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 thanks for the thread. Super interesting and some intelligent replies/questions. Sorry that a couple of people decided to shit on you - clearly the MH of staff doesn't matter hmm?

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

I agree. To the extent that I wonder if in the future, the EUPD diagnosis will be done away with altogether.

I believe in a significant amount of cases it is undiagnosed autism.

@Everysinglebloodytime

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.

Thanks for posting that. I did find the OPs perspective on the likelihood of people with PD being able to lead "normal" lives a bit depressing.

Interesting thread. I hope you keep posting OP.

What do you think of the Psychiatrists you work with?

Has your unit been badly hit by COVID 19?

MiniMum97
Thanks for posting that. I did find the OPs perspective on the likelihood of people with PD being able to lead "normal" lives a bit depressing

...but that isn’t what the OP said. She said that not many of her units patients will recover. She clearly wasn’t talking about Everyone who has a PD. She explained that the patients she worked with are at the upper end of high risk.

I work as a Bank HCA (I'm also a student nurse) one of the wards is specialist female PD ward and I find it awful. I wasn't expecting it to be so gory the inserting pen lids into arm wounds, pulling clumps of hair out, swallowing batteries the constant ligatures, the head banging. The mutilation at such a young age it's heart breaking.
It's definitely the hardest ward I have worked on much prefer male secure even with hardened criminals!

@Howallergic

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?

They do have access to treatment and therapy actually probably the most in the entire hospital but the women OP works with present with very serious self harming behaviours. Not just little a bit of cutting, it's severing arteries, multiple ligatures, breaking bones, swallowing lithium batteries, pulling out hair, headbanging, inserting foreign objects into wounds. Risks that cannot be managed in the community.

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

@Dino90 loved this response and so accurate

I have BPD, do you believe all people with BPD are manipulative, horrible people (this seems to be the general consensus on mumsnet) - or is it possible to be a good person and have BPD? I dont knowingly manipulate anyone - I try to be a good person but I'm scared I might just not know how to be good.

Op, can you please give us a typical work day?

Hi Op, you didn't respond to my earlier questions, wonder if you will to this one? How do you (and your colleagues, if you know!) feel about describing people's personality as "disordered" at the heart of your service provision? What impact do you think it has on the ability to build a proper therapeutic relationship? I know I couldn't work with people who were telling me there was something inherently wrong my personality!

I have worked with people who attract this diagnosis and morally and professionally cannot bring myself to use that term (I don't find any psychiatric diagnosis helpful in my work, though!) There is nothing wrong with their personality; their behaviour is simply an adaptation to traumatic events which are unimaginable to most people.

Do you feel that any services in this country really meet the needs of this group? I haven't found many I'm convinced of yet.

💐 for you. It's tough work

@Everysinglebloodytime

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.

Absolutely this. Thank you.

@EchoCardioGran I’d say being professional in many careers is often about acting - acting calm and respectful, for example, when a customer, client or patient is being rude or unreasonable? Health care professionals obviously aren’t robots, the ways they can be treated are appalling and of course they’re not going to respond with warm friendly feelings every single time. But they can keep their feelings to themselves and still take excellent care of the patient regardless of how they may instinctively respond to them. My dh is a doctor and is regularly verbally abused and has been physically attacked with syringes, bodily fluids and all sorts of random objects many, many times. Not to mention tirades of insults. Do you think he feels inside as though he’s really fond of the people acting this way? Most of them have serious MH issues, addiction problems and all sorts going on, so he acts in a calm professional manner and would never dream of allowing his personal feelings of like /dislike to creep into his practice. It has no place. And the way I read it, the OP was saying exactly that: she maintains impartiality but of course it will involve acting at times. That’s what being professional looks like.

@ItsIslandTime

MiniMum97 Thanks for posting that. I did find the OPs perspective on the likelihood of people with PD being able to lead "normal" lives a bit depressing

...but that isn’t what the OP said. She said that not many of her units patients will recover. She clearly wasn’t talking about Everyone who has a PD. She explained that the patients she worked with are at the upper end of high risk.

The biggest part of working in mental health is being able to hold hope and optimism for people when they have none for themselves. Not acting it but believing that change is possible.

Obviously that's hard when you are responding to very difficult situations day in day out, but that's why supervision is important and in my view, shorter shifts and opportunities for rotation. As soon as you start buying into someone's schema about themselves it creates an environment where change doesn't happen. You can offer all the DBT you want but if you then have people in an environment which reinforces the belief that you're unloveable and difficult, it's not going to work.

But there are some good services out there which get the balance right between supporting and not rescuing - that might feel hard during the process (for everyone), but it's so important that people are allowed to experience and deal with difficult feelings and know that they can do this. That's obviously harder on a ward, where there are other people to consider and the ward is ultimately responsible for keeping someone safe.

That's why wards are really not the best places for people with these needs but unfortunately a lack of services in children's services and community adult means that it happens too often.

[quote whatausername]@Dino90 thanks for the thread. Super interesting and some intelligent replies/questions. Sorry that a couple of people decided to shit on you - clearly the MH of staff doesn't matter hmm?[/quote]
This is an emotive subject where everyone has a very difficult time. The whole treatment approach currently is traumatising for everyone. The typical medical / behavioural approach lends itself to conflict so it's no surprise when people have been through or watched their family members go through awful times begging for help and being treated in a punitive way they will be angry and upset.

I'm sure that as someone who works in the field the OP will be aware of this and understand that the anger is not directed at them but at a system which is not working for many people.

@Dino90 thanks so much, you're great, and sorry about the shit-slingers.

Tho maybe they deserve sympathy, although not for behaviour like that.

Good post @Everysinglebloodytime. If I wanted an action plan to deal with my family and their various diagnoses who would I approach?

[quote Supersimkin2]@Dino90 thanks so much, you're great, and sorry about the shit-slingers.

Tho maybe they deserve sympathy, although not for behaviour like that.

Good post @Everysinglebloodytime. If I wanted an action plan to deal with my family and their various diagnoses who would I approach?[/quote]
I don't know what your situation is but if you want to share a bit more detail I could make suggestions.

I've never worked out messaging on here but you could try that if you want.

You think denying medical attention to mental health patients is reserved to just 1 trust? That's quite naive tbh.

Absolutely not. But how much control do you think the OP has over that? How much input do you think they have over the services offered to the patients? Do you think they're personally responsible for the decisions, budget, resources? You're shouting at the wrong person.

@AfterSchoolWorry

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

I agree. To the extent that I wonder if in the future, the EUPD diagnosis will be done away with altogether.

I believe in a significant amount of cases it is undiagnosed autism.

@AfterSchoolWorry ADHD can be a missed diagnosis too (this isn’t a comment on your facility dino I just mean generally in the community) because emotional instability and rejection sensitivity are often big ADHD symptoms in women.

@Everysinglebloodytime, I will, thanks a million. I'll PM you - when you get it a little bell graphic pops up on your top right hand corner. Will be later as I am off to do good works at me charity.

@gamerchick
I'm another one who feels compelled to point out that yes, it is possible for someone to undergo multiple psychiatric admissions with a false diagnosis of a mental disorder and undiagnosed autism. It happened to me. I told all of the professionals to whom I was subjected that the diagnosis I was given was false but they thought they knew better than me, and/or simply didn't care. I eventually managed to obtain an autism diagnosis though, and was proved right. It was so far beyond inappropriate for me to have ever been a psychiatric inpatient, and I now suffer severe PTSD from the experience. I'm not the only person this has happened to.
I'm saying this not to vent at the OP but because it needs to be known, especially by MH professionals, that this happens, and not that rarely. I think it is an issue that spans trusts and is at least partly the result of defensive practice and a worrying ignorance amongst most MH professionals about autism, especially autism in women.

Can I add to the issues by saying it's also possible to have ASD and BPD, as well as women with ASD being potentially misdiagnosed.
BPD and dementia together is another hugely misunderstood combination.

@Yoloyohol

Can I add to the issues by saying it's also possible to have ASD and BPD, as well as women with ASD being potentially misdiagnosed. BPD and dementia together is another hugely misunderstood combination.

Yes!

@Supersimkin2 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.

All of our patients display some degree of risk behaviours towards others when particularly unwell. This risk fluctuates in line with their mental state. I wouldn’t want to share a house with any of my patients, though not necessarily because I’d be concerned about the risk they could potentially pose to me.

Do you teach socialisation, by the way?

Yes we do. It forms a large basis of our clinical model

@Everysinglebloodytime 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.

That goes without saying