Monday, January 11, 2010

Mental Health Main House Birmingham PD Service Official Consultation



Well of course it was on the cards for a long time, but the Birmingham and Solihull Mental Health Foundation Trust has dragged its feet for a quite a time on altering services to fit more people in the community who suffer in the personality disorder spectrum (PD)..

Self harmers have self harmed and many have felt suicidal and often been alone or with ragged self help services in Birmingham UK and people have languished in the community with very little hands-on therapeutic help . We know that at UserWatch - we have heard it for years, and every year ..

Virtually all the resources for PD and Borderline PD locally were pushed into Main House ("specialism") and its outreach component Bridger House for those with "Tier 4" (a severity measure ) levels of Borderline Personality Disorder (BPD) .

Over a few years Main House has dealt with less than 15 people per annum.. This is in a population of over 1 million people in Birmingham UK ..

The question from those with other so called "Tiers of severity" (2 and 3) is , it appears to be a self fufilling service prophesy that people will get so bad and BECOME Tier 4 if they are not seen and helped far sooner ..Or they will die ..

BPD and PD have the highest suicide rates of all mental health suicides recorded in the UK (77 %) . Sadly that speaks for itself since UK services have often left people to themselves and offered just a bit of primary care drugging or "social inclusion" - or this and that, tinkering dressed up as "care" ...

Its often been a slow long death watch by some CPN's or Care-Co-ordinators.

What possessed BSMHFT Board delaying for so long a new Birmingham wide PD community orientated service as opposed to keeping a failed business model that had made money (because at one time it did) since the new push to help more people in the community with levels of Personality Disorder has had at least Dept of Health momentum for years since 2004 when a keynote document was produced ..

"Personality Disorder No Longer A Diagnosis For Exclusion "

That report surfaces again we see but its been a languishing part of the UK version of NIMHE's spread of dubious interest groups dressed up as patient reps .

It was a totally obvious report to write and showed up the previous know-it-all mechanical staff insight biased DOH patient anti-stance and critically showed nothing new but simple human sense :

I.E : If you don't hear damaged people in the community and allow them some ways to navigate pain, memories and feelings of child abuse, and relationship difficulties that evolve from poor or spoiled developments - you make them socially excluded and very unwell. The system of UK mental "health" actually therefore we have seen time and time again actively creates SOCIAL UNWELLNESS ...

BSMHFT has been hanging onto Main House because it did attract revenue- years ago - but slowly it has dwindled its capacity to attract bed purchases from other parts of the UK through other UK commissioning Primary Care Trusts (PCT's) . Those PCT's are looking to their own local needs and the push for local models of care instead of propping up a "specialist service" ...

One might say rather obviously - that if these other UK wide PCT's do push for more local models of PD help then perhaps the "Tier 4" population of PD suffering will slowly diminish - perhaps it will not, as more people come forwards for help as money is released into new opportunities for at least some kind of treatments , therapy and care local to people's needs ..We will all see .

There are some very good staff in personality disorder services who are eclectic of approach and will not necessarily be rigidly enforcing Cognitive Behaviour Therapy (CBT) type therapies on patients in the community who in any case have complex needs and not simple depressions for which CBT has been primarily recommended . [Dialectical Behavioural Therapy tends to be the preferred therapy of choice for many PD patients if they can get it ]

Yet perhaps the biggest lesson about PD comes from another but related quarter regarding better human and locally-inclusive therapy responses and it shows up the way services actually falsely construct themselves "into speciality " around other labels like "psychotic" regarding what has been seen to be seriously distressed and developmentally damaged mental health Users.

The Study of 500 (reported by the Guardian on Dec 9th ) Afro Carribbeans done by South London and Maudsley MH Hospital breaks open the mystification and uselessness of the term "Psychoses" . It is redundant, the study showed no disease process , or gene process but a massive correlation of socially distressed life events which it is arguable the health system just drugged out of the way into more personal and internal social isolation . Do you get the point ?

We have a socially unreal mental health system in the UK ..

Do the services and their personnel get the point yet .. ? After all they did the study and are more than silent about its "diagnostic-tool" shattering implications of the term "psychosis"...

Something else is needed ... Severely Socially Damaged Human Identity ?

People are made into damaged selves by socially and family constructed distress over the long term . Frankly having a (Tier 4 ) service like Main House re-inforces that too . People need intervention via better serious psycho-social-therapy in the community and we need to unravel people at that level there, and resolve issues there .

Think on, Birmingham and Solihull Mental Health Foundation Trust Board because you are presiding over descriptors of people's damaged lives in ways that are seriously pseudo scientific .

You see , read the study about the 500 Afro Caribbeans . No "psychoses" exists . There's no basis for it as medical label at all . Its a false shibboleth . False science . Its a mystification of hyper distress caused through family separations and social distresses and because it is, its arguably "mis diagnosis" .... And that my white brothers and sisters on the BSMHFT Board is legal territory ..

But that study begs looking at other descriptors (not diagnosis tools) of human damage and have a guess what ?

Those 500 Afro Caribbeans studied fit into the PD spectrum of human damage that for so long has been treated as "un-treatable" .. Yeah ... The services have helped perpetuate bad health and bad descriptions but most of all its killing people at a distance - either existentially or literally ..

Murder by mystification ? Suicide that is profoundly disguising not being seen , unless through a pseudo science and services that medicalises or invalidates many humans in the UK ....

Further reading :

Learning the lessons:

"A multi-method evaluation of dedicated community-based services for people with personality disorder"


Anonymous said...

I was sent to theraputic communities and they made me so much worse. They are the most negative, unnatural environments I have ever been in, full of self loathing, self pity, and competition between patients or residents as they like to call them at who can do the most self harm, starve themselves the most, come up with the most shocking events. I think they should all be scrapped. BPD is a diagnosis which means you are not treatable and of course this is right as the label is given to people who have suffered severe trauma - only when you realise that nobody can do anything to help you and nobody can change what happened, can you move forward, whilst you are in pursuit of 'a cure' to feel 'ok' you will never feel any better there is no help as TCs are no good either, this desparation of not finding any treatment leaves you with the feeling like you have to end it all, but once you stop looking for help and accept that there is no help nobody can change what you have experienced then you will accept your life for what it is. Even after being at TCs unsuccessfully I was constantly asked to go back to another so I have no idea why you believe the psychiatrists are not wanting to refer, its more likely the patient does not want to be refered

Anonymous said...

I just read that the last 3 residents tried to commit suicide this is an example of how TCs make people worse. In what other environment would you get three people making a pact like this? I have severe BPD and have been to TCs (they were unsuccessful and I have my own opinions that they are not of any use to many BPD) If I wanted to commit suicide I would do so privately not in such a manner as to trigger other people into doing so, and most certainly not in such a manner as to gain media attention, I feel disappointed that yet again somebody labelled BPD has given evidence to suggest attention seeking, yes I know how bad BPD makes you feel but you should not use this to manipulate others nor to put others at risk. Oh and why if they wanted to commit suicide did they return only to be taken to A & E, mental health professionals know that if a person wants to commit suicide they do, taking an overdose and then telling somebody or not taking the trouble not to be discovered is a form of self harm which BPD sufferers do frequently.

And self harm should result in discharge from TC especially when it is carried out as a pact.

You knew the TC was under threat of closing so why did you not prepare the residents for this?

And many residents leave before the treatment is complete due to self harming behaviour or they leave because it is making them worse, so leaving early is not unusual.

PatientGuard said...

Anon -

Amongst the UserWatch dog crowd, what dominates as a fundamental ideal position is "User-Choice" and the biggest injustice to BPD and various PD spectrum types is the way for years there's been little choice of anything but what Mr NHS Whackit Crackit head says .

That's a serious lack in the UK MH system of User Choice and we would prefer to see patient recovery-vouchers (a mechanism of personal funding) for those who need to try a number of therapy approaches so that a genuine patient market develops and layers of innovation is driven by the patient .

It's illuminating what you write and pretty much confirms what others have told us and even staffies - namely that TC's were only good for a few and acceptance of severe trauma backgrounds is part of the way forwards for some people .

Severe early trauma is mappable though and people can be helped in feeling they can live with it even if it still has crippling social effects on them . Living in hell sometimes is helped by others being kind too when the "patient" becomes overwhelmed by the inner world of trauma ... Yeah like you say - there is no cure but there can be aid to get through the black hell of dark and fire....But TC's ? Not good for some for sure .

The Main House service has gone and another type of service has grown (dubiously we think) in Birmingham though frankly we think User-choice should be employed as a mechanism and people should have budgets to maintain a therapy or management approach and the NHS should oh so partly, as our UserWatch office dog (says) barks :


Our Office dog cannot pronounce "W" as in WOOF but in any case , decoded that means he likes chinese food and the NHS don't supply it ..


As you can tell he is disordered .. Isn't everyone ...

Have a good day -

PG + UW team and Office Dog

Anonymous said...

Some people who anonymously leave comments sould get their facts right before they start labelling people attension seekers!!!!!!