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

[quote Dino90]**@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[/quote]
Thanks. That helps clarify a decision I think I already made about my EUPD/BPD relative and not allowing them to re-establish contact. We are both the products of an abusive upbringing (ironically I am the one who experienced CSA, yet my sibling with EUPD/BPD has still decided I am the root of all evil in their life) but I no longer need to feel bad if I decided to have noting more to do with them, despite the pain that decision is also causing.

[quote TitianaTitsling]@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!)[/quote]
You think denying medical attention to mental health patients is reserved to just 1 trust? That's quite naive tbh.

Are you male or female sex? Does your unit have males working with female patients? What sort of safeguards do both staff and patients have if so - as these are vulnerable women and may not use their right to request same sex practitioners, is there an automatic chaperone if a male HCP is working 1-1?

I know close family members and friends who work in mental health. I remember one of them saying if you work in mental health too long you will likely need mental health services yourself. Obviously that's a very simplistic view. Have you been in this field long and do you see any truth in this in older colleagues?

As someone who’s worked on secure BPD units and PICU in the early 2010’s, I’m interested to know if you feel staffing levels are now sufficient in terms of managing risk to both staff and clients alike, and to provide a suitable therapeutic environment tailored to the needs of the individual clients? Or if in fact little has changed or it had worsened in this respect in the last decade?

@gamerchick 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.

If you’re sufficiently concerned about the care of a loved one, it might be worth you asking the service you’re referring to about their complaints process. They should also be able to signpost you to their advocacy for support. If you’re still not satisfied with the response you receive, you can raise concerns with the Care Quality Commission.

[quote Dino90]**@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[/quote]
That doesn’t answer the question.

What advice would you give to relatives struggling to cope with the trauma of living with/ being abused by your patients?

In my own experience, I was very clearly told to have strict boundaries, and strict expectations of the patient (ie that they must stay in treatment, stay medicated, and allow the key therapist to be in contact with me in order to confirm that the patient was still in treatment, in order to maintain contact. I was also told (by said therapist) that the patient was extremely dangerous and that I should always have an escape plan (literal - to leave town with the patient’s child) and be prepared to dial 999 if at any point the patient turned up at my house.

Please don’t ignore the issue. You have already stated that you fear for your safety. Imagine living with your patient or having them turn up at your door at any hour of the day or night without any support staff to call on.

Hi. I've recently been considering a career change and I'm really interested in working with people with mental health issues, would you recommend it ? What is the best way to get into this field? Thank you

[quote Mandatorymongoose]@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.[/quote]
I totally agree, we need to get better in so many ways but are still underfunded and only just starting to be able to provide more specialist services as standard (rather than out of area placements).

There are so many developments in understanding; neuro diversity, polyvagal theory, the physical changes in the neurology of the brain and how this links with early life experience and attachment which don't seem to be understood in practice as standard. Unfortunately, mental health services (especially children's services) have been underfunded for so long that some people are heavily 'stuck' in services and systems (mental health and criminal justice) because the help wasn't there when they needed it.

If this happened in physical healthcare there would be an uproar. Imagine everyone being given the same treatment regardless of whether they'd had a stroke or a heart attack and when they don't respond, being sent to an out of area placement because their symptoms can't be managed safely in a local hospital.

And @gamerchick I completely understand your anger.

[quote Dino90]**@gamerchick* 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.

If you’re sufficiently concerned about the care of a loved one, it might be worth you asking the service you’re referring to about their complaints process. They should also be able to signpost you to their advocacy for support. If you’re still not satisfied with the response you receive, you can raise concerns with the Care Quality Commission.[/quote]
Thankyou, im aware of the complaints shizzle.

I'm asking you the questions. You've offered to answer questions....

If you hadn't have crapped over the autism question, I probably would have scrolled on.... Btw.

To be fair I have some sympathy with Gamerchick and my experience is restricted to a young person refused CAMHS support, a breathtakingly incompetent A&E Dept, and a CAMHS team who were only interested in looking for non existent family problems and who laughed that the issue could be an undiagnosed neuro developmental disorder. It was. IME MH professionals also wrote dishonest and disingenuous letters to the GP. Getting new versions to replace them was lengthy and required confidence and exceptional advocacy skills.

Even at that level MH services were an absolute nightmare to deal with and my dd only got the care and suppirt she needed because we could pay privately for it.

Do you think it's all about resources or would you agree some of it is due to incompetence, sloppiness and a lack of care?

Based on our experiences I can well imagine some young people spiralling because of an inadequate system.

How do you in good conscience hold these women in prison for want of a better comparison with no access to treatment or therapy. Just walking like caged elephants in a zoo from the toilet to their bedroom to the TV room. How can you think that you're helping in any way?

Are you in nhs ward or private hospital with mostly nhs patients
What tier patients do you have on your ward

What are the best and worst aspects of your job?

And @gamerchick I completely understand your anger

Thankyou. That made me cry.

The family get written off usually, but if you question the system you get banned as punishment. To read the opinions I've read on this thread alone makes me irrationality cross.

[quote Dino90]**@Youngatheart00* Do you ever have strong feelings of dislike towards any of the patients whose illness might make them very unpleasant to be around? Or root for others? Or are you just neutral towards all?‘*

Yes, almost all of us have a small handful of patients we like working with and an odd one or two patient we cannot abide. Then there are those inbetween. The skill is in not allowing your patients to know which camp they sit in. A lot of mental health nursing is acting[/quote]
I would have thought the role of a MH nurse would have been to support these women as impartially as possible rather than talking about "favourites" and patients that you "cannot abide."

A lot of mental health nursing is NOT acting, it's about dealing with very troubled people professionally and competently.
Acting? I find that such a bizarre comment.
It's not the Royal Shakespeare company .

@gamerchick

And @gamerchick I completely understand your anger

Thankyou. That made me cry.

The family get written off usually, but if you question the system you get banned as punishment. To read the opinions I've read on this thread alone makes me irrationality cross.

I'm sorry, first that I made you cry and second that you've had to deal with this all. (Maybe that should have been the other way around)

Nooo thankyou man I was wondering if I'd been totally desensitised.

Good to know

I think it’s very insightful to be aware of patients that trigger a response in the OP this is normal / human nature. It’s about being aware of it and managing it professionally / via supervision etc.

I totally understand gamerchick's anger also. Everysinglebloodytime
I doubt you upset her, more relief that you understand, I'm guessing.

As for the OP

Not by the time they reach our specialist service as they will have undergone so many prior assessments and likely had multiple hospital admissions.

Just wanted to say i don't really trust that this is the case. Not least because of refusal of many medical staff to even consider autism in women. There's still attitudes out there of only men have it and if someone doesn't fit a very stereotypical presentation it doesn't even get considered.
I once encountered a psych who didn't consider Aspergers to be "real autism." I frequently encounter medical professionals from mental health services with ignorant views of autism, so it's hard to have any faith in them in that regard.
I've also heard of a few cases of teenage girls/young women being admitted for mental health problems and coming out with an autism diagnosis.
And there's a case in the US of an autistic women who was wrongly treated (for many years) for schizophrenia. Which of course she didn't actually have. The doctors assessing her just didn't understand how to talk to an autistic person.

[quote Dino90]**@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[/quote]
Can I rephrase the question - do you accept transwomen on the unit?

@OhTheRoses - probably a complete thread derail but you have described my DD's circumstances almost to the letter. I feel a bit sick reading that someone else has had such a similar experience - have you posted about it before?

This is quite a triggering thread but I am not sorry at all to have read it, any insights and opinions are interesting.

@Asilisa76

I think it’s very insightful to be aware of patients that trigger a response in the OP this is normal / human nature. It’s about being aware of it and managing it professionally / via supervision etc.

Absolutely!