Apologies if I’ve double posted - will fix in the morning.
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I’m still very confused about BPD, because of the all the mixed messages from staff. Then when I read descriptions myself, only one of two points match J, out of fifteen or so symptoms, which is is the basis for us challenging the diagnosis.
I was just about to respond to your message about specialist care (sorry for the delay), but it might help me to share the thoughts here as well, and provide a bit more background to J’s recently planned referral to a specialist unit away from her home area.
I totally agree that some sort of specialist is required, the Bradgate Unit doesn’t even have therapists or counsellors (apart from very occupational therapists who have the broadest of remits, cooking and colouring etc). However her possible transfer to a specialist private PD unit in Birmingham for up to two years, for mainly DBT, which she has done a lot of, just didn’t add up. We were being faced with too many “what ifs” and the assessment itself was poorly implemented, and decisions were being made without her consent. Her self harm increased during this process because she was terrified of being sent away whilst under section, but also wasn’t being consulted. This compounded the view that somehow this /acute/ care ward could not cope with her behaviour. We recently acquired the patient notes for the assessment and they were peppered with contradictions. An explanation for this might be that they (the private unit) were making her match a template or nudging a point score. Strange things like, (paraphrase) “poor presentation and hygiene” (J’s OCD means that she wants to shower at least two times a day, but she’s cut back to one shower with rituals, she’s squeaky clean), “mismanagement of medication” (yes she ODed, but her phone bleeps reminders for meds with an efficiency which puts the ward clinic to shame, very little prompting required). They were references to very old notes and quotes which we found unrecognisable and unsourcable - negative anecdotal statements from nurses from previously disruptive ward stays when she was highly triggered (on a crapper wards perhaps?). This shit is worse than a criminal record because they don’t have to delete it after several years, it all just stays there, as does the diagnosis of BPD - which somehow becomes perjorative when she is in crisis. Even though J is supposed to see this part of the assessment, the doctor kept it from her until the last minute because she knew it would be upsetting and wanted to talk to the private unit first. The implication being that the doctor wasn’t too impressed with the way it had been written either.
The consultant decided (in a closed door meeting) that it would be better if J stayed at the Bradgate (where she currently was). This was a relief to J, myself and a couple of the nurses who had been investing time in J and had also been to some extent locked out of the referral decision process. During this time J has even started to challenge the MH section. I think by the time the tribunal occurs , there’s a chance that she’ll be a voluntary patient again. My point here is that at the start of her stay, and now, I’m desperate for the wards to keep her safe, and Mental Health Act Sectioning was a way which allowed them to do that, especially when J didn’t trust herself (she’s fairly honest about risk, it’s just getting staff to believe her). The locum doctor who set this process in motion also said he didn’t believe that she heard voices (she had been begging for an increase in anti-psychotics). That feeling of powerlessness means that the level of trust with the doctors and her own ownership over her recovery were reduced to a stage where she has to challenge this power legally. Get this. She’s challenging the Section, not because she wants to be released back into the community and home, she’s challenging the Section because it’s the only way she can guarrentee that the doctors won’t force treatment upon her, like being transported against her will to somewhere else, or ECT. That’s like having to divorce your husband to save the relationship. It’s crazy.
A few months back I had hoped that maybe this private unit (which she is now not going to) would have something new to offer (perhaps skme skills, perhaps for a short stay), but all impressions and gut instincts are now saying otherwise. I mean I’m not much of a fan of the Bradgate, but these guys had screwed up two assessments so far and the doctors weren’t even telling us why they thought J would be better there - just felt like clear-the-bed maths. J is a challenge because she may have a complicated diagnosis (depression, OCD, Bulimia, GAD), but she’s not “challenging”, not like some of the other psychos I’ve seen screaming at patients and staff.
We’re still waiting on some phone counselling for rapes. It was only recently that a doctor and nurses thought this might be useful - up until now all of the focus has been on childhood experiences (if any at all). How can professionals dismiss traumatic events from adult history? Maybe there’s a PTSD solution in there somewhere, but no, apparently it’s all about J having to learn to show “restraint” and “take responsability” when she is suicidal (which apparently she isn’t, we’ve been told, but they write “suicidal ideation” and say her plans and thoughts are “ambivalent”).
It would be nice if key professionals stayed in the post for longer than a handful of months as well. But that’s a whole other moan, which the LP Trust won’t take any of their own responsability for.
Just to end on a positive note (I may post this as a separate entry) J had her second visit home today. Apparently she’s safe to be alone with me, not needing a nurse as escort (this is most curious, because she’s also been with me when she is in danger). Funny thing, MH sections. Very flexible when they can’t spare the staff. Focus, stay positive. She gets to come home for a few hours and spend time with her cat Lucy, but the whole experience can be emotional exhausting for her. It’s early days, but the climb back to something a bit like normality has started.
Thanks for reading.
Anonymous