The state of personality disorder services in England #bigspd17

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firemonkee57

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#1
Posted by Keir Harding Mar 21 2017

Down in the woodland many elves have written about personality disorder. Often this has been around rethinking diagnosis or what treatments are effective. This week we’re looking at a paper that seeks to evaluate the availability and nature of services for people labelled with personality disorder. We’re all looking forward to discovering what’s out there…
The state of personality disorder services in England


My treatment for my PD has been being on an antipsychotic. Was told I was unsuitable for therapy nearly a decade ago.
 
rasselas.redux

rasselas.redux

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#2
The personality disorder service in my area is mostly provided by the police, the ambulance service and an A&E 15 miles away -- which is somewhat aversive to people of such grouping. But goes through the motions anyway (so long as someone is keeping tabs on things -- they might equally discharge someone to a bus stop if it's a busy night or if one of the doctors is having a bad day).

This has opened my eyes.

Exactly nothing has changed. In fact, with the closure of many centres, the situation has become far worse.

The only real improvement is the police. They are the only agency willing to stick their necks out. And they show compassion.

The Trust were found by the CQC as having a poor crisis service. The response? Nothing. Absolutely nothing.

When I think back to the situation people found themselves in when I first became acquainted with the MH system, about 20 years ago, the calls for change and improvements have got louder and more serious, and the decline in services more palpable.

So from the point of view of this area, that report is absolute bollocks.
 
rasselas.redux

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I should add, in all fairness...

after nearly two years of shunning, standing back, professional neglect, broken promises, and passing the buck, a gallant CPN from another Trust stood forward and volunteered himself.

That was an emotional moment. If resources were made available then maybe there'd be more like him. His offer was largely impractical but goldenballs material, nonetheless.

I see that the £800m extra funding for MH services nationwide will now not find its way to MH services after all, instead being used to shore up near-bankrupt A&Es.
 
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A&Es that are being put under pressure by the lack of availability of personality disorder and crisis services...
 
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firemonkee57

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#5
I do think the PD category is often somewhere for a pdoc to dump someone that he/she sees as awkward and doesn't like, and that other means of describing someone's difficulties would be more helpful and less abusive towards the patient.
 
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I've stated my opinions about labelling often enough. They undulate a bit but ultimately yes, in terms of personality disorder, although the criteria do make quite a good match for a person's problems by the by, the actual real-world effect of the label is to indicate a person that no-one hardly will be willing to work with.

And just like any label the most challenging people wit said label kinda echo forever through the corridors of time, and anyone else so-labelled will be struggling with collective memory and stigma as much as the struggle of their own to be taken seriously and helped.

Of the people with personality disorder I made acquaintance with 20 years ago, of about 15-20, 3 are still alive.
 
rasselas.redux

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Which is why you need staff with the skills and the resources. I mean, to have people of such chaos and frequent death on your books, it's a heavy toll to take on potentially.

But I'm not making excuses for the NHS. I think a lot of them would prefer people labelled with PD would just fuck off and leave them alone. They will die anyway and if involved it'll be them that gets blamed.

And I must say, there is a great deal of blamey shit that goes down in the mh system in all directions. It's all very tiresome.

So I think what most people find is they have to be pro-active and address their own issues, by their own volition. If they are very lucky they might get help from others in their life, but often won't.

So most will end up drugged and sedated, which in many ways isn't so bad -- everyone gets to have a quiet life. Although for a really really quiet life we could maybe bring back lynch mobs and hangings and any fucker that rocks the boat would have it.

I jest, but, ultimately, probably for anyone, it's largely pointless waiting for godot. Godot doesn't arrive. If you want to get better you've got to go DIY in some way or other.

People get shirty with me when I say that. But it's one of the harsh facts of life.

Many with personality disorder end up in prisons, where they'll get better and safer access to sedatives and heroin.

If I hadn't had such a conservative upbringing I'd probably be recommending people seek out diamorphine left right and centre.

Choose isolation or suicide? Nar. Choose drugs. ;)
 
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and just to add, for clarity's sake.

I've read a number of studies now, legitimate psychiatric studies, that make a link between effective self-medicating with street heroin and personality disorder, and in simple terms, the reasoning goes thus:

from what little we know of the workings of the brain, which for the sake of pragmatism we'll assume is good enough to draw some tentative conclusions from

and assuming a localised model of brain function

the areas of the brain most associated with feeling physical pain are the self-same areas of the brain associated with the subjective experiencing of emotional pain

the more severe the pain the more severe the pain killer

the more severe the emotional pain the more effective the opiate/opioid

medial heroin is safe, clean and does not impact on physical health adversely

people in extreme emotional pain seek out heroin as a logical panacea for their ills

(street heroin is dirty, bad for health, bad for society)

people in extreme physical pain seek out diamorphine and its synthetic cousins from humane doctors

(diamorphine is clean, good for health and good for society)

therefore, personality disorder -- if it is to be treated pharmacologically and humanely, should be treated, certainly in the worst cases, with diamorphine

it took a while for me to get over the WTFs and the inculcated brainwashing

but I'm tending to agree

to withhold morphine from those in severe physical pain would be immoral

to withhold morphine from those in severe emotional pain is immoral, given that, in a localised functional model of the brain, the brain -- and therefore the self -- experiences both types of pain in ways that are barely distinguishable
 
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Hairy.Mary

Hairy.Mary

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#9
As I've said to you Rass it's a liability issue with PD as they're considered high risk and people aren't willing to take that risk.
I had that comment to me too firemonkee too angry for the therapy to help me? So illogical but I believe they blamed me as it was easier than them admitting they couldn't offer the required therapy.

Here well be getting complex needs care soon so hopefully there will be more available for the PD and staff confident enough to support.
 
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mrspoon

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#10
I have diagnosis of PTSD and possible PD and right now at least they are supporting me quite well with a social worker, support worker, they are applying for a bigger support package and also a psychologist for therapy without time limit who according to him wants me to work with several different therapists of various types . But that might be because Iam not just a high suicide risk ,but in their view a high risk to other people as they say I have a history of violence . I did argue that bit ,when it was said to me, because while I admit I am high risk to specific people Iam not to random people. They also asked about weapons in my house and I was truthfull ,as I don't see the point in not telling them everything anymore. It seems the more I open up, the more support I get. Kept these ideas to myself about this town and other people for years.

There is confusion about my PD diagnosis as several staff say they think I have one, namely my psychologist, social worker, occupational therapist , but two psychiatrists so far who I have been sent to have said I don't have a PD,as I don't present like someone with one, but have PTSD , basically complex PTSD. and so they are treating me for PTSD.

There is a complex needs service in my area, but Iam not under them because Iam too high risk even for them, and they don't have the resources. They also say Iam not suitable for their group therapy because I am too aggressive and sensitive.
 
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