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

In an ideal world the services we can provide would allow for services to be completely single sex staff for those that it would be deemed essential for (maybe this happens I am not aware of it)

But there certainly can be benefits form have mixed sex staff for both male and female patients

There are many ways the services provided could be improved but it’s comes down once again to lack of resources/funding MH services are overwhelmed in many areas

If you had a loved one who suffered from a MH disorder such as the ones you see in your line of work, would you feel happy leaving their care and decisions about them by and large to the professionals i.e. trust them; or would you feel too uneasy that mistakes could be made and so delve into things far more deeply by asking questions and holding agencies accountable?

I have a relative with eupd. I believe had they been 40 years younger they would actually have been diagnosed autistic.

Care in secure units has been very mixed - they managed to strangle themselves to the point of unconsciousness whilst on one. Along with multiple other injuries.

They are currently going through the assessment process for a specialist unit.

I hope they get it but am very apprehensive about their long term future - how do you find supported housing if they can mostly live independently but basically need someone to make them take medication etc?

I’ll keep working through everyone’s questions but on the issue of TRANSGENDER:

A transgender patient is treated on a ward according to their preferred gender, unless there are reasons why this would lead to potential safety issues to either the trans person themselves, or to the other patients on the ward. We’d try to mitigate these risks but wouldn’t admit a transgender person if we couldn’t

I have diagnosis of BPD and been recovering with DBT and some other support. But in the past I had a lot of stigma from health care professionals and took an overdose because of a CPN who mocked me when I was anxious or agitated and disbelieve me when I disclosed about my abusive childhood. Why do so many MH professionals seem to dislike us or not take us seriously? Apologies if this been answered haven't RTFT

I’m finding a tone of complacency in some of your replies, OP, which makes for uncomfortable reading. For example, when you mentioned the risk of false accusations against male staff, but didn’t even mention the risk to patients of actual assault.

@Gingerkittykat

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.

I'm so happy for you. I think there's probably a lot more women out there going through the same thing. It's frightening.

Gingerkittykat ...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.

As an observer, I'd agree with you on both points. (I'm not medically trained, just lived experience, which I took into working in ancillary services)
I would say though that the issues behind why the above difficulties, require very different approaches to enable the person with difficulties, which is also why correct diagnosis is so important.

This especially if someone is unlucky enough to have both conditions.
In that situation it's also true that the ASD diagnosis ime has got the person treated more positively than when they only had the BPD diagnosis. I suspect it's because there's more understanding of treatment, but it wasn't always that way.

Autism used to carry a much bigger stigma than it now does.
Before it was better understood, it was called Kanners Syndrome and was a devastating diagnosis for the mother of the child, who was then considered to blame and to have created an condition that was untreatable. (in boys!) It lead to children being removed from often the only person who understood them at all.

It took a long time after those ideas were discredited before ASD lost that associated stigma, and we still have plenty of parents desperate not to have their children 'labelled' with it, and I think we currently have the same thing with BPD.

Lots of stigma generally arising from a lack of understanding reinforcing behaviors and stereotyping around specific areas, and the medical profession not knowing any treatment for a long time, and choosing to lay blame for that lack of knowledge onto the 'patient' and their symptoms rather than themselves, and the cycle becoming becoming self perpetuating.

More educated people than me might be able to explain this propensity to attach 'blame.'

I'm very glad for you that you were able to self advocate and change things, sadly many aren't.

BPD with dementia definitely needs an awful lot more understanding and recognition and preferably interest. It's really neglected and leads to difficult situations being so much worse.
Experiences have taught me awareness of the importance of tailoring activities and interactions differently for people with dementia combined with PD situations.
If it can easily be seen, why isn't it being advised on?
In seeking advice I've found understanding and interest to be very low.

As an observer it's also been really visible that at least for some, some medications that help slow dementia appear to have negative affects on BPD.

Interesting thread, you sound like a true professional.

Were a lot of your patients bullied in school?

The comment about “acting” seemed to upset people. I wouldn’t use that word but I do feel like I’m putting on a front when I work sometimes. I’m a social worker who may look calm and collected when someone is screaming in my face but I don’t feel it.
I see it this way; it’s not my job to like people for who they are. It’s my job to show the utmost respect to everyone and to be empathetic. Everyone has good and bad qualities. Even in those who may come across as angry and abusivr will have strengths and I’ll focus on those. I will deliver the same level of service to the family who offer me a cup of tea and cake as I would to those who scream and swear and intimidate. Is it an act? Maybe. I don’t think so, I am genuine in my desire to help.

Especially, will she be permitted to have /keep :'( children.

Not an adult mental health worker but as a children's SW I just wanted to be clear that no one is prevented from having children.
Anyone who is able to demonstrate good enough parenting (or likelihood of good enough parenting) would be able to parent their child.
It is a child focused and not an adult focused decision.
So can the individual adult provide the care, including emotional care that the child needs to grow and thrive?
Each case is considered individually. The decision to remove a child from their parents is undertaken by a judge following a detailed and structured multidisciplinary process.

@Restlessinthenorth 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!

For some patients the label of personality disorder is offensive and stigmatising, for others it’s a relief and can feel validating. It’s not a term I particularly like using, though it’s an accurate one; if we think about what constitutes a personality (behaviours, cognitions, and emotional patterns), these are all disordered to varying degrees in our patients. Our patients have typically carried the diagnosis for a long time before coming to us - I can’t see that it impedes therapeutic relationship building

@Supersimkin2 Good post @Everysinglebloodytime. If I wanted an action plan to deal with my family and their various diagnoses who would I approach?

I need a lot more information to be able to advise - please feel free to DM me

@ThousandsAreSailing I'm interested too if you retain a single sex space? Do you allow trans women onto the female unit?

Yes we do, only after a thorough risk assessment of any potential safety issues which could impact both the other female patients on the ward as well as the trans patient themselves

@weebarra 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 so sorry for the loss of your sister. I’m afraid I don’t know whether there’s an evidence base linking pneumonia in infancy and personality disorder so I cannot answer your question

Thanks for the reply. I have to disagree. The diagnostic critter is is entirely man made, and so meeting her criteria doesn't make the diagnosis "true".Kier Harding has published some great stuff in the Lancet and subsequently, more mainstream press about this recently . I feel deeply saddened that mental health professionals with an understanding of trauma would ever be complicit in agreeing that someone's personality is inherently flawed and in need of fixing

@GrimSisters So am I to assume that the needs and feelings of sexually abused and traumatised women are not taken into account when confronted with a clearly male bodied individual on their ward. Is it just the behaviour/history of the trans person that is taken into account?

You’re at risk at sounding very naive in suggesting that our patients are only, or even predominantly, abused by males. Many (if not most) of our patients have been abused, neglected, coerced, prostituted and so on by females.

It is a comprehensive assessment of the current and historical risks of a transgender patient, as well as the potential impact on our individual patients, which are considered when deciding whether or not to offer admission

Do you work with a 'Rachel Dios' in West Sussex? This six foot+ MH nurse runs a womens ward and has a particular interest in 'sexual safety'

No

@Restlessinthenorth interesting, though if you apply that rationale to all diagnoses (for example schizophrenia translates potentially equally unhelpfully to ‘loose mind’), how would you categorise different groups of disorders sharing common features? Would you do away with diagnostic labelling altogether?

@Restlessinthenorth meant to say *split mind (long day!)

@PicsInRed 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.

Within our service the reverse is true i.e our patients are well protected from rape and assault within the service (you must remember that every single aspect of our service is specially designed to safeguard our patients), however male staff are regularly subject to allegatious behaviour and sometimes (though rarely) even sexual assault by our patients

@thedaywewillremeber 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.

Similarly 18-65. Most of our patients range from 20-21 to 35

@Cocothefirst I’ve answered a couple of questions about trans patients. Let me know if you have any more questions

@Pandacub7

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

Both, though predominantly nurture

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

I’ve seen it a handful of times and a couple of our patients have experienced it in the past. I’ve heard first hand reports of it both working and not working. Most people with experience of ECT complain of memory loss

Do you prefer day or night shifts?

Day shifts

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

I wouldn’t use the term traumatised but I’ve managed some very difficult situations. One of my patients once removed a body part and was found sitting at one end of her room with the body part left placed on her pillow (I won’t go into this further as it may be potentially triggering for people on this thread) - that has stayed with me

Do you have dependent children?

Yes I do (I have a baby)

If so, how do you balance work and family time?

By working part time!
Yes I do (I have a baby).