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

@Dino90 Hi I've not got any questions for you but I'm due to return to uni next month to complete my training. PD really interests myself are a specific "diagnosis" so I'm placemarking your thread.

Did you specifically want to work with women with complex trauma or did you just end up working in that environment iyswim?

@peachpearplum01 How do the women come to be on the ward in the first place (as it’s so hard to get decent psychiatric help for personality disorders). Have they been sectioned?

Our patients are at the upper end of high risk. They’re likely to have had multiple acute hospital admissions and extensive contact with community mental health services, substance abuse services, police/ A&E. Their community teams will have typically reached a point where managing them in the community becomes unsustainable and short hospital admissions haven’t worked, so they’ll look for a placement which will offer a longer period of rehabilitation

@SingToTheSky How do the women come to be on the ward in the first place (as it’s so hard to get decent psychiatric help for personality disorders). Have they been sectioned?

No, we consider each referral as a team before we decide whether or not we’ll offer admission. We reject the majority of referrals

@Supersimkin2 And the big one; how damaging are the patients to others? Is it all bad news?

This is an interesting one. Can you be more specific about what you mean by ‘damaging’?

I am starting a mental health nursing degree in September as a mature student. Have you got any advice? (Please don't say don't do it )

@NiceGerbil How do you feel about facilities like yours operating on a self id gender basis rather than sex?

You would have to present to me an individual along with all of their pre admission assessment information for me to formulate an opinion on a case by case basis

How often does alcohol play a part in your patients lives before they are admitted?

I have BPD/EUPD do you think I’ll ever be truly happy?

[quote Dino90]**@AfterSchoolWorry* What is the most common one?*

Borderline personality disorder

Do you think many autistic women are misdiagnosed as having things like EUPD?

Not by the time they reach our specialist service as they will have undergone so many prior assessments and likely had multiple hospital admissions[/quote]
Bullshit. Women who end up in these places don't undergo autism assessments and getting one while they're in there is a joke.

I have a question. I want to know why medical treatment is delayed. I want to know why a patient with chronic toothache is left weeks before seeing a dentist?

I want to fucking know why a diabetic patient has to wait until her blood sugars reach 30fuckinf6 before getting some attention? That reaching 28 blood sugars gets a 'see the doctor on ward round'?

I want to know when the carer outside of those places get their visits stopped for 2 months If they kick up a stink over said medical treatment.

@Linaya What advice would you give to relatives impacted by the trauma of dealing with your patients? Would you recommend to those relatives to walk away for the sake of their own mental health or is there always hope?

For our patients, most of their families are far more detrimental to them than the other way round

I'm using the polite word; clearer might be 'horrible'. The overwhelming personality traits that characterise PD are overwhelmingly harmful - including to others.

You're not at work to make moral judgements, so that isn't really relevant.

What I want to know really is whether some patients/clients are harmless, eg whether you'd be happy sharing a house with any of them. Or whether IRL you'd run screaming, as their network has done many times. Do you teach socialisation, by the way?

@HotPenguin Do you think your patients can have enjoyable lives with treatment, even if they can't live "normal" lives?

In my experience yes, inbetween crises. They’ll often sustain stability for periods of time but life will usually be interrupted by relapses

@bathorshower *
You said in one post that most patients won't recover or cope well in the 'real world', and in another that they typically stay 1.5 - 2 years. What happens to them then? Is there suitable supported living (for want of a better term) or do they go back to 'normal life', fail to cope and end up with you again? What would be the ideal solution?*

It’s different for each individual. Some go to more secure services, other to step down placements such as supported living. Others will go home, though typically with very intensive support. There isn’t a one size fits all

@Dino90 I work in adoption and have noticed that many of our young people with significant attachment difficulties like RAD are often diagnosed with PD as adults, would you say there is a link there ? I noticed your earlier point about trauma which would certainly fit.

@Crustacean7 Are people with personality disorders aware that they have them?

Typically yes. Typically insight will fluctuate

I think it would be helpful for people to understand that whilst the views of the OP are apparent in some settings / professionals they are not universally shared by mental health professionals. I've worked with people with personality disorder diagnoses for coming up 30 years in a range of settings so am offering my perspective as an alternative. I'm doing this, not to undermine the OP but to (hopefully) offer more optimism.

There is a lot of controversy around the diagnosis of personality disorder, particularly around the tendency for complex PTSD and ASD being misdiagnosed as borderline personality disorder regardless of how far into the 'system' they get. I've seen it a lot.

There has been a real drive for improving understanding of people with a diagnosis of PD across a range of services to try and keep people out of hospital as long as possible and some great work has been done around this.

My view is that people with a personality disorder have psychological needs which are usually currently treated in a medical and behavioural way because that's how most people are trained and services are set up. They don't 'fit' with or respond to that model so behaviour is labelled rather than understood and behaviour can escalate and relationships break down.

By the time people find themselves in forensic services their patterns of behaviour and schema are even more entrenched so therefore it can take many years for improvement to happen, but it does. People can and do go on to lead fulfilling and normal lives if they have the right support at the right time - and this might look different for everyone.

I just wanted anyone with a PD diagnosis or with relatives with a PD diagnosis to understand that recovery is possible and it's not all negative.

@aquamarine1 When you say 'safely contain their risk behaviours', can you give some detail around what these behaviours tend to be?

Cutting, overdoses, tying ligatures, jumping off bridges/ buildings, running in front of traffic, setting themselves alight, misusing emergency services, police contact, non concordance with medication etc etc etc

Are any of your ladies autistic?

You mentioned early life trauma as being a major contributing factor in the women you see.
Is this primarily abuse in childhood? And/or emotional neglect? Poverty?
I suppose I’m trying to ask - is there anything, in your experience, that could prevent or at least reduce the prevalence of such acute mental health issues?
Thank you.

I'm not that recovery from BPD is possible, but learning to cope with it, and deal with it is possible.
I have bipolar and BPD and am a teacher, I know my way of thinking can be very fractured and disordered. I am incredibly lucky to have a supportive husband and colleagues who I can trust to help me. I can honestly ask questions of them and check my responses to situations and they help me. Years after traumatic events my husband is still patient enough to reassure me that I'm ok and not a terrible person when I have to check with him.
I recognise when I am spiralling and have started to be more open so I can have help to stop the spiral. I am learning that these illnesses do not make me someone who is undeserving to exist, but actually I should be here and would be missed. It isn't sunshine and rainbows, I still have the disordered thinking but can cope with it better.
OP, thank you for the work you do xx

@gamerchick you sound very angry and frustrated with mh services, I hop all is ok but your questions seem quite specific to a particular trust, and I don't think it's fair to swear so much at the op. (Although am sure that's nothing the op won't have experienced!)

@Strongswans I am starting a mental health nursing degree in September as a mature student. Have you got any advice? (Please don't say don't do it grin)

Try to establish a strong sense of who you are before you start the course. Learn very early on to leave work at work - don’t (metaphorically) allow other people’s problems in to your home

@everysinglebloodytime I'd agree with that. I think there is much better understanding of the links with CPTSD and there is some good recovery work.

We do need to get better at recognising Autism Spectrum and ADHD in women though and as with any MH services there is less support than there could be.

I have been hospitalized once. Do a lot of your patients present with vicarious war trauma even though they haven't personally experienced it in their lives?