Won't put a pure BPD on inpatient

I was in the ER after a halfsie suicide attempt and the ER psych gave me (another)diagnosis of BPD. When I asked why they weren't going to inpatient me, the ER team just said that they didn't think I was actually suicidal and short term hospitalization would actually have negative effects on a patient with BPD.

Has this happened to anyone else?

I read a review article on the subject a few months ago. If I have time I'll try to find it and post a link. But yeah, the summary was pretty much that - inpatient for BPD does more harm than good. I don't remember every argument, but I think one of the big ones was that people with BPD who become self-destructive and are hospitalized learn a dysfunctional way of coping with distress. Or anyway don't learn functional ways of coping with distress. Something like that.

I'm not sure I totally agree with it - people with BPD do have a very high rate of suicide attempts, but also a high rate of completed suicides. So I think if judgement isn't used, and they ignore everything but the BPD diagnosis, people are gonna die who could have been helped. Especially since - really - how common is "pure" BPD? Most people with BPD have other diagnoses like depression, bipolar, anxiety that are all important risk factors for suicide.

When I was hospitalized for suicidal thoughts I remember the ER doctor looking closely at both sides of my arms. I know he was looking for signs of self-harm. Turns out I had a tiny pinpoint scab on the back of my hand - I didn't even know I had it, let alone where it came from. But he pointed it out and asked me how I got it. Which is just a little ridiculous. It was the first time I'd ever been to an ER for anything mental health related so I was clearly not a frequent flier who had learned to use hospitalization as a way to escape my problems.

So yes, you can definitely take the principle that OMG you should NEVER hospitalize BPD patients - or apparently anyone with a tiny scab which might be self-harm, which might be BPD...way too far.

Granted, I'm no health pro, but that's messed! Like Angelina said, we've got a much higher knock-off rate than most others; brushing off a BPD attempt isn't always a wise idea.

And what exactly is a "pure" BPD? As in only BPD? Does that even exist? I thought it was pretty much a package deal, like having a car. You drive a car, you buy a car, you get your license, you buy insurance, you buy gas. BPD's the same way - it doesn't come as an individual product!

My concern is that the people who evaluated you were trained under the biased dogma that BPD people are incurable and more problematic than we're worth. We've all either experienced, or known people who have experienced this type of discrimination within the mental health field, even in this day and age. It's out there in private practice, so there's nothing stopping it from finding its way into the ER, as well.

I'm not saying that is what happened, but it is a possibility.

I agree that hospitalisation is not the answer in the long term. I think that for a borderline in emotional distress, hospitalisation can seem like a relief at the time however that is really only in the short term and psychologists are really concerned about actually helping the borderline recover over the long haul.

People can only really make progress when they're in their normal environment-in hospital, everything is done for the patient and that's not a normal environment. The aim should be to get the person back functioning as well as possible in normal everyday life.

I think you also have to take a broad perspective on this issue. Years ago, anyone with a mental illness was admitted into hospital and a lot of these people were in mental hospitals for so long that they became institutionalised-when they finally got out of hospital, they couldn't function on the outside world and had to live in a special community assisted by a special team. This is also what happened to children who had any type of learning difficulty or handicap-I actually watched a horrific documentary about that ages ago. Even Marsha Linehan, creator of DBT, was admitted into hospital for over a year for her borderline symptoms in 1960's USA. They put her into solitary confinement and when she was there, she just started banging her head against the wall. There is an article in the New York Times where she talks about this, just in case anyone is interested. It is perhaps unsurprising that she is firmly against hospitalising borderlines, believing that hospitalisation never did anyone any good. She is also against insurance companies not paying out for DBT treatment because she said that untreated borderlines will just end up in the hospitals through self harm etc anyways and that ends up costing more in the long run than just treating borderlines properly through evidence based treatment.

Basically society realised that it was more humane to treat people with learning difficulties and people with mental illnesses on the outside world-to help them to live as normal a life as possible. I literally think this is why Marsha Linehan in DBT mentions that phrase "build a life worth living". Psychology has improved so much over the last few years so I honestly think anyone with a mental illness is lucky that hospitalisation is no longer seen as an answer to mental illness or to any other issue that was heavily stigmatised in the past.

although borderline personality disorder has a higher suicide rate than most other mental illnesses, i might have to agree with your doctors on this one. i think that they figured since it was only a half suicide attempt, it would be better for you to stay out of inpatient or residential. inpatient treatment has a tendency to be addicting, especially for borderlines. a lot of people tend to see it as a safe haven. a place where you need not have any responsibilities and such.
that being said, they did set up outpatient for you, right?

Yes, they set me up with inpatient but my appointment is more than two weeks after the incident. I found it strange because every other time, THEY were the ones who were eager to put my me in the ward. The BPD and the fact that I'm of age seemed to change their entire stance. The nurses basically told my mother that if I was going to kill myself, there was nothing they could do to stop me. :/

littlearcher wrote:wow...they said that?

how did that feel for you?

because if i heard that i would feel pretty upset and like i was trying to get help but the nurses didn't want to help me.

Just because I mentioned that my bf had broken up with me, they wouldn't take me seriously.

Everything in mental health system seems so convoluted. I have to hush the fact that I have an eating disorder in order to get help for a mood problem and they referred me to a DBT program where you can't even get ON the wait list. UGH.

Ah Stalkers be damned. I'm BPD; I welcome them.

I'm in Toronto. I suppose that I should be grateful that this is all provided free but it doesn't help much when you have to go private in order to get help in a reasonable time frame.

Even once you get on the waitlist, it's a year long wait.

I have had so many suicide attempts and this is what happens

Try's suicide, goes to hospital, wait for five hours to see a physciotrist, gets asked how I am then return home

Saw a previous physcotrist, got asked what I wanted treatment wise said DBT, he disagreed. And told me to buy a cbt book and return three months later

Wanting to kill myself everyday. Will probably do it and then they will regret it

I asked them to put me in a mental health hospital and they said it wouldn't help I'd still have my problems by the time I come out....

I'm in ayrshire Scotland by the way

Thanks to another member here, I've discovered http://www.dbtselfhelp.com/html/mind_states.html. It has helped me get a sense of what DBT hopes to accomplish. This could maybe be of use to either of you?

To my fellow Torontonian:

I've found this: http://www.themindfulnessclinic.ca/dialectical-behaviour-therapy-dbt/ and http://homewood.org/ for other DBT options. Idk if these are covered by OHIP though.

I'm meeting with a case worker on Thursday and she said that she'd look up alternatives to the program at camh. I'll let you know what we find.