Women and mental health services

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Been thinking about a lot of things recently. Hope I can put this coherently...

Basically I'm concerned about the effect of mental health services on women, regarding therapeutic approaches and general approaches of professionals, including misogyny and attitudes to abuse and expected gender roles. (Am in the UK so specifically thinking about NHS services).

For example, everything seems very focussed on positive thinking, thinking about what you can change in your life rather than what you can't. This is I suspect very influenced by severe funding shortages meaning a service that tries to get people vaguely functioning in their expected roles ASAP rather than bringing about lasting insight or change. But sometimes, people need to get angry. On a personal note, despite feeling terrified and helpless at some of my life experiences, simply understanding the context is a help.

I suppose I sort of feel that services gaslight women. (Potentially men too, but I think there's particular issues for women.) A service that aims to get a woman out the door as soon as possible isn't going to be very good at spotting the signs of abuse, for example - or at least, of realising abuse is happening rather than the woman just being mentally ill. And in fact services try to push as much care as possible onto family/friends of the unwell person, so a woman could be doubly trapped.

Also men working within mental health services can come with shedloads of misogynistic attitutes (as can women actually). I won't repeat some of the advice I've been given here but it's hair raising.

Plus the whole idea of trauma as a mental illness, naming the problem as being within the person rather than the experiences they've suffered. Are women viewed as unstable because on average we kind of are, as so many have been traumatised (by men) over the years?

I don't know... I mean, psychiatry is set up to preserve the status quo, I guess. So it shouldn't come as a surprise... (And saying something like "psychiatry is set up to preserve the status quo" sounds like tinfoil hat territory... amazing how th system does that to you )
I suppose I'm still reeling at the shock of a system one expects to be there to help, not being. In fact potentially being harmful. And a sort of realisiation I'm not that crazy, but the world sure is

I hope this post makes some kind of sense... er...

BPD is a feminist issue.

I was psychotic at the time I was in an abusive relationship, and one of the things advised was to move out of the house I shared with him.

BPD was considered for me at one point, but the label was removed and bipolar decided upon, for various reasons.

When I was considered to be BPD, which was a label I had for several months, I don't think I was treated any differently in terms of kindness. They were reluctant to put hospitalisation on the table, as data has shown that hospitalising people with BPD just leads to continued admissions and a negative cycle appearing. I was told this at the time and they worked with me on an outpatient basis. There was a significant focus on supporting me, but keeping strong boundaries in place. I was told about DBT and advised to buy a book to get started. I was also referred to a service that does some kind of DBT based therapy, but my diagnosis changed before I could get there.

My diagnosis changed because I moved back to my home town and was re-assessed when in crisis again. As said, there were reasons bipolar was more appropriate, mainly because my symptoms only occurred during a mood episode, and medication resolved the mood episodes.

When I was diagnosed bipolar, my psychiatrist would occasionally do me a favour, like drop me at the station after an appointment (in her car) so I could go to work. This only happened about once, but my understanding is that this would not be appropriate for a patient with BPD, because it would blur boundaries, and destabilise the relationship.

The books I read about borderline and DBT, when I was thought to have BPD, mentioned traditional therapy for BPD. Apparently it's unsuitable because patients end up retraumatised from going over trauma, and often go through a cycle of devaluation/putting their therapist on a pedestal and wanting constant contact, so it ultimately doesn't do any good. The therapist ends up feeling drained and useless, and cannot give the person what they want.

Atrocious I wish that there was a way where people could come together within a community, tell stories, listen to each other, hang out, eat together...spend time together in a healing way which didn't revolve around drinking or religion.

Yes, wouldn't it be wonderful?
I have had a couple of experiences of something like this and both times were wonderful. I became a lot more capable too.

Fall people with PD were NOT excluded from MH till 2007. That is completely incorrect.

The Mental Health Act was changed in 2007 meaning that personality disorder is now categorised as a "mental disorder" for the purposes of the act, ie. detaining people in hospital.

Practical examples of disorders which would now be covered by those provisions are forms of personality disorder which would not be considered legally to be “mental illness”
Previously to detain someone they had to consider the "treatability test", and PDs were considered untreatable. This put the onus on services to actually provide some kind of service for people labelled PD, previously they had no such responsibility because they didn't have to admit people even if they were very unwell. Obviously they would want to provide (cheaper) community services rather than just waiting for the person to require hospitalisation. But before then it was not in their interests to spend any money on it.

Also, the report "Personality disorder: no longer a diagnosis of exclusion" was only written in 2003.

This document provides information for Trusts about the Government's intentions for the delivery of personality disorder services within general mental health and forensic settings. All Trusts delivering mental health services need to consider how to meet the needs of patients with a personality disorder who experience significant distress or difficulty as a result of their disorder. Funding will be available to enable Trusts to develop personality disorder services over the next three- year period from 2003- 2006.

So, no PD services before then, or very few.

Thanks for sharing, namey. That's really good that even with psychotic symptoms they believed you, and that the BPD label made no difference in terms of kindness. God it's actually like a ray of hope.

Apparently it's unsuitable because patients end up retraumatised from going over trauma, and often go through a cycle of devaluation/putting their therapist on a pedestal and wanting constant contact, so it ultimately doesn't do any good.
Yeh I've heard/read this too. But then apparently also people with BPD get weirdly attached to their therapists. I saw a private therapist for a while and didn't get attached (in fact I was worried because I thought one was supposed to get attached to a therapist a bit). IDK, it just seems obvious that they're a professional providing a service. It seems to be much more individual than they make out.

Also, I found talking about some stuff helpful. A lot, actually. It helped me piece some things together and just someone hearing for the first time seemed to be mysteriously helpful. Unfortunately there were other things going on in my life so I wasn;t getting a clear picture - let's just say I now know I need to steer clear of romantic relationships for a while as I attract wankers and my own uncertainty (constantly having to reassess everything, checking I'm not over- or under- reacting) means Im quite easy to manipulate still (btw I've never been one to go from one fling to another, and have never been "looking"... which I previously thought meant when I found someone they would be agood 'un). I also feel I'm trying to figure out how humans behave (in order to protect myself and understand others) and the therapist kind of didn't see that as relevent. (I'm being assessed for ASD before anyone asks!) I used to have a very political/philosophical friend who actually seemed to "get" more than the therapist...

oops, linky: <a class="break-all" href="http://webarchive.nationalarchives.gov.uk/20130107105354/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009546" rel="nofollow" target="_blank">Personality disorder: no longer a diagnosis of exclusion

I am uncomfortable with much of what is said on this board. And I absolutely consider myself a feminist. I think that mh services are struggling terribly and in times of cut services and social inequality, mental health is also suffering terribly.
I think sometimes it is hard to help people to feel better, despite all the best will in the world. Sometimes it is just hard. However I do agree that pd is a feminist issue (or rather people issue as feminist issues are issues for women and men) but women are more likely to get this diagnosis while men are more likely to be diagnosed with asd/ adhd and end up in the criminal justice system/ committing suicide. The reasons for this are complex but I do feel uncomfortable with how bpd can get overused for women. I also agree that there should be more long term talking therapy around. And there is now evidence for it e.g.: www.bpc.org.uk/news/publication-landmark-psychoanalytic-psychotherapy-depression-study
It is however expensive and measuring 'outcome' for constellations of difficulties such as complex self sabotage, repeated abusive relationships, trauma etc are not as straightforward as measuring outcomes for other types of nhs treatment.

I was working on acute wards in the 90s and early 2000s. I'd say about 25% of the service users who had admissions under a section of the MHA had a diagnosis of BPD (PD not bipolar).

If anything, I think it's less likely that someone with a diagnosis of PD is admitted to hospital now. Because it's hard for anyone to be admitted now and because the admissions that were had back in the day for people with PD were often lengthy but not particularly helpful in a lot of cases.

People with PD may have been technically excluded due to semantics around language but they were not being excluded from services.

That's interesting Fallon.

This is a very interesting book about feminist historian Barbara Taylor's experience of needing proper long term help. Really long term. (Actually it's just a review of the book but the book is very interesting and a challenge to the system we have now)
www.theguardian.com/books/2014/jan/30/last-asylum-barbara-taylor-review

This has been a subject on my mind for a while now.

My personal experience was similar to others here. After a decade of depression I built myself up to approach the GP. I had been really bad for the 18 months before that due to the birth of my youngest and some really shitty circumstances.

He was ridiculously patronising. But medication was given based on a 5 minute conversation. I went away feeling confused. I always knew that my MH issues were mostly, if not entirely, caused by situations in my life but treating the symptoms was more important than treating the cause?

I took the first prescription and yes, they numbed me. But I couldn't bring myself to go back to get more. So I found a private therapist and accepted that I was going to be skint for the foreseeable if I was ever going to get better.

That therapist halved her fee at the first appointment and she went on to change my life. Just being able to talk and be heard and feel understood and respected felt like a miracle. It wasn't just that. I had to make some massive changes in my life. But sge supported me through it.

I have always had an interest in Psychology, and I hope that someday I will be a therapist and help someone else the way she helped me. I am working towards that now.

But lately I have been becoming a bit...deflated? The issues mentioned om this thread are all around me and they seem so ingrained. Children are being socialised into these patterns and really the MH services are coming too late. Feminism is a dirty word. Feminists are crazy, men hating, bra burning lunatics. There are men who actively despise women.

I am actually considering whether I am strong enough to go into the NHS and work in an environment that does nothing to challenge these issues, and actually might be perpetuating them.

I am rambling on now...but this is a very interesting thread OP.

I am actually considering whether I am strong enough to go into the NHS and work in an environment that does nothing to challenge these issues, and actually might be perpetuating them.

I'm not sure how much of that type of longer term therapy is actually offered by the NHS now? How many posts there are/might be very competitive etc.

Might it be possible to set up privately but with a charitable arm to the business? So the well-off clients provide income meaning you could see poorer clients for a very low cost?

BPD is indeed a feminist issue. They are too quick to dish that diagnosis out and then refuse to help women who have it.

There are nhs services that offer long term psychotherapy (in nhs terms 1-2 years)for bpd (and other pds), but it does vary nationally. The cassell hospital in richmond and the tavistock in London both do. But I agree there are not nearly enough and everywhere is facing cuts. But not everyone will like or feel helped by these services either.
I feel mental health provision for men is actually worse than it is for women.

I think BPD/EUPD is a feminst issue and it's just the latest name for Hysteria. It's a very gendered diagnosis.

I have been diagnosed with Avoidant PD, or Anxious PD as it's known in the UK. That isn't really a matter of gender, as most people aren't even aware of it. It doesn't seem to affect the support I recieve and it appears that Avoidants are largely viewed with sympathy and occasional annoyance as we tend to just be reclusive, socially awkward and socially inept sad sacks who don't like to rock the boat. Unfortunately there are no NICE guidelines for treating this PD. I've heard a lot about people with BPD getting shoddy treatment from CMHTs. That's really shit IMO.

I also have a diagnosis of Bipolar 1. I have had really good treatment all in all, especially when you consider the state of the NHS and funding issues. The professionals I've seen have all been kind and compassionate - apart from one locum psychiatrist who was a complete arse. He was a semi retired bloke and he was very sexist.

However, I didn't experience sexism from the other psychiatrists I've seen. I have a male care coordinator/CPN and he's a really nice bloke. He's in no rush to discharge me. They haven't pushed me into becoming 'normal' and into female roles, because frankly, that's not going to happen. I have a severe manic and depressive bipolar episode every 18 months to 2 years (even on meds) and struggle with AvPD the rest of the time.

However, I have a really supportive husband and there's no abuse going on, so I can't comment on how they'd handle it if there was.

I'm just sorry that so many people have had negative experiences. On the whole I think my CMHT has done a good job with the resources on hand, apart from that wanky locum psychiatrist. I have a lot of respect for them.

I'm finding this thread fascinating and am really learning a lot from the experiences that have been shared here. I agree that psychiatry and mental health services provision is very gendered, and I think the pp who described EUPD as just a new term for Hysteria has it spot on.