104. The impact of community-participatory governance models on the rehabilitation outcomes of borderline personality disorder patients

Abstract Background Borderline Personality Disorder (BPD) is a severe mental illness whose treatment has long relied on specialized psychological and pharmacological interventions within hospitals. However, patients often experience high relapse rates upon returning to the community due to social dysfunction and weak support systems. In recent years, participatory governance models integrating community resources have demonstrated potential in mental health. However, research on their specific application and efficacy assessment for BPD patients remains limited. This study investigates a community-based participatory governance model grounded in the biopsychosocial framework. It aims to explore whether a novel approach—integrating patients, family members, community workers, and healthcare providers into a collaborative governance alliance—can effectively enhance patients’ long-term rehabilitation outcomes and social adaptation capabilities. This research seeks to provide crucial practical evidence and theoretical reference for optimizing the comprehensive management of BPD. Methods The randomized controlled trial was performed for 12 months. One hundred twenty BPD patients meeting diagnostic criteria were assigned at random to the experimental group (EG, n = 60) and control group (CG, n = 60). The CG received routine outpatient treatment and case management. The EG, in addition to routine treatment, implemented a structured community engagement intervention comprising: establishing a multi-stakeholder “Community Support Group” holding regular shared-decision case conferences, conducting family empowerment workshops, and organizing peer support activities led by recovering patients. All patients were evaluated at baseline, 6/12 months post-intervention by the Symptom Checklist-90 (SCL-90), Interpersonal Trust Scale, and Global Assessment of Functioning (GAF) scale. Repeated measures ANOVA was taken to compare group differences. Results After 12 months of intervention, data indicated that the community participation governance model were significantly positive on the recovery of BPD patients. The EG exhibited a mean reduction of 28.5 points in SCL-90 total scores compared to the CG (p<.01), with particularly pronounced improvements in the hostility, depression, and interpersonal sensitivity subscales (reductions of 4.2, 5.1, and 4.8 points, all p<.05). Regarding social functioning, the EG’s GAF score improved to an average of 68.3 points, obviously higher than the CG’s 59.7 points (p<.01). Specifically, 71.7% (43/60) of patients in the EG achieved a GAF score of “mild functional impairment” or better, whereas only 41.7% (25/60) of patients in the CG reached this level. Additionally, the EG exhibited a lower rate of emergency department visits (15%) compared to the CG (36.7%), and their interpersonal trust scores increased by 22.4%, both demonstrating obvious differences (p<.05). Discussion The findings confirm that the community-participatory governance model effectively alleviates core BPD symptoms, significantly enhances social functioning, and reduces crisis incidents, demonstrating clear practical value. By establishing an inclusive, empowering supportive environment, this model transforms external interventions into patients’ internalized social capital and self-management capabilities, serving as a potent complement to traditional medical approaches. Future research should focus on optimizing standardized operational procedures for this model, exploring its cost-effectiveness and long-term sustainability in broader community settings, and examining its differential effects on patients with different BPD subtypes. These efforts will advance the transformation of public mental health services from a “treatment-centered” to a “health management-centered” approach. Funding No. 21VMZ016.