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

@iklboo

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.

I'm talking about medical attention. Basic shit I want to know why suffering is ignored. The nurses aren't totally helpless.

How do you feel about PD terminology? Obviously it is necessary to have clear definitions. But I'm not convinced that perpetuating a message that someone's fundamental self is faulty is a productive message therapeutically. It also feels inaccurate to say someone is disordered when their presentation is a logical consequence of their developmental trauma.

Manipulative is the most overused word in MH services imo. My teen daughter, adopted, attachment issues, has been described by her school as manipulative. I don't believe it is as commonly used to describe bed
I worked in an acute MH service for a while and it was so overused. In reality we are all manipulative to a degree. None of us go through life openly stating our intentions at all times.

I dread the day my child has to access adult services, they are dire
I'm interested too if you retain a single sex space? Do you allow trans women onto the female unit?

AfterSchoolWorry that’s interesting what you have said about undiagnosed autism. I work in forensic and a number of those we work with we believe that have undiagnosed autism. Does this impact some of their behaviour and it’s put down to their mh diagnosis.

VanillaShake I absolutely believe that you are not alone in your terrible experience. I’m sorry with what you have been through it’s terribly traumatic and life changing.

As for having those that you feel warmer to than others this is perfectly normal human behaviour that patients/clients/residents will have too. That does not stop us being professional and neither does it stop the possibility of being manipulated (which is something we address often in staff meetings and supervision) that’s why good team work is absolutely essential. Some will work very hard to be your favourite and not in ways that are obvious some will work hard at you being always angry/disappointed in them. Is this a conscious choice yes at times and no at other times.

There is still so much to learn and understand that the criteria for diagnosis will change the problem is often once someone has been diagnosed and Is medicated and settled why rock the boat but there is no doubt that some people need to have their diagnosis looked into and for them to be fully assessed again it’s shameful they are not

My younger sister had EUPD and made the decision to end her life last year. It was always going to happen.
She spent time in locked wards, I don't think much therapy went on and her psychiatrists were useless at seeing her as a person within a family context. There was very little continuity of care. She also ended up in ITU after a UTI was completely ignored by unit staff.
There was also a huge assumption that her PD arose from trauma in her early years. She herself completely denied this as did we.
She was hospitalised as a near cot death as a baby and ended up with pneumonia. Could this have been a contributing factor?

@weebarra

My younger sister had EUPD and made the decision to end her life last year. It was always going to happen. She spent time in locked wards, I don't think much therapy went on and her psychiatrists were useless at seeing her as a person within a family context. There was very little continuity of care. She also ended up in ITU after a UTI was completely ignored by unit staff. There was also a huge assumption that her PD arose from trauma in her early years. She herself completely denied this as did we. She was hospitalised as a near cot death as a baby and ended up with pneumonia. Could this have been a contributing factor?

I'm sorry about your sister.

There are definite links to attachment issues and prolonged hospital stays can lay a foundation for this.

You don't say how long she was in hospital for but there is a definite school of thought that the absence of nurturing touch because of the prioritisation of medical care can have a toxic impact. That's why (as I understand it) many NICUs have dimmed lighting etc and are much more mindful of creating a more nurturing space than perhaps they did in the past.

PD is an awful diagnosis, it seems to have a lot of blame attached. Autism gets much more understanding and empathy. I've seen this even from professionals

@ASmallMovie 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.

Often always abuse in childhood - physical/ emotional/ sexual/ neglect. It often carries on into adulthood via damaging relationships. I think it’s unrealistic to hope that these experiences can be contained by any external services sufficiently enough that they are eradicated

@balloonsintrees you sound as though you’ve got really good insight into your difficulties. Most of what I am saying in response to the questions I’m being asked is applicable largely to people with extremely debilitating symptoms of the diagnosis. I’m glad that you are managing as well as you are and that you have sufficient support around you. Being a teacher is hard work - I’m not sure I could do it!

@nachthexe 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’m female. Yes we have a number of males working with female patients. Patients’ risk of making false allegations is regularly assessed and plans put in place if staff need to be protected. Males are never allowed to support a female patient to use the toilet/ shower etc and are chaperoned if undertaking any kind of physical health check which involves physical contact with the patient*

@panicovernow 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?

Hm, I think a lot of people drawn to working in these sorts of clinical settings are inherently predisposed to mental health issues themselves. I’ve been qualified for 8 years and haven’t seen my own mental health being impacted by my patient group but that may well change over time. I’ve definitely felt anxious and stressed in response to the workload however. I think a clinician’s resilience also has a lot to do with the quality of support and supervision that they receive within the workplace

Yes we have a number of males working with female patients. Patients’ risk of making false allegations is regularly assessed and plans put in place if staff need to be protected

I find it so jarring that the automatic first response to that question and the overwhelming emphasis of the response was on protecting the staff from false allegations, rather than protecting the patients from rape and assault, when the former is rare and the latter is a common experience amongst women - and as you've acknowledged yourself, these women are very, very often victims of extensive abuse.

I wonder how much of their illness involves the lack of acknowledgement of CSA and later sexual/domestic abuse, a lack of specific trauma counselling, and how much progress could be made if they were able to put boundaries in place with perpetrators within their wider family and/or domestic situations?

@Orangesox 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?

We have a very full therapeutic time table and a team sufficient to be able to deliver it. However, often outside of core hours staffing can certainly at time be too low to be considered safe. We’ve had to be supported by the police on some of these occasions, though this is rare and is considered a serious incident when it’s happened

@nachthexe 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.

That sounds very difficult. I have concerns about the advice your therapist has given you. If a patient is as dangerous as you describe on account of their mental ill health, it’s questionable whether they are ready to be outside a secure setting. However I obviously don’t know the details of the case.

I agree that families implementing boundaries is helpful to both them and the patient. We also run family psycho education sessions as sometimes just supporting families to understand some of the theory behind the emotional complexity and maladaptive behaviours being exhibited by their relative allows them to contextualise the situation they as care givers find themselves in

@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.

Agree on the first point, I didn’t know that about dementia though!

@lovelychops 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

Yes I would recommend it. In what capacity are you looking to work with this patient group? As a support worker, nurse, social worker etc?

@OhTheRoses 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?

Most certainly both. As with all areas of medicine

Are the patients treated well? So many people I’ve known have had awful experiences

Do you think admitting them to the unit your on is helpful long term or a sticky plaster and just keeping them alive?

@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?

We offer a huge array of treatment and therapy - both pharmacological and psychological

Do you allow trans women onto the female unit?

Patients’ risk of making false allegations is regularly assessed and plans put in place if staff need to be protected

Jesus wept. Let's make sure the mad women don't accuse the nice male nurses of anything inappropriate!

@EchoCardioGran 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."

I implore you to spend 37.5 hours a week with some of the country’s most complex personalities and not develop strong feelings about them as individuals. The support we provide is of course impartial and a large part of the skill of a mental health nurse is not allowing our own thoughts and feelings to surface whilst working.

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

A lot of the time you have to act well to be able to deliver that care professionally and competently. I can give you a couple of examples of times that what I do is an act:

appearing confident in the face of escalating risk on the ward

appearing unafraid at times when there has been significant risk to my own safety or that of my team

appearing calm in response to emergency situations

maintaining composure in response to disclosures involving graphic reports of abuse, such as towards children

I could give you many, many, many more

@PicsInRed

Yes we have a number of males working with female patients. Patients’ risk of making false allegations is regularly assessed and plans put in place if staff need to be protected

I find it so jarring that the automatic first response to that question and the overwhelming emphasis of the response was on protecting the staff from false allegations, rather than protecting the patients from rape and assault, when the former is rare and the latter is a common experience amongst women - and as you've acknowledged yourself, these women are very, very often victims of extensive abuse.

I wonder how much of their illness involves the lack of acknowledgement of CSA and later sexual/domestic abuse, a lack of specific trauma counselling, and how much progress could be made if they were able to put boundaries in place with perpetrators within their wider family and/or domestic situations?

This is spot on!