Dr Ruchika Gajwani's new research will test a new intervention for young people living with Borderline Personality Disorder (BPD). We caught up with her to find out more about her career to date, and her motivations behind researching BPD.
Could you tell us about your academic career so far?
My longstanding interests in developmental psychology and mental health inspired me to pursue a Masters in Developmental Psychopathology. I was awarded the School of Psychology Scholarship, at the University of Birmingham, to pursue my Doctoral research with young people at high risk of developing psychosis. As a post-doctoral Research Fellow on the Department of Health-funded ENRICH programme, I led the study examining ethnicity and detention.
I trained as a Clinical Psychologist at the University of Birmingham to develop as a relational, evidence-based practitioner allowing me to engage in clinically relevant research. Since moving to Scotland and joining the Adverse Childhood Experiences (ACE) Clinical and Research Centre in 2014 at the University of Glasgow, as a clinical psychologist and a research fellow, I have had the opportunity to spend the last six years engaging with local services and experienced service providers, as well as researching the gaps in young people’s mental health provision.
I am part of a unique multidisciplinary team of clinical-scientists who are supported in a collective endeavour of early identification, intervention and prevention of mental health in infants, children and young people.
How long have you been at your current university?
I have been working at Glasgow University for almost seven years. I joined the Adverse Childhood Experiences (ACE) Research Centre within the Institute of Health and Wellbeing in May 2014, as a Clinical Psychology Research Fellow. I have also worked alongside as an Honorary Clinical Psychologist at the Psychotherapy service in specialist Child and Adolescent Mental Health Services, NHS Greater Glasgow and Clyde.
What is your area of study?
I have been involved in research on youth mental health, with a particular interest in early detection and intervention for borderline personality disorder and psychosis. I have worked on investigating the extent to which genetic and environmental factors contribute to mental health difficulties, specifically the links between neurodevelopmental conditions and adverse childhood experiences, using data on twins in Sweden. Engaging substantially in the model of early intervention, I am interested in clinical research to understand what are the developmental pathways to mental health (both in relation to at-risk and resilience).
What motivated you to research borderline personality disorder?
My career, leading to this MQ fellowship application, has focused on understanding the developmental pathways to risk and resilience in young people’s mental health. The kind of research I do, which engages substantially in the model of early intervention services based on good relational clinical care, has shown me that it is crucial to focus on both excellent mental health assessment and the quality of young peoples’ real lives. This includes ensuring that young people do not fall into the cracks between services and ensuring that all those people involved in the young person’s life – the young person themselves, their family (where possible) and the professionals supporting them – really understand how this unique individual functions.
What are you hoping to achieve as a result of your research?
Currently, borderline personality disorder (BPD) is viewed by many clinicians, young people and family members as intractable, entirely trauma-related and, where specialist services exist, treatment provision is delayed and limited to a few. Without a diagnosis, it can be hard for young people to access services, yet with diagnosis, there is a risk of labelling, stigma and discrimination.
Our own pilot (the ‘Pathways study’) and work from other groups have shown that, despite their high psychiatric risk, young people with BPD symptoms are less likely to be assessed or treated and often fall into the gap between child/adolescent and adult mental health services. They are often out of school, not in work or training and, as a consequence, there is a huge impact on their quality of life.
To improve the quality of life of these extremely vulnerable young people, during this most important life transition from childhood to adulthood, it is crucial to fully understand the contexts in which they live. My previous research has shown me that focusing entirely on the mental health aspects of BPD will not suffice. If their quality of life is going to improve, and if the development of additional problems like severe depression or psychosis is to be prevented, young people with BPD need a focus on all of the many aspects of their lives, things that are meaningful to each unique individual.
"If their quality of life is going to improve, and if the development of additional problems like severe depression or psychosis is to be prevented, young people with BPD need a focus on all of the many aspects of their lives, things that are meaningful to each unique individual."
Young people with early BPD benefit from good clinical care management and targeted intervention, however, are regularly missed or mislabeled because of high levels of stigma attached to the diagnosis. By taking this project into the general population of young people aged 14-24, and not limiting intervention to secondary mental health services, we:
- may identify “hidden groups”, for example, young people avoiding contact with services due to their trauma, neurodevelopmental symptoms or complex family needs
- assess the feasibility of early identification of BPD symptoms in the general population, and
- assess the clinical utility of integrative, multi-agency work for complex needs.
How do you feel about getting the Fellows award from MQ?
The opportunity to be an MQ ambassador for mental health research for young people is very fulfilling! Research leading up to this has shown that early intervention, when delivered in collaboration with universal services (good clinical care in schools, social services, vocational services) has good outcomes. Yet, the model is not universally adopted. The reasons for this are complex, for example, different service delivery contexts.
I feel very fortunate to be awarded the MQ fellowship, which gives me the opportunity to support the feasibility trial in Scotland. A commitment to the mission of early intervention - not just in principle but through multi-agency collaboration and partnerships with experts in the field.
How important is it to invest in research for the progression of our understanding of mental health conditions and treatments?
Mental health research is hugely underfunded in relation to clinical research within health. Within mental health research, Borderline personality disorder research receives approximately 1% of research funding – this has implications on assessment, intervention for some of the most vulnerable and underserved people in our society. Importantly, there is now good evidence that early intervention is possible and negative long-term outcomes can be avoided. However, this has not been looked at for adolescents and young people in the community, who may not be seen by a professional in a mental health team, who may be missed from services as they don’t “fit” a model or diagnosis.
This study will hopefully give us insights on how we can meet the needs of young people so there aren’t missed opportunities, making health, mental health more equitable. During the pandemic, investment in infectious diseases research has got us a vaccine within less than a year, showing us what can be achieved through focused scientific effort.
"Mental health research is hugely underfunded in relation to clinical research within health. Within mental health research, Borderline personality disorder research receives approximately 1% of research funding – this has implications on assessment, intervention for some of the most vulnerable and underserved people in our society."
Is there anything else you would like to say?
BPD diagnosis is a controversial one. And with reason. Without diagnosis, it can be hard for young people to access services, yet with diagnosis there is a risk of labeling, stigma and discrimination. The study aims to engage with young people early in the course of BPD, so their voice is heard by researchers, clinicians and stakeholders - so its meaningful not only for young people that have a diagnosis but those that may be discriminated when left unsupported or mislabelled.
