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

LaureBerthaud I know a number of male mh nurses who will no longer work on female wards. Unfortunately some with a pd diagnosis become sexually disinhibited. Also many women unfortunately have been abused in care and feel it’s the norm to trade their body they will think nothing of being overtly sexual towards male staff

It’s very difficult for anyone to work under those circumstances. We don’t see it play out in quite the same way with men.

There is protection around female patients but staff also have to be protected and to be able to work within boundaries to provide the best care

With some men I work with at times female staff will not lone work with them. They don’t tend to act in such an overtly sexual way it’s more intimidation which is too very difficult to work with

@ItsIslandTime What do you think of the Psychiatrists you work with?

They’re very brave considering the amount of responsibility they undertake (and also very well paid!)

Has your unit been badly hit by COVID 19?

We’ve been very fortunate and not had a positive case. We’ve been hit in other ways though - such as by reduced community team involvement, delayed discharges and so on. Not to mention the impact on the quality of life for our patients

@CarrotCakeCrumbs 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.

Gosh no. I don’t think that at all. I don’t believe that anyone is all good or all bad, however the very fact that this matters to you means that you’re really not likely to be any kind of ‘horrible’ person

What sort of age range is your ward? I know my son has been in adult acute wards with people from 18 to 65 plus.

Do you allow transwomen onto the female unit?

To those who keep asking about transwomen she has already said they would assess it on a case by case basis.

I thought the trans woman response was a non answer
So I guess the answer is yes

I have eupd and have been on acute wards but not a personality disorder unit and have been on with trans patients including on wards where the bedrooms are not individual rooms and also when waiting for a bed ot was chairs.

I have been called manipulative when I have lied and said I was safe when wasnt but also when I have told the truth and said I couldn't. With eupd you cant win I try my best to not be manipulative and dont think I am but with the diagnosis you are automatically a horrible person In my experience.

Also staff do have favourites and most the time you do know when a staff member dislikes you.

Hi Op- just waving as have dine your role in the past and your thoughtfulness shines through your responses. Working in mh is the greatest privilege.
Someone earlier asked about training in mh and my thoughts would be to have (and continue to have) your own therapy in place. Being able to separate what is “yours” and what is the clients is hugely important.
I also think it helps with what you referred to as “acting”. Wouldn’t be the word I’d use but I know what you meant.
Having increased self awareness through therapy has been hugely helpful for the times when I’m Needing to work with clients and situations that are generating a strong (positive or negative) reaction in me.

Not a question as such but I often feel really sorry for some of the patients whose parents also have mental health issues as they are not being helpful to their (usually) son or daughter, can get aggressive and demanding and sometimes are not allowed to visit.

Some of the patients, especially the women have had such dreadful lives you wonder if they can ever come back from it.

I do find the mental health service is frustrating sometimes with what they can and can't do.

Unfortunately some with a pd diagnosis become sexually disinhibited.

Oh yes, this is very familiar. One of the maintenance guys working in the kitchen had to lock himself in, as a lady was taking off her clothes outside the door!

Do you believe personality disorders are caused by nature or nurture?

How common is ECT? I know it’s still used in the U.K.

Do you prefer day or night shifts?

Have you ever been traumatised by something you’ve seen on the ward (or heard a story from a patient)?

Do you have dependent children? If so, how do you balance work and family time?

Not sure why some posters have to be so rude towards the OP. She isn’t to blame for your problems.

JanMeyer- I would say they gave the only answer available- that each case is considered on an individual basis. I suppose if you’d prefer the OP could lied and said “no that would never happen”. But they didn’t. Not liking an answer doesn’t make it the wrong answer or mealy, just accurate.
And having worked in the level of ward the OP is talking about, I would agree with her- it would be rare for an admission to be agreed without EVERYTHING else having be ruled out- because there are so few beds for so many referrals. However I would agree that it is not considered enough in many other services and this is an area mhs need to improve on. The increased understanding of ASD is women is not incorporated into assessments enough.

Do you find many patients are afraid of men? And if this is the case do you avoid their being with males or use immersion therapy? And do you increase the time with males?

If the patient is afraid do they have a safe place?

I would say they gave the only answer available- that each case is considered on an individual basis. I suppose if you’d prefer the OP could lied and said “no that would never happen”

No, i would have preferred her to be honest and say "yes, in line with NHS policy we do accept transwomen on the unit." I'm also curious what the OP thinks about such policies. Given that so many women with severe mental health problems have been abused by men. Surely accepting any transwoman makes no sense in that regard. I'm curious what would happen if they did accept such a patient and the women on the unit didn't feel safe. Would their feelings be listened to on such a matter?

@ItsAlwaysSunnyOnMN - I would suggest that male nurses have no place on female mh wards with such disturbed and vulnerable women.

Not all women on the wards will act out in this way. Interactions between male and females is how we live. The relationships built with staff can be very beneficial for patients progression. Maybe some will learn that they do not need to act out in such a way and not all men are going to take advantage them. They can’t live in a female world forever

And mixed staffing has been shown to balance things out.

What about female staff working on male prisons or male only mh units. It’s known to calm down the levels of violence. I have seen this myself levels of aggression drop (though can still be pretty frightening) when female staff members are involved not just male and that is not how the male members of staff are reacting

When you work in mh you have so much projected onto you from those you work with to work with that is part of the work. I don’t go round mothering those I work with but I’m a women who is being kind, who is accepting, who listens, who will try and sort out issues they face, who will not be disappointed when they have done something wrong, who will at times inform them what they have done is wrong, who won’t turn their back when they have been hostile towards me, who won’t mock them when cry. This is what so many have missed growing up and likewise with women who often only see men in a warped sexual way. To be able to build up a trusting relationship is a vital part of their progression.

Unfortunately at times it’s too much and staff have to know their boundaries too in what they are comfortable working with.

Do you think starting this thread is ethical?

I want to share my experience of being an autistic woman who was misdiagnosed with BPD, I had asked for an assessment and a psychiatrist told me I didn't look autistic so refused the screening. I got a psychology referral (22 month wait once I was referred!) and then went through the rigorous screening process, it is certainly not standard for patients to be given this.

I eventually got this screening because I am someone who had done a lot of research and was able to advocate for myself, a lot of women don't have that ability.

I have officially had the BPD label removed from my notes, again something I had to fight for.

The BPD label is an awful, stigmatising one. I was treated by MH services with disdain a lot of the time, the attitudes changed immediately when I had a new diagnosis.

A lot of the behaviours are the same, the inability to relate well to people, poor communication skills, trouble with recognising and expressing emotions in a healthy way. I am very lucky to have accessed treatment now which has helped me with this.

Thankyou for such an insight , you give me the impression of someone who does care and does the best they can with the limited resources available.
As to 'acting' , don't we all do that to some degree ? , not just in the workplace .

My daughter probably has dependant personality disorder. How likely is this to result in hospitalisation?
Will she be able to live a normal life? Especially, will she be permitted to have /keep :'( children.

Maybe some will learn that they do not need to act out in such a way and not all men are going to take advantage them. They can’t live in a female world forever
But surely for the time they are LOCKED IN A WARD they CAN live in a female world? Is that really too much to ask?

I have heard too many heartbreaking cases of women suffering with PTSD due to abuse (mostly from men) and being diagnosed with some kind of personality disorder.
To lock them in with male staff, and then assume that some of them will invent sexual assaults seems beyond cruel to me and like the opposite of proper safeguarding (although I'm not an expert in that).

Just placemarkung as this is very interesting.

I'm fascinated in MH and have suffered my own troubles so this is very informative.