To think this psychiatrist neglects their patients

[User5373839]

I’m on a support group for people suffering from mental health problems in my local area. The main point to to offer support and signpost people to support groups etc in the area. It’s been mentioned on there recently though about the local unit and the consultant at the unit. He removes people of a section within a day usually if they have a particular condition. Aibu to think this is dangerous and if someone meets the criteria to be sectioned less than 24 later you don’t remove the section? Surely it undermines the decision of two other senior doctors and a amhp.

People with eupd may be sectioned as they are presenting in crisis and at that moment they are so distressed or fixed in self harm cognitions that they can be deemed to lack capacity.

Often the crisis passed and our trusts current guidance is for an admission lasting no more than 72 hours. Whilst the consultant does have the authority to rescind the section I’d be surprised if there wasn’t a bed manager breathing down his neck ensuring this happens!

For all but the most risky individuals with eupd community care delivers better outcomes and more dignity. Many ex service users who agree.

These people are still saying they feel at risk though and they are often re admitted within days/weeks.

No I understand that people don’t always need to be there the full 28 days but a day seems very quick.

Have you ever been an in patient op? I have and they are absolutely terrifying places. Even with lovely staff people are very unwell and have really extreme behaviours. I may be wrong but I have had contact with EUPD sufferers on programmes though they decided I had bi polar and from what I remember they can soak up other people’s behaviours quite easily. So if this is the case I can see the danger, are there any MH professionals on here who can confirm and maybe post a link to a reliable source?

I’m assuming though a short period they are observed closely.

On the flip side I do prefer home treatment and therapy etc. But I was too unwell at that point and had I had any other diagnosis I wouldn't become the bloody Terminator. I was so hellbent on ending things. Nothing but a forced stay in hospital and some forced medication would have stopped me.

I guess it's about reading between the lines and looking at the patients history and hearing what friends and family has to say. They see it day in and day out and are more likely to know if its their "usual" level of distress at crisis point or if its taken a turn for the worse etc.

valkadin inpatient wards are grim, like holding pens that have minimal therapy and lots of very psychotic and distressed people wandering about, but its better than being dead. I hated hospital the few times I've been but I'm forever grateful in retrospect to the staff. No one goes there for a jaunt or for a break. It's bleak.

These people are still saying they feel at risk though and they are often re admitted within days/weeks.

But what about being hospital would change or treat the risk?

Do you keep people in hospital long term to stopping them harming themselves whilst making them more dependent on you, making them conform to an institution and its rules, and expose them to others who may be violent, traumatised and graphic about self harm?

Or do you accept the risk and that they will need a brief hospital respite every now and again, and try to engage them in psychologically informed work with a team who set boundaries and can help engage them in community life?

I feel passionately about good care for those with eupd and I do feel that services don’t adequately meet the needs of the population. This is not an example of poor care for them.

CMHTs with no psychologist, a locum consultant and not enough CPNs to care and advocate for their caseload- that is something to get pissed off about.

The diagnosis of EUPD/BPD is frequently made for the sole purpose of getting 'difficult to treat' patients off wards and off caseloads - research has shown that psychiatrists tend to apply it most readily to patients they dislike. That's why such individuals usually do best at home without 'professional' help.

thenanny I think the difference there is the level of risk. Are they "just" scared they'll self harm or have they got an actual plan to kill themselves. Do they have form for mini attempts that are more like cries for help or one or two big ones that caused serious damage physically. How do they present. Is it severe or are they "high functioning" etc.

What does help is having more therapy tailored to it in the community. I've just started a dbt course and it's been incredible. I'm able to self manage at home much more easily and when I do have blips they don't reach crisis point easily. I can't believe its taken me so long to get it. The waiting list was 2 years long.

There is a stigma around eupd. I was only diagnosed at 28 and before, when it was "anxiety and depression", professionals were far kinder and less included to think I was bloody lying.

And I do think I would've been diagnosed differently had I responded better to traditional medication or been male. My uncle presents exactly as I do but he's diagnosed as bipolar. I don't have attachment issues but I fit lots of other criteria for eupd so they diagnosed me anyway, and I'm certain some of it was down to just not knowing what to do with me. Especially as I didn't seem to be improving quickly.

(sorry op, I totally derailed there but it all drives me mad, excuse the pun).

@lhia29

You are right- I do work at the moment with eupd patients who are long term inpatients due to their level or risk but whilst the service is great it is for the extreme end of the spectrum and it is not a good place to be in.

In general the guidance is there for a reason but is not a replacement for clinical judgement.

I agree DBT should be much more widely available!

Unfortunately clinicians are regularly criticized for not admitting people with EUPD when in crisis (there was a recent thread here), but staying in usually isn't helpful. Teams have to act on the presentation at the time, so detain people if they are felt to be at risk, then follow guidelines for longer term management (which is not long admission). People with EUPD often experience very extreme and impulsive crises which resolve rapidly. So the doctor is following the right guidelines. The staff sectioning the patient do what they have to do at the time. If the patient is already known, they are unlikely to need a full Section 2 assessment, but need to be made safe immediately. Staff are usually in a fairly impossible situation at these times, with limited options so they do the best thing for the patient at the time.

I do hope that in the future eupd/bpd isn't such a catch all. Its a diagnosis that often fills a gap where people aren't sure quite what's going on but enough criteria are met (ie in women there's a lot of overlap between autism and bpd).

It could do with having subtypes or the like. Because like schizophrenia or bipolar it can present in very particular ways and the stereotype does no one any favours. Or at least acknowledge that there are "quiet" borderlines, who don't make much noise because everything is internalised rather than the traditional angry outbursts that people expect of borderlines. Both are valid presentations of the condition but vastly different and cause different problems and difficulties.

Sometimes the help that people need can be put in place after they've been sectioned, but sadly not before. That's the case locally here as things are so stretched

The point I forgot to make there was that subtypes or some kind of similar system would maybe reduce the chances of professionals making the wrong decisions with patients they don't know well. And the guidelines for treating eupd during a crisis could reflect the "type" of bpd they're treating. Just a pipedream but the system at the moment is definitely a bit flawed. I see why they discourage hospital but sometimes it is necessary to keep people alive. Obviously I feel passionate about it though so I'm probably biased. My boys wouldn't have their mother if they hadn't detained me and I did some serious damage from the 2 attempts that I'm still living with now which could've been avoided if I was kept in after the first 136 (the 48hr section). Why is it ok to let people die from this condition to make a point about never ever treating that condition in hospital, y'know?

Mental health services in the UK right now are just fighting fires rather than preventing them. There's no money. If they invested in dbt courses and better therapy and treatment in the community people with eupd would reach crisis points less often and be better equipped to handle them when they occur. It's a very difficult condition to treat and not one that's (usually) appropriate for GPs or inpatient wards to treat and yet that's all there is for a lot of people. The services just aren't there. And the police who are also super overstretched end up having to 136 people all over the place. Its a really strange state of affairs.

Lhia29 Thank your posts are really insightful and helpful. Have you ever considered attending a service user feedback meeting? I think your view could be quite useful to professionals.

I have done. Partly to feel it wasn't all for nothing. Glad you didn't mind my mini essays 😂

I do hope things change overall for the mh system and especially for people with chronic or complicated issues. They need funding, further research and more awareness/reduced stigma.

I wonder if those competing the MHAA cannot/are not willing to take the risk of D/Ch'ing someone expressing suicide plans, but the Psychiatrist sees D/CH as positive risk taking? In the context of inpatient stays generally not being considered best treatment for those with diagnosis of PD.

I think Lhia's post is very good.

The situation in mental health services is desperate at the moment.

A lot of behaviour seen in patients with EUPD is not behaviour that places them at immediate risk (even if to someone untrained it might appear that way / they might say it does) and remaining as an inpatient is actually detrimental to them.

Police might issue a 136 on someone threatening harm, who is then seen by an actual MH professional who assesses their risk and decides the best way forward in accordance with current guidelines. This is a very rough and non-specific example to explain what you have experienced. It's not because the consultant is lazy though, I can tell you that much.

It is true that some autistic people are misdiagnosed as BPD and visa versa. You can't have both but there are traits in common. The system is underfunded and horribly so, but so much of the evidence points to people with BPD having better outcomes via community support and admissions worsening their symptoms and coping mechanisms.

With EUPD that’s usually quite standard practice as in they often hit crisis and leave crisis points very quickly. Yes they may need to be detained for a short time but then are often ready to go back home and continue out patient treatment very quickly.

The people I’m referring to are still having many incidents in the community so for them the crisis hadn’t passed when they discharged them.