Project Air Strategy for Personality Disorders (projectairstrategy.org) enables the delivery of better patient care for people with personality disorder. It partners UOW with people with lived experience of personality disorder, the NSW Ministry of Health, Local Health Districts, NSW Department of Education, schools, community organisations, consumer groups, health professionals, families and, carers. Although Project Air formally commenced in 2011, background research and applied work started in 2001 with a Commonwealth Mental Health Integration Project that led to the initial pilot studies into personality disorder treatment. The key benefits have been improved clinical practice, patient outcomes, and better patient and carer support, information and research.
3. Good health and well-being
11. Sustainable cities and communities
Details of the Impact
The research that has led to Project Air has delivered tangible benefits for health services and patients, with health, societal, educational and economic impacts. These impacts have been achieved through (a) improved clinical practice and patient outcomes and (b) better patient and carer support, information and research.
Impact claim 1: Project Air improved clinical practice and patient outcomes
This project is the first in the world to develop a ‘whole of service’ approach to improving the treatment of personality disorder. It has implemented the first peer-reviewed stepped-care model of personality disorder treatment, including comprehensive whole of service clinical guidelines, which have since been cited by the National Health and Medical Research Council. It has influenced national strategies aimed at improving clinical care for those with personality disorder, increased awareness, and given the community a national voice.
Project Air has deeply impacted health care, training >3000 staff (comprising 32% nurses, 24% psychologists, 24% allied health workers, 15% psychiatrists, and 5% senior leaders). Of those trained, 97% said they would recommend the training to a colleague. Post-training reports also showed significantly increased clinical skills, confidence and changed attitudes in clinicians.
Following training, researchers have worked closely with health care services to establish new clinics using the Project Air model to treat the disorder. To monitor and understand the impact, outcomes from the clinics were tracked longitudinally. Comparisons of initial and 12-month follow-up assessments of patients graduating from these clinics showed a significant improvement in symptoms, quality of life, and productivity in their daily activities. Patients also reported significantly lower ratings of suicidal ideation and attempts, and reductions in deliberate self-harm. Evaluation of the stepped care approach, compared with treatment as usual showed presentations to Emergency Departments significantly reduced by 22%, and admissions and length of stays in hospitals significantly reduced from an average of 14 days to 4.3 days per admission. As a consequence, the mean cost saving for implementing personality disorder psychological treatment is estimated to be AUD $3,900 per patient per year in both our data and global benchmarks. The NSW Minister for Mental Health, Pru Goward MP, summarised: “Reductions in presentations in emergency departments, reduced length of stay in hospital and of course, improved experience of families and carers… Project Air, one of our success stories, is instrumental in our efforts to better address self-harming behaviours and reducing suicide risk”.
Impact claim 2: Project Air led to better patient and carer support, information and research
Project Air was the first to evaluate, with a randomised controlled trial, a new family and carer intervention, that significantly improved relationships, family empowerment, and active support from family with a relative with the disorder. The family and carer approach has been widely disseminated with hundreds of families benefitting from access to this new evidence based intervention. The accompanying training video has over 1,000 views on YouTube.
Project Air has a dissemination strategy to increase the reach of our research and improve the understanding of evidence-based treatment for personality disorder both for health professionals and the general public. Website statistics show over 25,000 page views of our team-produced manuals, clinical guidelines and fact sheets to support clinicians, individuals, family members, and carers as they navigate through the health service. The Project Air website has had over 40,000 unique people visiting over 5 years, with 32.5% returning. We have produced and published over 30 fact sheets, 18 original videos with more than 3,300 collective views, and over 500 followers on Facebook. These resources assist clinicians in providing effective care, and the consumer resources help patients understand and better manage their mental health difficulties.
Project Air has sponsored over 10 international conferences, which have predominately been opened by Ministers of Health or Commissioners of Mental Health. These conferences have had over 3,000 delegates in attendance; integrating research leaders and clinicians alongside the patient and carer community. The conferences have provided a valuable forum for the discussion and dissemination of evidence‑based clinical care.
Work by Project Air has included end-user driven research: people with lived experience and their families and carers were directly involved in the co-production and implementation of the work within communities. This was recognised by a prestigious Mental Health Matters Award for Cross-sector Partnerships (2013) presented by the NSW Minister for Mental Health (Kevin Humphries) and Governor of NSW (Marie Bashir) at Parliament House. This award recognised the collaborative nature of Project Air with Consumers and Carers in enhancing partnerships and reaching out with new models of care into the community. Minister Goward stated: "I congratulate the work of Project Air in asking these questions and delivering on a strategy now across the state ... Finally we have the beginning of a systematic state wide response... In supporting clinicians, providing an academic hub and disseminating information and resources [the Project Air] team are pivotal to making this change for the better. And the New South Wales government is therefore proud to continue to support Project Air as we do, and we've committed to another five years [of funding], across the state". Graduates from UOW involved in Project Air have also gone on to be leaders in the field, with over 10 PhD graduates and more than 30 peer-reviewed publications providing support for the new models of care and the underpinning science behind the disorder and its treatment.
- Patients with personality disorder and their family and carers
- Social workers
- Occupational therapists
- Drug and alcohol workers
- Other inpatient and community mental health staff
- Emergency departments and inpatient units
- The NSW health care system
Approach to Impact
Summary of the approaches to impact
The strategic goals of UOW are to enable our researchers to act as social catalysts for positive change in the community. We empower individuals and communities by working in partnership with government, non-government, social and health care agencies and the not for profit sector to achieve social impact. Our approach to implementing key strategies has been to embed impact within our research culture by nurturing long-standing and robust partnerships with the wider health system and end‑user beneficiaries (e.g. people with substance use or personality disorders), appointing and mentoring staff in key strategic areas, and supporting research financially and with significant infrastructure.
Approach to Impact
Psychology research at UOW encompasses basic/brain science, experimental, cognitive, developmental, personality, sport, health and clinical areas, with an overarching strategy to encourage development toward applied outcomes. We utilise our understanding of human behaviour to produce highly applicable research. Our research empowers individuals and partner organisations to make positive change, especially for the most vulnerable in the community, as well as influence policy and leaders in government, health services and industry. Meaningful partnerships with community organisations enabled by our initiatives have also been established.
We achieve our goals with grants, infrastructure that enables translation of research, and strategic staff appointments. UOW psychology graduates are motivated to improve the mental health and well‑being of the community by our embedding of highly applicable research into teaching, prioritising future-oriented learning experiences connected to the community, and promoting evidence-based practice. A key example is our clinical psychology training facility, Northfields Clinic — a high quality, effective resource for the community, providing greater community engagement and early childhood research opportunities — improved by the appointments of field experts de Rosnay and Herbert. Grenyer as Chair of the Psychology Board of Australia for the past 9 years is another example of UOW’s influence in the wider profession and community.
In our approach to increasing research excellence toward real-world societal impact, we facilitate sourcing of diversified funding, provide grant writing support and seed funding for new areas (including university funding for new research groups and strategic international partnerships), and significantly invest in facilities and infrastructure that support ECRs and PhD students attached to community projects. Research-based training is also prioritised to enhance the scale of our impact for uptake by key beneficiaries. Impacts from these targeted approaches include: Grenyer’s Project Air; Deane, Crowe and Oades’ Collaborative Recovery Training Program in Mental Health that has trained >3000 mental health workers (multi-award winning program across the public, academic and commercial sectors); Johnstone’s 'Focus Pocus' (2013 Vice Chancellor’s Award), a world first neurocognitive training tool improving behavioural control in children with ADHD, that has been expanded for research/implementation with partners across China (e.g. Peking University); Marceau, Solowij and Kelly’s research into cognitive remediation training in substance use in partnership with the NGO, We Help Ourselves, which has been taken forward for end-user driven implementation across national health services; Palmisano’s application of vision research to aircraft pilot landing and space travel (2015 Vice Chancellor’s Award) in partnership with the Canadian Space Agency and NASA; Vella and Deane’s implementation of “Ahead of the Game”, addressing mental health in adult and adolescent males through sport, in partnership with the Movember Foundation and multiple end-users e.g. Cricket Australia, Football Federation Australia.
These initiatives are supported by maintaining productive long-term research partnerships and recognising the value of end-user driven research. Research efforts are not only concentrated in areas of research strengths, where existing robust partnerships are underpinned by solid research, but also by actively encouraging new relationships — early childhood development collaborations with the Departments of Education and Health and schools; omega-3 and aggression research with the Department of Justice and Corrective Services. In addition to Project Air’s partners, Deane and Kelly’s >10-year collaboration with The Salvation Army has led to their research being embedded within The Salvation Army’s routine practice to improve service delivery and client care. This is progressed further with our researchers conducting multi-site, controlled studies to trial innovative clinical interventions for implementation within addiction and mental health services. Croft and Loughran’s mobile phone and radiofrequency research (NHMRC Centre of Research Excellence) informs the Australian Radiation Protection and Nuclear Safety Agency and the World Health Organisation. Some of these and other initiatives (e.g. Byrne’s antimicrobial resistance research) were funded by UOW’s Global Challenges Program that specifically targets initiatives addressing key areas of societal impact. Research that has proactively responded to community demand and is poised to make significant impact on multiple levels (health, policy) in the community is Solowij’s work on medicinal cannabis, where Solowij now co-leads a NHMRC CRE to ensure safe and appropriate implementation.
Visibility of our research outcomes has been maximised by: highlighting the research on UOW websites, encouraging publication in Open Access journals and articles in general audience publications (The Conversation) to reach broader audiences, and dissemination of School Research Reports and University publications profiling our researchers (Women of Impact, Partners for Research Impact, Big Ideas) to key stakeholders in the community. By recognising the contributions, work and dedication of our community partners with networking, social/community fora, inclusion in conferences/workshops, and authorship to collaborators on publications, we ensure iterative, interactive and engaged collaboration with end-users. This is maintained by our support of Project Air’s annual international conferences that are significantly attended by end-users and beneficiaries, and Croft’s NHMRC CRE annual conference and work with community, industry, government and academia that translates research outcomes to better public health knowledge about radiofrequencies and electrohypersensitivity.
In 2001 a psychotherapy research laboratory on complex disorders was established at UOW to progress underpinning scientific studies into the mechanisms of change into clinical treatments for complex mental health disorders. The team from the laboratory forged close connections with the International Society for Psychotherapy Research, connecting its research program with world leaders and collaborators across the globe including the USA, Germany, UK, Sweden, Italy, Israel and Singapore. Brin Grenyer (UOW) chaired the local hosting committee for the 44th International Meeting of the Society for Psychotherapy Research in 2013.
Collaborative research between Kye McCarthy (UOW) and Professor Erhard Mergenthaler (University of Ulm, Germany) has clarified how important it is for the therapist to integrate attention to both the emotional and cognitive components of psychotherapy, and illuminated how critical change events attended to by therapists lead to surges in patients experiencing clinical improvement. These outcomes from this associated research have been incorporated into the essential clinical strategies in Project Air.
1. Ng, FYY, Bourke, ME, Grenyer, BFS. (2016) Recovery from Borderline Personality Disorder: A systematic review of the perspectives of Consumers, Clinicians, Family and Carers. PLoS ONE 11(8): e0160515. doi:10.1371/journal.pone.0160515.
2. McCarthy, KL, Lewis, KL, Bourke, ME, Grenyer BFS. (2016) A new intervention for people with borderline personality disorder who are also parents: A pilot study of clinician acceptability. Borderline Personality Disorder and Emotion Dysregulation. 3(10). doi:10.1186/s40479-016-0044-2 (open access).
3. Grenyer, BFS. (2015) Explainer: what are personality disorders and how are they treated? The Conversation, 24 March 1-4.
4. Grenyer, BFS. (2014) An Integrative Relational Step-Down Model of Care: The Project Air Strategy for Personality Disorders, ACPARIAN (Australian Clinical Psychologist), 9, 8-13. https://ihmri.uow.edu.au/content/groups/public/@web/@ihmri/documents/doc/uow177533.pdf
5. Bailey, RC and Grenyer, BFS. (2014) Supporting a person with personality disorder: A study of carer burden and wellbeing. Journal of Personality Disorders, 28(6), 796-809. doi:10.1521/pedi_2014_28_136.
6. McCarthy, KL, Mergenthaler, E, Grenyer, BFS. (2014) Early in-session cognitive-emotional problem-solving predicts twelve-month outcomes in depression with personality disorder. Psychotherapy Research, 24(1), 103-115. doi:10.1080/10503307.2013.826834.
7. Grenyer, BFS. (2013) Improved prognosis for Borderline Personality Disorder: New treatment guidelines outline specific communication strategies that work. Medical Journal of Australia, 198(9), 464-465.
8. McCarthy, KL, Carter, PE, Grenyer, BFS. (2013) Challenges to getting evidence into practice: Expert clinician perspectives on psychotherapy for personality disorders. Journal of Mental Health, 22(6), 482-491. doi:10.3109/09638237.2013.779367.
9. Fanaian, M, Lewis, K, Grenyer, BFS. (2013) Improving services for people with personality disorders: The views of experienced clinicians. International Journal of Mental Health Nursing, 22, 465-471. doi:10.1111/inm.12009.
10. Bourke, M, and Grenyer, BFS. (2013) Therapists' accounts of psychotherapy process associated with treating Borderline Personality Disorder. Journal of Personality Disorders, 27(6), 735-745. doi:10.1521/pedi_2013_27_108.