Children and youth (ages 3-21) receive special education and related services under IDEA Part B.