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

@Binglebong 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?

Yes. Many of our patients are also afraid of women/ people from specific ethnic minorities etc. It’s unlikely that you’d find any mh service that would limit patient contact with a person based on their sex, ethnic origin etc.

@ravensoaponarope Do you think starting this thread is ethical?

Yes

@Wisenotboring 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 would probably be insufferable. Though that’s probably more of a reflection on me than it is on mental health services

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

There are lots of reasons as to why I disagree with this. Here is one of them:

Mental health nurses (especially those specialising in BPD) are generally very self-aware and conscious of their interpersonal style. For women who have been exposed to abusive males, being around male mental health who are skilled in building safe therapeutic relationships is often a very cathartic experience

@SparklingLime 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.

Mental health nurses are very aware of risk. Day in, day out, we risk assess. The risk of my patients being allegations is high, whereas the risk of them being assaulted by staff within the confines of our tailored, specialist service is very low, hence my response

@JanMeyer What if the actual women on the unit objected to the presence of a " transwoman" on the unit? Would they be listened to on that count? Do you personally agree that such patients should be able to be placed on a female ward?

Yes our patients would always be listened to, and their points considered, though we would not refuse a referral solely on the basis that collectively the other patients wouldn’t want a trans patient on the ward. There would have to be risk factors which could not be mitigated before we would refuse a trans referral. I think our implementation of the policy works well in practice

Thanks everyone for your questions so far. I’ve enjoyed considering and answering them and am following all the narrative on the different topics with interest

@Dino90

Thanks everyone for your questions so far. I’ve enjoyed considering and answering them and am following all the narrative on the different topics with interest

This has been super interesting and I admire your diligence in answering as many questions as possible.

Did you ever consider any other type of nursing? Why did you choose MH when it is known to be so extremely challenging?

Are your patients mostly young people or older? Do the women you work with develop friendships with each other?

Do patients ever get days out (supervised)?
Are they allowed to smoke?
Do you have to approve their reading material and tv shows?

This thread is fascinating.

Early on you mentioned that patients families are often more detrimental to the patient in terms of behaviour than vice versa - is that because of an element of enabling behaviour?

@Dino90 thank you for answering my questions! It’s great you can work part-time to spend more time with your baby! I appreciate what you do do x

Hi op.

What's a female?

You can't be real. Wishy washy answer to what you know is a charged question. I worked in cmht for many years too. I can't even be arsed... Ridiculous

It's nature and nurture. It's the only logical conclusion.

Someone asked about touch in the early years. There is evidence that a lack of affective touch in the early days can have a massive impact on future mental health. CT afferent nerves are a recent discovery. They are found in glaborous skin and they're the nerves that are responsible for pleasurable touch. When someone gently strokes your skin and which we instinctively do with babies. Now take babies in SCBU who can't really be touched, they are more likely to have ASD. Anyway, it's now thought to be very important that new babies have regular touch.

This is a fascinating thread, thank you for sharing OP, and thank you for not allowing the thread to be derailed by the usual trans hysteria.

Do you get to follow the "success stories" - i.e. patients who have gone on to positive outcomes, whatever that might look like for them on an individual basis?

Now take babies in SCBU who can't really be touched, they are more likely to have ASD.

Do you have some kind of link to back this claim up? Because what you're saying sounds a little bit too close for comfort to the whole refrigerator mother theory.
Also children are born with autism are they not? It's not something that can be caused by parental neglect or lack of affection or touch in a child's early years.

The whole nature/nuture discussion was about personality disorders.
Given that ASD is neither a personality disorder or a mental health problem what's the relevance?
There is no nature/nuture debate about autism. Autistic children cannot be made.
Also babies in SCBU are more likely to have special needs in general aren't they? Given that such babies are preemies or have other health issues?

@whatausername Did you ever consider any other type of nursing?

No, though I did consider midwifery.

Why did you choose MH when it is known to be so extremely challenging?

I thought that it was a career that would lend itself well to my skill set and I wanted to help a suffering and often repressed group of people

@thedaywewillremeber Are your patients mostly young people or older? Do the women you work with develop friendships with each other?

Mostly young, sometimes older. Most are in their mid twenties. Yes they do form friendships though often need support from the team working through problems in their relationships with their peers as and when they arise

@MinnieJackson Do patients ever get days out (supervised)?

Yes, often. Some patients are allowed out on their own, others not unless it’s a medical emergency. Decisions about leave are made dependent on risk

Are they allowed to smoke?

Yes, though there’s talk of us becoming a smoke free hospital in which case they won’t be able to

Do you have to approve their reading material and tv shows?

Not unless there’s a specific concern that arises from us not doing so I.e accessing illegal material or material that has a detrimental impact on their mental well-being. We do screen material we make available on the ward

Are patients more typically from certain social classes? What proportions are from wealthy, more privileged backgrounds compared to less wealthy, less privileged backgrounds?

Thank you for this very interesting thread Dino🙏

I’m one of these patients CPTSD with the occasional psych throwing in EUPD as a top up diagnosis without me meeting the DSM-5 criteria. I’m poorly enough for community care to be three times a week but not unwell enough for inpatient treatment. How do you handle the knowledge that if it was not for evil people in the past the majority of these people would be leading relatively normal life’s