Blog Carnival - Stigma and Discrimination.

This is quite an important topic to me. So important I am writing my dissertation for my Masters in Social Work on it. In particular the stigma of personality disorders.

With people I know, i.e friends and family I don't make well known the problems I have experienced or experience. Being a Social Work student perhaps I should be more able to let other people be aware of the issues that I face. But I don't. The reason being is I fear discrimination. The friends (if you can call them that, I have written posts before on the problems I have had with friends) that do know about some of the problems have seemed to have distanced themselves from me. The night I fell over and broke my ankle saw me being open-ish with them about what has been going on. Since then, I have not heard from them and not seen them. That's two and a half months ago. I have been left out of group things and no one has really been in contact. I wonder if they think it's catching, or, if they just don't want the hassle of having a friend who is slightly different to them.

I say that in being a student in Social Work I should probably be more open. You know, fighting for acceptance etc of mental health. But in reality, I know there is massive stigma and discrimination of people with MH problems. There are all these campaigns out there such as Time to Change which promote the acceptance of people with MH problems and encourage people to speak out about it. I am a big believer in this. I believe that people should be able to openly discuss that they have problems. I mean, if someone had a physical illness such as diabetes they wouldn't be chastised for talking about that. So why with MH? Yet, even though I am a believer in this, I can't find it in myself to be open with people I know or meet about it.

I want to be a MH Social Worker. I eventually want to do my AMHP's training. Surly as someone who wants to do this I should feel that I could be more open about the issues I have faced? But no, it's because I fear discrimination and stigma.

It's not just the wider society a person experiences stigma and discrimination. It's from the inside also. Especially if you are fortunate enough to have been given the "diagnosis" of a personality disorder. I wont go on about my thoughts of the concept and diagnosis of PD as I have many times before. There are studies out there that have shown that the patient with the diagnosis of PD is the least preferred patient. So what does this mean?

Off the top of my head and sorry if I am wrong, but 1 in 3 people will experience a mental health problem at some point in their life. 30% of people with MH problems have been diagnosed as having a PD. I don't know if this means that nearly 10 in 100 therefore are able to be diagnosed with a PD? Maybe I am getting it round my neck. But either way, the prevalence of PD is quite high. So, why is this the diagnosis that experiences most stigma and discrimination? You would have thought that a person who works in mental health would be used to dealing with people who are diagnosed with this (considering the prevalence), so why the stigma? It's something I am going to look into more when I start writing the dissertation.

I have also seen the stigma and discrimination first hand. Some of the things that qualified members of staff have come out with... such as "that's typical, she's PD" in regards to someone being upset over an event. "Be careful with them, they're a PD patient, they'll switch and use anything you tell them against you". "Typical PD" about someone who self harmed. I have seen people who have been diagnosed as having a PD being treated as second class citizens. This was in a unit specifically for PD. You would expect the staff to be a little more understanding and less harming to patients really. This particular unit I worked at has been in the news a couple of times recently as of bad management though, first a patient succeeded in killing her self as her obs weren't done correctly and then because of a riot breaking out! It was a horrendous place and I was so glad when I found another job to go to. Again, I have written more about this unit previously.

I have noticed the stigma when being in hospital. For instance, when I have had to go to the ED as of self harming or suicide attempts I have found that the staff have been very brisk with me. There is one member of staff who hates me. Well there's probably more but she makes it quite well known. She says things like "you are being a silly girl". "I thought you were going to sort your self out". "There's people who need our help out there"... and a few other nasty comments which have just not been needed. There has been a doctor when I asked how long it was likely to be (in a nice pleasant way) snap at me and say "bloody typical of you self harmers, you come here after self harming, expect to be patched up and rushed through". Never in the ED has someone asked why? They see self harm as an attention seeking thing.

When I have been at the hospital as my own accident proneness (usually 2x a year that is in no way related to self harm), I have been treated with respect, they have been nice to me and caring and showed an interest in my life.

It's not just with self harm that they are bad. I went in with a service user a few months ago. Basically I was concerned that the stress she was under because of the housing issues would trigger an episode for her as they had in the past. So I went out my way to take her to the emergency doctor, miles away from her house and then to the ED as the emergency doctor wouldn't do anything. Anyway, I took her to the ED as I wanted to get her seen by someone as I was concerned. They were awful to her. Shoved her in a cubicle and didn't come check on her or anything. 6 hours we waited and not once did they come to volunteer how long it was likely to be. The only information I got was when I kept asking and asking and then eventually saying I felt we were being fobbed off as no one was telling me anything.

Everyone holds prejudices. If you think you don't then you are not human. It's how you handle them that count. I have also written posts on the prejudices that I hold. But, most people learn to not let them affect what they do. I leave my own personal feelings and values at the door when making decisions. I think in some cases they are ingrained in to you from a young age.

When I was growing up I lived near a Psychiatric Hospital. We used to scare each other with stories of what the "psychos" would do and we would worry about them escaping. This is from being about 4 or 5 and talking about it with your friends. I have found myself correcting people now though about it. My brother being one of them calling it a mad house. And then he was getting it all wrong about the difference between the drug and alcohol ward and the normal wards (normal psychiatric wards). I was trying to explain that not all the people and the D+A ward were mentally unwell etc etc etc. And he was trying to tell me how it had moved from a place where it wasn't to the place he was now. Anyway, I had a lot of correcting to do. But it's amazing how people will describe psychiatric hospitals and wards with such throw away words like "mad house, crazies, loony bin" and a few others. Why can people get away with this, you don't hear people talking about physical illnesses like that. Why is it worse to be seen talking about someone with a physical illness in a derogatory way and not a person with mental health problems?

I've not quite written this blog how I wanted to so maybe I will come back to it and change it at a later point, but for now it will do...

xxx

Patients and Professionals.

I thought I would give the blog carnival thing a go this month. The Madosphere is hosting it and I am going to have a go at making a contribution.

The theme...Patients and Professionals.

I am not usually one for joining in with things but this theme kind of spoke out to me. You see, I have experience of both sides.

Currently I am doing a Masters in Social Work. My aim; to be a mental health social worker. I want to do my AMHP's training and work as part of a crisis team. To get on to the course I have worked as a support worker in hospitals on the psychiatric wards. I have previously written about my experience of working on a ward and how I was attacked by a patient which landed me in hospital having a CT scan and being off work with concussion and work related injury. I had a comment on that post saying that I provoked that person just by being who I was and having restrained people in the past. As a support worker no one likes restraining people. It is done only as a last resort of in an emergency situation if they are endangering their own life or they are likely to cause harm to another person.

 Restraining someone is horrible. It's uncomfortable, it's hot, it's sweaty and you can end up with your head in body parts of other members of staff that usually you would wait a good few dates before going there. There is techniques you learn where everyone has their part and place. It's choreographed. In theory it works smoothly and doesn't cause you as a restrainer any pain. In practice, it's messy. You grab on to the bit that is flying towards your face and don't let go. Getting down on to the floor is not the nice 3 movements that is practiced but more of a stumble and then you right yourself in to position. Very rarely do you have the nice 3 steps.

There is more to being a support worker than restraining someone though. A lot more. When people ask what I do (or did) the usual reply is "I couldn't do your job". I even had it from police officers. I went in to the job taking a £13k a year pay cut. So when patients in their anger said to me "you only do this for the money". No. I don't do it for the money as the money is shit! Yes. It is really shit. In my first job when I would work a 60 hour week every other week and a 30 hour week every other I was taking home less than £900 per month. I did the job because I wanted to do something with my life that was meaningful. Working as a sales manager in a high street bank was not meaningful. Ok, I used it as a stepping stone to get somewhere else but the somewhere else has the same reasons behind it. I want to be in a professional role that means something. I want to feel as though I am making a difference.

Having worked in a few different settings I have found the same attitude from professionals. And that would be a long the lines of "not another PD", ( can I just say here I appreciate I may look as though I am being demeaning by referring to it as PD, however, can I assure you I am not it's just that it is a lot quicker to type PD than personality disorder each time) "why waste resources on PD's, they are never going to change", "that's typical PD, attention seeking, look at me behaviour". I have also seen how quick they are to diagnose PD. It seems to be the first thing that is diagnosed. "You are female, you self harm, then that has to be PD".

 I have seen professionals make jokes about patients and their diagnosis. Not exactly professional. Some of the professionals I have worked with really should not be doing what they are doing. I have had doctors tell me how much they hate their job and they followed the Psychiatry route as they thought it would be easier. OK, having a joke sometimes can make the job a little easier. In my first role there used to be quite lot a jokes made while in restraint. Not because they thought it was funny, not at the patients expense but because it was a highly stressful situation to be in and it dispersed some of the fear/stress/tension that they may have been feeling. But to joke about patients themselves it doesn't look good. Joke with patients but not at them. There is a thing going round on the internet about being a psychiatric nurse...

You know when you're a psych nurse when...

1. The words 'Sorry, what?!?' Come out of your mouth at least twice a day.

2. A lighter is as vital a part of your working equipment as a ballpoint pen.

3. You're more worried about the staff then the patients.

4. You spend your first shift feeling like batman with half the stuff you have to wear on your belt.

5. The first hour of your shift is gossip and cuppa time.

6. You realise you're called a nurse because they couldn't fit nurse-councillor-cleaner-cook-occupational therapist-social worker-Mother-security-clown-voice of reason-secretary-bank clerk-typist-public relations-personal shopper- maid-waitress- expected expert on everything there is to know ever, on your name badge.

7. You've ever had to stuff your fist into your mouth to stop yourself laughing because it's just not professional.

8. You'll quite happily throttle anyone who suggests you're not a 'proper' nurse.
9. You're amazed at the sheer randomness of the things you're paid to do.

10. You don't have to eat general hospital food and you're damn glad of it.

11. A cuppa is the life blood of your working day. If it aint there, you aint there.

12. Students are a brilliant one size fits all scapegoat.

13.You'll complain about what a god awful job you have but you'd never leave cause where else would you meet a group of people who could make your jaw drop, your sides ache and your heart bleed as much as this lot.

14. You realise that every taught bit of restraint goes clean out of your head and you just grab the first thing coming at you and hold on!

15. No management issues means: Couldn't think of anything to say about this patient but I thought it would look bad to write 'Patient has done nothing all day'.

16. You'll fight to the death for a black biro.

17. People are always telling you how much they admire what you do but still tell you you're mad for wanting to do it.

18. General nurses when they find out you're psych invariably answer with 'What made you want to do THAT?' As if you've just told them you juggle radioactive material for a living.

19. You find yourself trying to pull an imaginary alarm outside of work.

20. You leg it to find out what all the shouting is about and realise it's actually none of your business as you're currently in a supermarket.

21. You begin to realise that you less you do, the better the job you're doing.

22. You go into a blind panic cause you think you've lost your house keys cause they're not attached to your belt

I found the private company I worked for the most unprofessional of all the places I have worked in. That and the fact none of my views were considered were the reasons I left.

I have found working in mental health a lot of the people I know who work in the same area do so because they have had their own mental health problems. What draws people to it. Is it because they are looking for answers about why they are like they are. I was drawn to it because of my own experiences.

I have seen it from both sides from professional and from patient. I have never been an inpatient (unless you count the 9 hours on a section 136). But I have had lots and lots of dealings within mental health services for my self. Does having the experience give me an advantage? And who has the advantage?

Well, in some ways yes. I feel I can benefit from having worked in that as it makes me more patient when it comes to receiving services. I know there are big shortages within the area. I know there is a strain on the area and it makes me more patient when I know why I am having to wait. I don't have the "they don't care, I am not important enough, I don't matter" kind of thoughts. Because of this I am patiently waiting and they don't have me on the phone chasing things up all the time (I am not saying that people who haven't worked in mental health would be, but it's the kind of person I am...I don't have much patience when it comes to things like this....being told I can have something but not knowing when and having to wait).

I do feel though when I am being interviewed by a professional for the first time or for example by the psych medicine department (which always interview you after you have received treatment for self harm), I have feel as though I get an attitude of "you should know better than to self harm, than to try and kill yourself". It's like because I have experience in that area I should see what it's all about and not do it as it is stupid. And the intelligence thing. Do intelligent people not have mental health problems, do they not self harm? What the hell has being intelligent got to do with anything?

There are disadvantages also.

The embarrassment.

I am so embarrassed by the things I have done. I hate being the way that I am. If someone said to me can I take away the self harm that it never happened and take away all the issues and interestingness I would jump at it. Mental health is so stigmatised. You would think as a person doing what I do and what I want to do I would possibly be able to be more open about things. But not at all. I am ashamed of the way that I am and I do what I can to hide it. If other people have mental health problems I am fine with it. I am not prejudiced at all. But when it comes to myself. I feel the stigma.

This also comes in when waiting in a waiting room and you see someone you know. I have seen ex patients numerous times now. Luckily I have not been recognised but I am embarrassed by it. There is also meeting someone in a professional context after you have met them in the patient-professional. And the other way around. Like when I was 136'd and taken to local hospital, the people that were on duty were people I had worked with numerous times. It was shameful. And I know. As a person training to be professional I shouldn't probably feel this way.

Another possible disadvantage is that I know how to work the system. In that I can say the right things to avoid being hospitalised. There are buzz words I know not to say...like when you are flying you know not to say the b word. It's the same with this. My biggest fear is hospital. I'm sure if they knew what was going round in my head.. Or if they even read this there would probably be doubts about my ability to keep myself safe etc. They know that I self harm everyday. But they don't know my thoughts.

As a patient I don't feel that I have a very good relationship with the professionals. I am not very honest with them and I keep a hell of a lot of information to myself.



This is going to sound weird but, I like to think because I am also a fellow "professional" I am treated differently than I would do if I was Joe Bloggs. That they are more open with me, that they are more relaxed and they don't need to follow a strict protocol as I'm in the know and all that shebang. That is probably not the case though.

As a professional I am the patient I hate. The one who is stubborn, is set in her ways, wont listen to people, wont try certain things, and has things keep happening even though I have worked really hard putting a lot of effort in to working with her and yet she goes and messes it up and un does all my hard work.

I am an awful patient. I bet there are worse ones than me though!

Attention Seeking!

Dave says he is going to kill himself. Every night he writes how he can't handle life and there is no other way out. Dave has children, and a wife but it seems as though they don't feel or understand his pain. Every night for the past week Dave has said he has had enough and he has taken an overdose of something. Does Dave not know that is not the way out? Sorry, I know it sounds heartless but to me this is just Dave's way of getting attention. He goes on and on about how much he wants out yet uses methods that will not work. I don't know Dave that well. I know he is hurting and there are obviously issues. The way he writes screams personality disorder. The neediness, the constant wanting.



I know, me of all people should be supportive. However, there is only so many times you can say to people get help, what you are feeling is wrong. But this person doesn't listen, he doesn't do anything other than say I'm going to kill my self I've had enough. If someone is that serious then just do it! Don't keep writing about it and grasping out for the attention. I find it quite annoying how people pander to it. These people do not make it any better. It reassures the person if they behave in that way then if they do the same again they will get the same response. I've done it. I've been there and taken overdoses and have written about it while doing it. Have waited for peoples replies to my thread.



I know I sound heartless. It probably is. I have been on the other side where I have felt so suicidal I have done things to try and kill myself. Mainly overdoses. I know now that that is not the way to do it. It will just make you sick and is painful and drawn out. Someone will usually figure out what is wrong with you before anything happens and you will get treatment. I read a lot of blogs; mainly medical ones. I have a fascination with medicine. There was one blog that really caught my eye it was medic999 I follow him so check him out. He wrote about a nurse from down south who od'd on paracetamol, went to a hotel and waited a couple of days. She went to a hotel outside her area as she knew that if she was in her area her collegues would be the ones who had to try and save her, and more than likely fail. She was in for a long and painful death. She was probably past the stage where you could get a liver transplant. That's another question that I am unsure of. If someone tries to kill themselves by way of overdose and the only way to save them is a liver transplant...should they get one? I mean. there are people on the waiting list for transplants that need them, they through no fault of their own need that transplant so they don't die. Yet someone can jump infront of them in the queue who tried to kill themselves. They don't value their life and they are taking the chance of life away from someone who really wants it. I know the person who took the overdose would have to consent to surgery and if they wanted to die then they would not consent. But still. It's weird for me to take this stance. I mean, I self harm, I have taken overdoses. I have been and still am quite suicidal.

I have even gone as far as telling a friend to take an overdose. But wait, before you judge let me explain why and the situation. My friend is a neurotic, needy person. She was with this guy for a couple of years. She was always coming to me with some problem or the other and to be honest she was treating him like shit! She would not let him be his own person and wanted to mould him in to what she wanted. She was really awful to him and I felt sorry for him. On numerous occasions I had said to her you are being out of order and if you don't do something about it you will lose him! But she didn't listen. So he finally broke up with her. I actually felt like congratulating him for standing on his own two feet for a change and freeing his balls from her vice like grasp.

Anyway, the break up hit her hard. I was there for her as you do as a friend. Went round, made her tea, listened to her, spoke to her in the middle of the night when we was upset and never said anything bad. But then it started getting that she was relying on me far too much, that I couldn't live my own life. She got to the stage where she was going on about it all the time and it was wearing me down. I tried to take a back seat by not answering her calls but she would call on the home number and my parents would answer etc. In the end she was going on and on about how she didn't feel life was worth living. I said to her don't be stupid. You are starting at uni in September, you have got a lot going on for you. And, if I can get through a 9 year break up (on the surface to other people I look as though I am coping) then you can.

She then was saying how she couldn't live without him and she was considering taking her medication for night terrors. I could tell by the way she was saying it there was no seriousness in it. I asked her how many pills she had and she said about 10. So I told her to take them! It shocked her in to seriously thinking about things and the way she was. I knew that they would not do any harm other than make her sleep for a bit. And, I thought she needed a mental health assessment so I thought it would be a good way of making sure she got one! I knew the pills wouldn't do her any harm, but she didn't. Also, in her telling me I thought that if she really wanted to die she wouldn't say she was going to as I had keys to her house and I would have gone round there and I would have got help etc. Maybe I was wrong. Maybe I put too much of my own feelings in to it thinking how I am when I have been suicidal or wanting to self harm etc. I don't tell anyone! But my method worked anyway. It made her sit back and look at things.

My other friends thought it was quite ammusing anyway!

So, what I suppose I am talking about her, is how can I take this view point when I myself have been one of the "oh another self harmer" and "oh, you again". I suppose when I am self harming I don't think about the long term or even the immediate future of having to go to A+E to get stitched up. I think about how good it feels to be making the cut. Nothing else matters at the time. I even got corrected by a counsellor I went to see last week. I was talking about self harm and I said I have worked with self harmers and I am a self harmer. She said "no, you have worked with people who self harm and you are a person who self harms". You can expect to find the labelling and negative stereotyping from people who don't do it, but when you do it your self, what's that all about?

If you look at the list of blogs that I follow you can see I have a bit of a fascination with medicine and hospitals. My friend even said to me not long ago that I was weird as I like hospitals. I wouldn't go that far. But growing up I wanted to be a doctor. Then reality hit and I realised you actually needed to put more than average effort in and get more than average grades to study medicine. I gave up my dream at about 14 when I realised I was Miss Average! I think also I am scared of failure and never like to give things all my effort incase I still get average grades. I know they are grossly inaccurate but I love and always have loved programmes such as Casualty, Holby City, ER and so on. I know the facts are not right on them and not even being medically trained I get annoyed when the defib pads aren't in the right place, CPR is not being carried out deep enough, that they defib when it's not a shockable rhythm, and when they leave bra's etc on when doing defibs. But I love the programmes still. I also watch the more real life ones like helicopter hero's, the real A+E. My parents take the piss as I only seem to watch medical based TV.

I think maybe I have chosen the wrong career. I know doing the Social Worker training in a few years I will not be able to afford to go back to the bottom rung of the ladder and taking a massive pay cut. Don't get me wrong, I do think I will be a good SW. I never let my opinions of someone show, I listen to people, I don't let other peoples views of someone cloud my own judgement. I will make my own judgement. I think I am quite a good judge of character also.

I know that TV glamifies positions like Doctors, paramedics and nurses. In reading these peoples blogs they talk about a nice job or a good job being one that involves trauma, not picking people up off the floor who have had a few too many. I know that if I was one I would spend most of my day dealing with drunk people etc, but it doesn't stop me having a slight niggling feeling that I maybe should have re-done a couple of A-Levels and gone in to medicine!

Oh and if anyone does read this and has got this far can you leave me a comment to let me know what you think of my viewpoint. It would be interesting to see if other people share the same views as me...or if I am mad!