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

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 (ORday-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.