Uncertainty of Fit - Serving People with Borderline Personality Disorder on an Assertive Community Treatment Team Setting: Experiences and Perspectives of Clinicians from a Flexible ACT Team.

People with Borderline Personality Disorder (PBPD) have been historically excluded from Assertive Community Treatment (ACT) teams. The 'gold standard' ACT service model in community psychiatry aims to serve people with serious mental illness (SMI), typically diagnosed with psychotic and mood disorders. For various clinical, administrative, and model innovation reasons, PBPD are notably present on ACT teams, presenting unique clinical challenges; yet clinician perspectives and experiences are little known. Qualitative study using semi-structured interviews and thematic analysis on experiences and perspectives of clinicians from a well-established ACT team in an academic setting that transitioned to a Flexible ACT team in Toronto, Canada. Clinicians reported working with PBPD presents unique training, skills, clinical, team, system, and personal level challenges Five main themes included: (1) Lack of specific training among clinicians in serving people with BPD; (2) Diverse views of suitability of ACT for PBPD; (3) Specific challenges for clinicians working with PBPD on ACT; (4) Positive aspects of using ACT to serve PBPD; (5) Potential adaptive changes to ACT teams working with PBPD. Conclusion: Having PBPD on ACT teams is a little acknowledged and less known area of ACT and has significant impact on ACT services. Further attention to training and skill building, service adaptation, and research that improve care and therapeutic relationships with PBPD on ACT are warranted. Having PBPD on ACT teams is a little acknowledged and less known area of ACT and has significant impact on ACT services. Further attention to training and skill building, service adaptation, and research that improve care and therapeutic relationships with PBPD on ACT are warranted.