Telemedicine in the Management of Borderline Personality Disorder and Suicide Risk: A Scoping Review

Introduction/Objective: People with borderline personality disorder have high rates of self-harm and suicide attempts and often present in crisis, yet many cannot access consistent inperson care. Telemedicine may expand timely, less-stigmatized treatment. To map and synthesize the available evidence on the effectiveness, safety, acceptability, and implementation characteristics of telemedicine interventions for adults with borderline personality disorder and suicide risk Methods: We conducted a scoping review in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched MEDLINE, Embase, PsycINFO, Web of Science, Cochrane Library, and Scopus from inception to 30 June 2025 using combinations of keywords related to borderline personality disorder, BPD, telemedicine, telepsychiatry, telepsychotherapy, digital mental health, suicide, suicidal ideation, self-harm, and non-suicidal self-injury. An updated search was conducted from 1 July 2025 to 1 May 2026, using the same databases and search strategy, to identify newly published eligible studies before resubmission. We included studies on adults with diagnosed or probable borderline personality disorder that evaluated clinician-led, cliniciansupported, or adjunctive digital/telephone interventions delivered via video, telephone, secure messaging, mobile applications, web-based psychoeducation, internet-based self-management tools, or blended digital formats, and reported outcomes on suicidality, non-suicidal self-injury, crisis service use, treatment engagement, or functioning. A total of 19 studies met the inclusion criteria. The updated search did not identify additional studies meeting the eligibility criteria. Methodological quality and study limitations were examined using design-appropriate appraisal tools. Results: Across the included studies, clinician-led telemedicine interventions showed promising but heterogeneous findings for suicidal ideation, non-suicidal self-injury, treatment engagement, and crisis-related outcomes. Several studies reported reductions in suicidal ideation or self-harm, while others showed comparable outcomes to in-person or usual care. Because numerical effect estimates were available only for a subset of studies and outcome measures varied substantially, the findings should be interpreted cautiously. Therapeutic alliance, adherence and satisfaction were generally acceptable and, in some comparative studies, broadly comparable to face-to-face care when core treatment components were preserved, and between-session coaching was available within steppedcare pathways with explicit safety procedures. Discussion: These findings indicate that telemedicine can support core components of borderline personality disorder care, including skills training, structured crisis follow-up and between-session support, when delivered within structured, safety-focused pathways with explicit crisismanagement protocols. However, the certainty of the evidence is limited by heterogeneous study designs, small samples, short follow-up and inconsistent outcome reporting, so telemedicine is best regarded as a promising complement to, rather than a replacement for, in-person care. Conclusion: Telemedicine may represent a feasible and promising component of care for adults with borderline personality disorder and elevated suicide risk when implemented within structured, safetyfocused pathways. Its clinical relevance depends on explicit crisis-management protocols, routine verification of patient location, predefined emergency procedures, and coordination with local services when acute risk escalates. Larger, longer-term trials with standardized self-harm outcomes and explicit attention to digital equity, clinician workload, and cross-context applicability are needed.