When someone with BPD does not want help

Find out what made help difficult

They may want support and still find it hard to attend, trust a new clinician or return after a difficult appointment. Ask about the particular problem rather than treating a missed session as proof that they do not want to get better.

You could say: “What made that appointment hard? Is there anything you would want to be different before trying again?”

Offer help they can accept: writing down a concern, arranging transport or contacting the service together. You do not have to persuade them to agree with the diagnosis before talking about sleep, distress or something they want help with.^[1]

If they stop attending

With their agreement, ask the team what happens after a missed appointment and whether a conversation about restarting is possible. Ask who they can contact while that is being arranged.

If a letter says “non-engagement”, help them describe what prevented attendance and what might make support workable. Avoid promising that the service will reopen the case; ask for a clear decision and the next route.

You can still pass on factual safety concerns if they do not want you involved.

If care is ending or they are being discharged

Ask for a planned handover: who will provide ongoing care, how to get help in a crisis and how to return if things worsen. NICE recommends discussing changes or withdrawal of services beforehand and making a structured, phased plan.^[2]

• “Who is taking over, and has that referral been accepted?”
• “What should we do if the next appointment is weeks away?”
• “Can they have the plan and contact details in writing?”

Use services are taking too long or saying no if no one is taking responsibility.

If things become urgent

A previous refusal of help does not settle what they need now. Describe the current change and use their crisis plan or urgent mental-health help. Call 999 if someone is in immediate danger.

If a service says it does not admit people with BPD, ask how it has assessed this person’s current risk and what safe alternative it is offering. Admission is not always the best option, but the diagnosis alone should not exclude someone from care. See when crisis services turn someone away.

Keep your own limits clear

You can care about them without becoming their only source of support. Say what you can reliably do, and ask for help when the arrangement is no longer safe or manageable. Our guide to intense conversations and support when you are running on empty can help.