Friday, July 20, 2012

living on the borderline

You might think I'm going soft reading this. Oh well. Yesterday I attended the annual "de-escalation/self protection in dangerous situations" class. I approach these classes with a couple of thoughts:

1) Oh man I have to sit through this for 8 hours.
2) If they want to pay me to sit through this, well OK.

I DO pay attention. I even got a couple of things out of it. Sort of a new perspective as it were...

These classes center mostly around dealing with mental health patients. A group I have a lot of sympathy for, actually. They talked about a fairly new approach to mental health care: trauma informed care. Basically it approaches care of mental health patients with the idea that the majority of them have had some kind of trauma in their lives that has led to/contributed to, their mental illness. Many have PTSD from childhood trauma. Certain situations can cause them to re-experience the symptoms around their trauma. It attempts to recognize triggers and teaches the patients, and caregivers how to deal with them. There is a lot more to it than that too.

One of the statistics that struck me is that 81% of those with boderline personality disorders experienced some kind of trauma. How does that apply to the ER? We get many people in the ER with the symptoms of this disorder.

What is borderline personality disorder? ".. an emotional disorder that causes emotional instability, leading to stress and other problems....your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away.." Often times the continual stress of their lives manifests itself physically with vague symptoms, chronic medical conditions. We see this every day in the ER. These are those difficult patients that are so hard to deal with.

My thought: Wouldn't it be nice if using this information and a different approach, we could learn how to deal with this type of patient? It would make our lives, and theirs, a lot easier.


Mark p.s.2 said...

Don't forget the mental health patients are on drugs. Drugs from mental health professionals. They need their drugs just like the illegal drug addict.

"anger, impulsivity and frequent mood swings" are from their mental illness not from the legal drugs messing with their brain chemistry. (sarcasm)

Sardonyx said...

@ Mark p.s.2 - I resent that comment. Not all of us mentals are on drugs. In fact a lot of the time those of us who don't have meds are probably more difficult to treat as we become increasingly unstable, irrational and paranoid. (I speak from experience as a med-free borderline).

Madness, it is a lovely thought, but I believe it would be incredibly difficult to come up with a workable strategy that would apply to all. Then again, it shouldn't be too hard to recognise when something is causing distress, even if you can't easily identify what.

Unfamiliar men are a known trigger for me and I make sure that staff are aware of this if I have to go to A&E. This info is given in writing along with my basic details and why I'm there and is generally attached to the front of my notes by the triage nurse. I also tell them that I am more likely to cope with a man if a female is also present. I often end up with a lone male doctor who looks at me like dirt when I can't look at or speak to them, let alone shake their hand or let them physically examine me.

Mark p.s.2 said...

You just don't get it do you? A person can be experiencing withdrawal from a legal drug, the same way a junky withdraws from illegal drugs.
"those difficult patients" might be having withdrawal from the legal drugs, but no one can say that. They blame the bad behaviour on the mental illness.
The psychiatric medicines (just drugs) can only do GOOD things to the patient. sarcasm