To think the NHS was completely useless for this.

[cuckoonut]

My daughter has severe depression and a potential diagnosis of BPD in January when she turns 18. Recently she's been in an extremely dark place. She's been in and out of inpatient units since she was 14 so we're kind of used to the process of what happens when she attempts to end her life. Two weeks ago she took an overdose, she was taken to a&e, checked over and had a mental health assessment. They deemed her fit to leave and sent her on her way. She has been given no extra support since then despite us asking multiple times. Last night she attempted again. She took 16 Paracetamol with half a bottle of wine and intended on taking another box if we hadn't have stopped her going out. She almost collapsed about 3 hours after and we put two and two together. We called the ambulance and they said they'd send somebody out within 2 hours and to call back if anything changed.

We sat up and waited with her for about 45 minutes when her breathing became very painful, and she said if she didn't force herself to breathe she thought she would stop altogether. She was struggling to stay awake. My DH called the ambulance again to tell them. They said 9 minutes and to hold for a clinician. When we were put through to the clinician she said, quote "from a medical stand point there's nothing wrong with her. She doesn't need to be seen" despite her not being able to breathe and taking an overdose just hours earlier. She kept insisting DD was fine and that she would cancel the ambulance. We asked to talk to somebody else and she kept refusing. We hung up and called again but they kept saying we had to speak to the lady. The ambulance arrived as she was saying she would cancel it. The paramedic checked DD over and said it was best if we went to A&E because of the dose and it was an attempt to end her life. Then her radio buzzed and they asked "why are you still there?" She called up the lady we had been on the phone to and they had a long conversation outside. She then came back and said it was unnecessary to come to the hospital and that DDs mental health team would be informed on Monday. DD has been up all night vomitting and wanting to hurt herself. They didn't even give her a mental health assessment like they're supposed to when somebody tries to commit suicide. She's a minor for God sake!!

Here we go, nasty posters dismissing the poor girl.
An overdose is a reason to call an ambulance. Don't tell a worried mum she shouldn't have. Guess the DD is just an evil EUPD attention-seeker. Twats. Do not listen to them OP. I hope you're in A&E.

Do be wary of a BPD diagnosis though, there’s a big chunk of sexism that comes with it and it’s often an excuse to say ‘we can’t help you’. Most women given the diagnosis should actually be diagnosed with complex PTSD, autism or both

This is more likely to be the explanation for the lack of concern. It's quite likely that BPD + self harm or suicide attempt will have been written up as = attention seeking.

Any form of self harm presenting in A&E should result in a psychosocial assessment. But if you have a BPD label, it's more likely you'll be sent on your way and told to stop attention seeking.

BPD is not a particularly valid diagnosis - there are countries that won't even entertain it as a diagnosis, because the evidentiary basis for it is a load of rubbish - and it is used in abusive ways. It shouldn't even be something under consideration for teenagers, because they're still developing.

With a BPD diagnosis any manifestation of distress will be marked up as "behavioural" and therefore something she is "choosing" to do. Whereas if she had a PTSD diagnosis (for example) the exact same manifestation of distress would be responded to as distress. There would be none of the bullshit about "attention seeking" or "poor behaviour" or "making better choices".

I'm sorry you're dealing with this. It must be incredibly frightening. Mumsnet is not the best place for support on mental health matters tbh. A mental health forum or Mind would be more likely to get you responses from people who get it, can help, and won't blame or judge.

Broken11Girl

No, posters who are saying that OPs DD needs to be seen and given help, but that using an ambulance isn’t the way to do it.

Stop twisting what people are saying and projecting.

If you’d called an ambulance for a cardiac arrest and it was late because of a non emergency call you’d be raging. Because due to cuts that’s where we’re at, having to prioritise immediate threat to life and sadly that means having to let others make their own way to A&E.

Nobody is dismissing OPs DD, at all. We’re just saying that to slate the NHS in this instance isn’t on.

Sorry OP it sounds like a horrible situation. But if you were triaging ambulance requests and you had say a choking baby, a person having a heart attack and someone having taken a non life threatening overdose, I'm sure you wouldn't send the ambulance for the overdose either.

for @yorkshireyummymummy

I think in this case there was not an appropriate response. The overdose she took was capable of causing her serious harm, she should have at least been taken to hospital to be checked.

The nhs seems to be unable to offer decent care in many areas. I’m glad we’ve got it but we shouldn’t kid ourselves that it’s perfect or comprehensive. Mental health seems to be a particular area where it’s lacking but I would say a whole host of other areas are struggling too. It’s a vast contrast to the healthcare I saw in other systems when I lived overseas. But generally in those, you have to pay or have insurance and not everyone has good care, depending on their circumstances.

That being said bpd is very hard to treat successfully and it sounds like your daughter has had a lot of care.

According to guidelines, taking less than 150 mg paracetamol per kg of body weight is not likely to cause liver damage.
Assuming the person weights 50kg, which is quite small, they should be able to take 7500 mg which is 15 tablets. Patients do no to typically present with any symptoms for the first 24 hours following an overdose. If they then do show symptoms, struggling to breath is not one of these. It is a sign of anxiety.
The NHS guidelines have been followed. The number of paracetamol taken was not a fatal dose, not even a dangerous dose. It was not an emergency. The amount of alcohol consumed is not a risk factor. The OP should have taken their child to A and E themselves if they felt the need.

patient.info/doctor/paracetamol-poisoning

The crisis team offered myhusband an appointment 5 months down the line - and reminded me that if he should kill himself in the interim could I make sure I cancel the appointment so someone else could have It!

yorkshireyummymummy - I'm speechless. I understand the staff must be under all sorts of pressure but that still seems unduly callous as a 'reasonable' request.

glintandglide yes, but I have also said she should go to A&E, they'd probably do bloods anyway to be safe. And she needs a mental health review.
Unfortunately mental health is woefully underfunded and people like this don't get the help they need, there's no quick fix I'm afraid

Guidelines are from toxbase. Kind of our overdose/poison bible For people asking credentials, A&E consultant.

However I would urge anyone in this situation to go to A&E, just not via ambulance!

What an unpleasant lot some of you are. Put yourself in OPs shoes and consider how you might of reacted had it been your child who had taken more tablets than she should and was struggling to breathe.
Yes I agree that Op should have got her daughter to A& E as soon as it became apparent that the ambulance wasn’t going to come quickly but even so I can understand her view that the NHS was next to useless in how her request for help was handled.

@Bezm

You ve not even read our own link!

"Yet paracetamol can cause serious or fatal adverse effects at around 150 mg/kg for many adults. There is considerable interpatient variability which depends on age, health and substances taken with the paracetamol"
and
"Commonly, patients are asymptomatic for the first 24 hours or have nonspecific abdominal symptoms (such as nausea and vomiting)" which the girl had.

Just because the NHS is underfunded, doesn't mean we should just accept such shitte.
You dont know how far the OP lives from an AE, what would they have done if their DD had required emg treatment on their drive to the ED?

However I would urge anyone in this situation to go to A&E, just not via ambulance!

Written by an A&E consultant!

Right, you/your husband should have just taken her yourself (ie car, taxi) instead of waiting around and faffing. Surely the initial 2 hour triage slot told you that this wasn’t considered life threatening (due to what she had taken not being that serious). You didn’t need a physical ambulance, others did, and you would have gotten to the hospital sooner if you just took her yourself! You can’t have been that scared if you just waited around for hours rather than putting her in a car and making the trip yourself? If you were truly concerned that she was dying?

Secondly, if she has attempted to take her life various times before, as recently as 2 weeks ago, why does she have easy access to paracetamol, wine etc? Or free reign to go out and buy whatever she likes? We’re no discussing the average teen here, but one that is sucidal after all. That’s an immense risk

Finally, I can’t help but think that there is more to the story here regarding the clinician. Is it possible that the clinician came to this conclusion as they have been involved with your daughter’s care before? Did they think this was a repeat of last time sort of thing? Did they confer with the staff that treated her last time? There seems to be more to the story that lead to their decision.

Poor thing, she has been treated badly. I agree though, the standard thing is to offer antidepressants and send people on their way. It's shocking. Mental health is one of the great challenges of our generation, in many cases people suffering have physical problems too.

When I was younger, I had a friend B. B wouldn't go to school or eat, everyone without exception thought they were just being lazy. I didn't even hear about mental health, other than suicide but more generally I mean, until I was 18. I used to think people that completed suicide where very selfish. I didn't know any better and unfortunately a lot of people still don't.

Sending love to your family, OP.

@AnoukSpirit agree on women with BPD being dismissed as attention seeking, though OPs DD doesn’t currently have throat diagnosis and we don’t know that it was mentioned at all. But personally, although my distress over many years was certainly real, getting a BPD diagnosis (it was previously Bipolar) and coming to see it as an issue I could learn strategies to cope with, maybe like ADHD or ASD, was the key to me starting to get better. Bipolar existed above me and couldn’t be controlled, borderline behaviours could. My responses to things can still be quite disordered, but I’ve learnt ways to cope with lots of it and live a much happier life. I know not everyone will have the same response as me though, I also don’t have the trauma background many BPD women have (who should probably be diagnosed with complex PTSD for a start)

Wow, such a lot of judgement on this thread!! The stigma surrounding personality disorder is alive and kicking on here I see.

A&E is absolutely the right place to go in this situation and is a way to access mental health support in a crisis.

To the poster questioning why OP’s daughter was able to access these items - OP is not a prison guard. You have absolutely no idea how difficult it is to look after a suicidal person in their own home.

They didn't even give her a mental health assessment like they're supposed to when somebody tries to commit suicide. She's a minor for God sake!!

But they did two weeks ago, and before that and before that and before that. What help would another assessment do? Nothing.

Sounds like she needs to go back into inpatient care OP.

No more ambulances though. Take a taxi if she's still awake. Been there, done that.

Unless there's a huge backstory, this would be nowhere near yhe threshold for an inpatient bed

I think the OP is referring to Bipolar Disorder not borderline personality disorder when she states BPD.

Sorry I can't be helpful and it's a shame others can't either instead wish to bash OP for calling an ambulance when her child has made an attempt at her life (not for the first time and after years of MH struggles). Unless anyone has some helpful or useful advice how about say nothing. OP is clearly desperate for some help for her DD and can only imagine all her DD is going through too.

Lots of threads recently about a 17 year old soon to be diagnosed with BPD.

There is no cure for BPD sadly

That is not true - see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158489/ - high rates of remission over 10 years.

IMO BPD is just poorly understood and inappropriately treated. It is not primarily about cognitive dysfunction but relates to how neural pathways in the brain have developed, and a suggestion that people feel emotions more strongly than others, which causes the behavioural / emotional regulation problems. I agree there's a lot of crossover with trauma / cPTSD. For this reason I suggest reading Bessel van see Kolk The Body Keeps the Score, which is ostensibly about PTSD, but as someone who used to have BPD I found spoke to me about what BPD is all about at a physiological level. Most importantly it allowed me to realise it was a problem with a physiological cause and not all my fault.

I recently read Jenny Valentish's book A Woman of Substances about a doctor's response to a patient whom a nurse was saying was "attention seeking", "Well done, you've got my attention, and you deserve my attention". How amazingly refreshing, yet it shouldn't be. It makes me so angry that we have to deal with something that is bloody difficult and not our fault in the first place and then we get abused again for it.

I work with women with similar issues and the response of so called professionals is often appalling and services practically non-existent. You may find a women's centre near you who provide better support, or a counsellor with experience of BPD, for example one that's DBT trained or possibly EMDR.

Really sorry you and your daughter are going through this

I think the OP is referring to Bipolar Disorder not borderline personality disorder when she states BPD.

Ah, I guess some of my post still stands if it's bipolar!