The document discusses impulse control disorders and provides information about establishing an Impulse Control Support Service in Western Australia. It notes that impulse control disorders are characterized by a failure to resist urges or impulses that may harm oneself or others. Multiple disorders feature impulsivity, including substance abuse, ADHD, antisocial personality disorder, and borderline personality disorder. The proposed service aims to provide evidence-based treatment and support for individuals with impulse control disorders to reduce social costs and improve outcomes.

1. Impulse Control Support
Service of Western Australia

2. Impulse Control
Disorder (ICD)
Is a class of psychiatric disorders characterized
by impulsivity – failure to resist a temptation,
urge or impulse that may harm oneself or
others.
Multiple disorders feature impulsivity;
• substance-related disorders,
• attention deficit hyperactivity disorder,
• antisocial personality disorder,
• borderline personality disorder,
• conduct disorder
• mood disorders.

3. #1 Predictor of
Success….
The Dunedin Study by Moffit and
Caspi
Model: 1037 children born in Dunedin
between March 72 & April 73
Findings: Children who show high levels
of self-control do better in adulthood.
Even after accounting for things like
intelligence and social class.
SELF-CONTROL

4. Social Costs
 Twice as likely to commit domestic violence
 Lower educational attainment
 Difficulty obtaining and maintaining employment
 Ten times the incidents of unplanned pregnancy
 Reduced earnings
 Increased emergency room admissions
 Greater healthcare utilization
 Twice as likely to be divorced
 Four times more likely to commit a crime
 More likely to have traffic accidents
 Twice as likely to smoke cigarettes
 Six times more likely to develop an eating disorder
 Twice as likely to abuse alcohol.
 Four times more likely to have sexually transmitted
diseases.

5. Emotional Costs Compounded
 Research studies have indicated that 77% of adults with
ICD have other mental disorders in addition to ICD with
most adults having three to four additional disorders.
 The most common comorbid disorders are social anxiety
disorder, other phobias, bipolar disorder, depression, and
post-traumatic stress disorder.
 Learning disorders, sleep disorders are also common.
 Two disorders that share a lot of symptom with ICD, are
bipolar disorder and borderline personality disorder
(BPD).

6. “
”
Our Vision:
THAT INDIVIDUALS AFFECTED BY IMPULSE CONTROL DISORDERS WILL
HAVE AN EQUAL CHANCE AT LIVING A MEANINGFUL, HARMONIOUS
AND INSPIRING LIFE THROUGH EDUCATION AND SUPPORT.

7. 1. Impulse Control disorders underscore some of our societies biggest problems and costs (addiction, crime rates & high welfare costs). We aim to reduce
the inevitability of these sad statistic.
2. By creating a treatment specific centre for generic impulse control support we are encapsulating multiple conditions without the stigma of a “diagnostic
label”.
3. Many consumers are reluctant to accept a diagnosis of a “Mental Health Disorder” therefore unwilling to seek treatment. By omitting / reframing all
clinical implications we can achieve greater participation, thus recovery.
4. Within our envisioned centre we aim to create a “Sit and Feel Safe” drop in centre, this will reduce ED admissions and hospital bed usage.
5. Currently Western Australian hospitals are heavily utilised by BPD patients, however they are discharged into a community that does not offer the proven
therapies needed to address the harmful behaviours, yet we expect them to heal in isolation. We will redress this.
6. By intervening early (prevention) in all impulse related disorders, negative health and social costs can be reduced.
7. We are proposing the financial barriers to accurate diagnosis and treatment be removed, in full or in part.
8. The One Stop Shop Concept;
1. By utilising modern diagnostic techniques, (increases accuracy)
2. Building a comprehensive team of clinicians who are not generic but have expertise in ICD (from assessment to recovery)
3. All working in one central venue (talking to each other) that’s case management and that’s progress.
9. With an accurate diagnosis, and a person centred participation plan we can then establish and commence the necessary treatment/therapy that is proven
to be most effective.
10. No one individual has this condition, it is always a family/ripple concern so we have internationally recognized support for loved ones as well.
Our Objectives…

8. Four Pillars For Change

9. Two Most Harmful
Disorders Associated
With Impulsivity
 ADHD in adults and BPD share some similar
clinical features (e. g. impulsivity, emotional
dysregulation, cognitive impairment).
 ADHD in childhood has been reported to be
highly associated with the diagnosis of BPD
in adulthood and adult ADHD often co-
occurs with BPD.
 BPD and adult ADHD; neuroimaging and
psychopharmacological studies showed
evidence for a common neurobiological
dysfunction suggesting that ADHD and BPD
may not be two distinct disorders, but
represent two dimensions of one disorder.

10. Treatment Cost-Effectiveness Studies
QALYs = quality-adjusted life years
BOTH TREATABLE
ADHD
75% response rates of core symptoms
Symptom improvement correlates with improved function
Treatment in childhood in a Finish study markedly decreased burden of illness in adulthood and capacity to function
German Study: The Benefit-Cost analysis suggested that reasonably effective intervention justifies considerable
investment in ADHD targeted intervention.
Medication for ADHD improves attention and concentration, yet it does very little to help symptoms of disorganization,
poor time management, forgetfulness, and procrastination this can only improve with therapy and skills training.
BPD
Found CBT the least affective treatment in some cases detrimental
three major outcome studies have shown that many patients with Borderline Personality Disorder can achieve full
recovery across the complete range of symptoms. Schema Therapy was shown to be more than twice as effective in
bringing about full recovery.
Schema Therapy was also found to be more cost-effective and to have a much lower dropout rate. In a Dutch study
schema therapy compacted (briefer period) had a 0% drop out rate and a recovery rate of 94% over an 8 month period.

11. Addressing The Ten Year
Plan…
REFORMING THE SYSTEM

12. Reform
Together with key stakeholders (including
clinicians, consumers, families and carers),
implement a range of system-wide reform
initiatives to support the transformation of the
mental health, alcohol and other drug service
system.
www.mentalhealth.wa.gov.au/ThePlan.aspx
ICSSWA Objective 1-10 Address this point

13. A Partnership Approach
to Implementing
Reform
Page 168
The Plan is highly ambitious in the extent it recommends
service expansion and systemic change. Achieving such
widespread reform requires commitment from all levels of
Government, the private and non-government sector, other
health and social services, and most importantly
consumers, carers and their families. It also necessitates a
phased approach over the next ten years which allows for
effective implementation, evaluation and adjustments to the
Plan.
Western Australia has already implemented important
measures to facilitate partnerships between Government
agencies and nongovernment organisations. In 2011,
Western Australia introduced the Delivering Community
Services in Partnership (DCSP) policy, which aims to put the
individual at the centre of the relationship between the
public and NFP community sectors by requiring a joint
approach to contracting between government agencies and
not-for profit organisations.

14. Co-occurring Alcohol and Drug Problems
ADHD BPD

15. Suicide Prevention
Page 31
Suicide Prevention 2020 seeks to balance investment in community
awareness and stigma reduction, mental health and suicide
prevention training and coordinated services for high risk groups
through the provision of activity across six key action areas:
 greater public awareness and united action across the community
 local support and community prevention across the lifespan
 coordinated and targeted responses for high-risk groups
 shared responsibility across government, private and non-
government sectors to build mentally health workplaces
 increased suicide prevention training
 timely data and evidence to improve responses and services.

16. Recovery Focused
 Acceptance and Commitment Therapy (ACT) – Not available in WA
 Cognitive Analytic Therapy – Not available in WA
 Cognitive Behavioural Therapy
 Dialectical Behaviour Therapy (DBT)
 Dynamic Deconstructive Psychotherapy (DDP) – Not available in WA
 Family Connections program – Not available in WA
 Helping Young People Early (HYPE) – Not available in WA
 Mentalization-based therapy (MBT) – Not currently available in WA
 Mindfulness
 Relaxation
 Schema-focused Therapy (SFT) – Not available in WA
 Systems Training for Emotional Predictability and Problem Solving
(STEPPS)
 Transference-focused therapy (TFP) – Not available in WA
Expanding the availability of personal recovery-oriented support services is a common
theme throughout the Plan. Recovery-oriented services are inclusive and holistic.
Services can assist individuals through the delivery of personalised support and
through linking in with other services and programs.

17. Expand Carer and
Family Information
Improving the availability of timely, accurate
and reliable information is essential for carers
and families, as is their inclusion in the care,
support and treatment of individuals. Support
for children who have parents with a mental
health problem and/or alcohol and other drug
problem is a key priority area.
The Family Connections program – Not in WA
 Education and research about BPD
 Akin to Dialectical Behaviour Therapy (DBT)
 Teaching and learning of treatment theories and
practices, and the latest research on BPD
 Support for parents, spouses, children, and siblings of
someone with BPD
 The latest knowledge and skills to enable the well
being of participants.
Course content focuses on:
 Education on BPD
 Research on BPD
 Family Perspectives and Experiences
 Relationship Mindfulness Skills
 Emotion Regulation Skills
 Effective Communication Skills
 Validation Skills
 Problem Management Skills
We aim to make it a regular program at our centre.

18. Specificity of Services
Treating ADHD:
• Longitudinal studies have also found that
teaching methods need to vary for those with
ADHD, for example, providing 90 minute CBT
classes to someone with inattentive ADHD is a
pointless exercise.
• This is why we believe that a specific treatment
centre is required.
• There is substantial evidence that by imparting
good habits, positive modelling, cognitive
behaviour and certain learnings early,
substantially reduces the risk of addiction, self-
harm, suicide and poor peer choices.
Because Only The Experts Know What to
Look For

19. Evidence-Based Care
We aim to bring the most successful programs
from abroad proven to treat BPD into our
Therapy suit.
The Haven in the UK
Spectrum in Victoria
TARA Method in New York
Sierra Tucson

20. Treatment Follow through
Bateman and Fonagy 2000) concluded that treatments shown to predict the most
compliance are:
• BPD specific
• Make considerable efforts to enhance compliance
• Have clear focus, whether the targets are behavioural or interpersonal
• Utilise a strong case-management approach
• Well structured
• Are relatively long-term.
• Offer opportunities for 1 on 1 counselling after a learning program.
• Are well integrated with other services available to the client.
• Treating clients as capable (not fragile)
• Emphasising hope and recovery
• Providing a framework for coping
• Share a social element
Meta-analysis suggests
that specific
psychotherapeutic
treatment for BPD is
associated with a
sevenfold greater rate of
recovery compared to
the natural history of the
disorder
(Perry et al, 1999).

21. The provision of adequate community beds
and the strengthening of appropriate
services in the community are crucial to
reducing inappropriate and therefore excess
demand for acute hospital beds. Evidence
shows that individuals with mental illness are
occupying hospital inpatient beds for longer
than necessary due to the absence of more
appropriate community services.
BPD patients don’t necessarily want a bed but rather somewhere they can feel safe
and relieved. By creating a Sit & Feel Safe Centre we believe BPD patients will forgo
the ED and attend our centre directly. This has been tried and is currently successful in
Victoria (see Spectrum).
Based on our costings this will produce a $9,000,000 savings per year.
Reducing Hospital Beds
Numbers & Readmission
Rates

22. Addressing
Criminal Justice
Compared to the general
community, the prevalence of
mental health issues is higher at
every stage of the criminal
justice process. Internal
modelling shows that
approximately 65 per cent of the
juvenile and 59 per cent of the
adult prison population have
mental health problems.
While only 2% in the community.

23. Your mission should you choose to accept
it……
The Adult Marshmallow Test
Help us to break this cycle.

24. Let’s Make This A Reality…
Impulse Control Support
Service of
Western Australia

25. ADHD Services in WA

26. BPD Services in WA