I’m a mental health nurse working on locked ward with females with personality disorder - ask me anything

[Dino90]

Please ask away if there’s anything you’d like to know

How do you handle the knowledge that if it was not for evil people in the past the majority of these people would be leading relatively normal life’s

I know I'm not the OP but I don't think it's that simple. I have CPTSD but definitely don't have EUPD - I've been formally assessed several times and it doesn't fit. I have a friend who is regularly hospitalised with EUPD and we deal with very different issues and behaviours - she self-harms very badly and has smashed up her hospital room in the past and attacked nurses, for example. I also know others with CPTSD with backgrounds of extremely severe trauma who also definitely wouldn't be diagnosed with a PD - they function in many ways although have other issues with things like nightmares, being easily scared, etc.

I think having a personality disorder is in part an innate/genetic issue in addition to being related to trauma. So trauma can provoke or exacerbate it but it isn't the case that if you have experienced severe trauma you have a PD.

Obviously I still find it massively problematic that there are scores of women with PD's and without who are having to spend a lot of their lives trying to undo the damage done by others. It's an example of life being very unfair. I do hate the stigma around PD's when many sufferers have survived some dreadful things and many aren't really harming anyone - one of the gentlest, kindest women I know has EUPD. She will never be any risk to anyone other than herself.

We do screen material we make available on the ward
I’m assuming that means things like DVDs and TV channels - do patients have access to the internet on their own devices etc though? Like Facebook etc? Does that cause issues if so? (Sorry if I’ve missed it, not caught up yet)

I was in a regular psych ward as a teen and I’ve no idea how they’d have handled smartphones and such. I think I had to give my (brick) phone in to the office most of the time, but maybe it was different for adults.

SingToTheSky Ds was in an adolescent ward as a teenager smartphones were a thing then. He was allowed his smart phone but the internet was blocked as was the camera. In adult wards he’s always been allowed his phone with the internet on it. Although I would imagine it can vary from patients to patient.

Is there any particular misconeption about patients or the illnesses that you'd like to dispel?

Any particular misconeption or message about your work that you'd like to get out?

Jan meyer look up the work of professor Francis mcglone

@JanMeyer So women objecting on the grounds that males have no right to be in female spaces isn’t enough?

Are you able to explain what you mean by no ‘right?’ What legislation are you referring to?

Do women not have the right to "not want" a man in their space?

Yes women are able to express not wanting a man in their space

What's the point in having a sex segregated unit if you're going to allow people on the unit according to their gender identity?

We are a female and trans female ward (risk dependent)

What would happen in a situation where a female patient refused to use the correct pronouns or accept the transwoman's gender identity? How would that be handled? Would the same line be taken that is in some refuges, that is would the complainant be told "transwomen are women" and they have no choice but to accept that view?

As always, we would provide support to all involved in any difficult interactions. Nothing would ‘happen’ as a result of the situation you describe

Why do you think it's acceptable and safe that male bodied people are allowed on a female ward? Would you be comfortable with that if you were a patient on a secure locked ward?

‘There would have to be risk factors which could not be mitigated before we would refuse a trans referral.’

Risk factors like them being male?

Fortunately for us as team, for our patients, and for anyone hoping to access our service, our risk assessments are more sophisticated than marginalising entire groups of people based on a shared characteristic. Our risk assessments are individualised, evidence based and very thorough.

There are certain ethnic and religious groups, for example, which statistically present with increased risks in certain areas. Again, we aren’t discriminatory against any one group of people.

As I’ve said before, it’s naive to believe that there’s a particular ‘poster’ male/ female/ transgender male/ female that embodies an abuser

@SemperIdem Early on you mentioned that patients families are often more detrimental to the patient in terms of behaviour than vice versa - is that because of an element of enabling behaviour?

Sometimes. More typically by being invalidating, reinforcing patients’ core beliefs and/or continuing with systematic abuse of the patient

*Risk factors like them being male?

Fortunately for us as team, for our patients, and for anyone hoping to access our service, our risk assessments are more sophisticated than marginalising entire groups of people based on a shared characteristic. Our risk assessments are individualised, evidence based and very thorough.

There are certain ethnic and religious groups, for example, which statistically present with increased risks in certain areas. Again, we aren’t discriminatory against any one group of people.

As I’ve said before, it’s naive to believe that there’s a particular ‘poster’ male/ female/ transgender male/ female that embodies an abuser*

This is frankly gibberish.

@bananabanona Are patients more typically from certain social classes? What proportions are from wealthy, more privileged backgrounds compared to less wealthy, less privileged backgrounds?

If I think about our patient group, generally no. The common denominator is typically abuse of some kind, often from primary caregivers

@SparklingLime This is frankly gibberish.

Sorry, I’m not sure how I can be clearer in my responses to questions about trans patients. It seems I’m not providing the type of response many posters appear to be looking for. I’m by no means an my kind of expert on the topic and am trying to communicate my thoughts about the potential issues as best as I can

@peachgreen Do you get to follow the "success stories" - i.e. patients who have gone on to positive outcomes, whatever that might look like for them on an individual basis?

Only if they themselves choose to keep us updated after discharge

@SingToTheSky I’m assuming that means things like DVDs and TV channels - do patients have access to the internet on their own devices etc though? Like Facebook etc? Does that cause issues if so? (Sorry if I’ve missed it, not caught up yet)

Yes, it means that we restrict things like especially violent or sexually explicit DVDs from being available in communal areas. Most patients have access to the internet via their mobile phones. We would consider removing someone’s phone for various reasons, for example, if they were known be in contact with an abuser and it was having a detrimental impact on their mental state to the point that they were at an increased risk of causing themselves harm. We’ve often had to remove mobile phones from patients incessantly calling emergency services

[quote Dino90]**@SparklingLime* This is frankly gibberish.*

Sorry, I’m not sure how I can be clearer in my responses to questions about trans patients. It seems I’m not providing the type of response many posters appear to be looking for. I’m by no means an my kind of expert on the topic and am trying to communicate my thoughts about the potential issues as best as I can[/quote]
Yes, that’s the problem - it’s very apparent that you are not at all clear on this issue and it’s implications. It’s worrying.

@SparklingLime I’m not really sure how I can be any clearer than by communicating that I don’t consider a trans female to be a risk to females based solely on them being trans

@SparklingLime I would be interested to hear why you do

Hi, fascinating post, thank you.

I was wondering if delusional disorder is classed as a personality disorder, and if you can offer insight into causes, and if it's treatable.

After 15 years I finally left my husband and took our 3 children away with me. He was diagnosed with psychosis about 18 months ago, and further appointments with his psychiatrist lead to a diagnosis of delusional disorder.

He has always been paranoid, but it has got worse and worse, and now I have left he is beyond vile. The ideas he has about me and others in general are far fetched to say the least. And if it was just me to consider I would walk away and never look back. I suppose what I'm basically asking is if my children will ever have the dad they need, as right now he just isn't capable of managing with them (and I'm aware of how harsh I sound, but after years of being beaten down I struggle to think favourably towards him)

Do patients often have co morbid diagnosis alongside their personality disorder diagnose? E.g. eating disorders?

@thedaywewillremeber Do patients often have co morbid diagnosis alongside their personality disorder diagnose? E.g. eating disorders?

Yes, in the majority of cases. Often we see co morbidities such as depressive disorders, PTSD and ADHD

[quote Dino90]@SparklingLime I would be interested to hear why you do[/quote]
The risk lies in them being male. You cannot be unaware of that.

Given the context of very vulnerable patients who have experienced high levels of distress, I find your disingenuous reply very uncomfortable.

Do you look after patients psychical health on the ward? I know in units ds has been these been a weekly psychical checks on all the patients.

I think the OP has been very clear about the situation.

The ward she works on is for women and trans women who have been fully risk assessed using standardised assessment tools.

There is no blanket rule which says all trans women will or won't be admitted.

There are massive safeguards in place to protect women on the wards and if there has been an incident where this did not happen, there are huge issues with that service specifically.

It is a massive issue which needs to be dealt with sensibly and sensitively and on a case by case basis. One of the challenges of working in these settings is that the media present a very skewed version of situations and professional ethics (quite rightly) stops the detail of a situation being shared. So really, unless you're directly involved in an investigatory panel you're unlikely to know the full story.

@SparklingLime The risk lies in them being male. You cannot be unaware of that.

I’ve nursed males very unlikely to ever cause a female harm and others who have posed an extreme risk. Similarly I have nursed females who have only ever been victims of violence, as well as having reviewed countless referrals for women who are sexually deviant and have been assaultive towards other women within services.

No doubt this debate will continue to rumble on for many many years and care service reviews to come. All I’m able to do in the meantime is provide treatment that is effective in an environment that is above all else. safe, for both my team and any patients in my care

As the mother of a son with enduring mental ill health I just want to say thank you. You're the unsung heroes of the NHS, vastly underfunded and over subscribed. Xx