Keir Harding Profile picture
Oct 27, 2022 25 tweets 13 min read Read on X
And we are here (late!) To the @rcpsych GAP conference. So far we think we've spotted @lovebillybragg and @SameiHuda. Looking forward to an interesting day #rcpg #rcpsychgap2022
Some talk about the long term plan. Years ago "personality disorder" wouldn't have got a mention... #rcpsychgap2022
Up next is @Shrink_at_Large on Changing the Srory around PD #rcpsychgap2022
The pros and cons and diagnosis

"Do better than a thorn in the flesh" #rcpsychgap2022
Does a diagnosis get in the way of the credibility of those it is given to?

#rcpsychgap2022
google.com/amp/s/www.huff…
The borderline pattern collapses the model of the ICD-11 @Shrink_at_Large
The problem with borderline is it links to such a powerful prototype (cartoon?) of manipulative, attention seeking etc...

Is that useful and what does it hide? #rcpsych2022
3/4 people will get a personality disorder label of some description (mild/moderate/severe/difficulties), which is a problem if it links to that prototype/cartoon 🤔

#traumanotpd #rcpsychgap2022
So we need to remember the huge levels of trauma in the lives of those diagnosed with "bpd" (or bpd pattern) #rcpsychgap2022
So what else is hidden in the BPD pattern? Well, there's a lot of ASD around #rcpsychgap2022

Can we see past that cartoon/stereotype?
Do we just need a new name?

1 Personality is not a neutral term.

Others reaction to "personality disoder" ramps up shame.

#rcpsychgap2022
2 You stop being believed

"If you wanted to kill yourself you would have" etc

#rcpsychgap2022
Attempted solutions to manage distress are seen as symptoms of illness/a disordered personality

#rspsychgap2022

Credit to @RRowanOlive
"BPD" reaches back in time and rewrites our history, validating the worst things people have ever taught us #rcpsychgap2022
It is a closed system, everything is understood as bpd. Silent = attention seeking or communicative = manipulative

#rcpsychgap2022
So why isn't there more change? We've been going on about this for years... #rcpsychgap2022
The @rcpsych position statement says great things about relational working, but this diagnosis undermines relationships

#rcpsychgap2022
The thorn in flesh course...

#rcpsychgap2022
The status quo is maintained by the idea that good care is dependent on the diagnosis of personality disorder

It's not just "bad staff". This term allows the pathologisation of difficulty/discomfort

#rcpsychgap2022
Some solutions 👇

#rcpsychgap2022
There's a question along the lines of "but how do we help," is SCM the answer?

In some ways it's a brave question but in others it shows how unprepared services are for helping people who have survived neglect/abandonment and abuse #rcpsychgap2022
If EUPD/BPD doesn't exist how do we account for people benefiting from DBT/MBT?

Those therapies aren't diagnosis specific and offer things helpful to many people. Why can't we offer them without people having to accept a PD label? #rcpsychgap2022
And that is my @Mental_Elf audition over.
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More from @Keirwales

Dec 20
2 billion on private placements…but is every patient being treated equally here?

I’d suggest not. The NHS inpatient provision for those I work with is a handful of beds. Those displaying recurrent self harm and suicide (all female trauma survivors)…
…are near exclusively given inpatient treatment in the private sector.

How much does it cost? It’s hard to get a clear answer but no one seems to disagree with £300,000 a year per person.
Is it good value?
Well you’d assume so for £300,000 a year. Unfortunately you become a specialist unit by saying you are one. You can hear about the specialist providers mentioned above here

bbc.co.uk/programmes/m00…
Read 9 tweets
Nov 23
Normally it's @PsychToday with the most stigmatising articles on BPD but here's @verywellmind with an expose on "Why people with BPD tend to lie.

You might think this clickbait title then refutes that bpd lying/manipulative trope. It does not...

.verywellmind.com/link-between-b…
Some studies of those told they have BPD put experiences of abuse at over 80%. Zanarini did a study of over 300 inpatients told they had BPD and found over 90% reported childhood abuse. So to reframe the article lets explore

"Why do survivors of childhood abuse tend to lie?
"they tend to lie, which ruins trust and intimacy, fosters resentment, and harms the very relationships they fear losing." - this statement isn't cited. If there is evidence to back it up, the author opts not to use it.
Read 19 tweets
Oct 4
It was great to see this article in @OTnews this month. Why? Because the @BIG_SPD conference was resplendent with Occupational Therapist people not only attending, but heavily contributing.

Is this new? 🧵 Image
Not new maybe, but this was from the conference in 2015 - 1 OT present and a poor example of one at that! Image
This year we got OT Student @ZM_LXP describing her research on the impact of a personality disorder label. “Accused of being ill, commanded to be well” was an ace title Image
Read 15 tweets
Jul 7
So what do I want from a new government in the world of mental health?

Well, 8500 new people working in mental health. Why is that?

news.sky.com/story/sir-keir…
That's important because the community mental health teams I worked in 10 years ago were drowning in the demand THEN. With the workforce dropping, those who remained have done less with less. Image
The focus on child mental health is important too and it's good to hear them talking about the appalling waiting lists for desperate children and families
google.com/amp/s/amp.theg…
Read 12 tweets
Oct 10, 2023
It is #WorldMentalHealthDay with a focus on Mental Health being a universal human right.

If you're struggling, remember to ask for help. Image
When you ask for help, you'll be joining a fifth of all 16 year old girls in the country:

"16-year-old girls are most likely to be in contact with NHS mental health services - with 22.8% of the population (69,580) having been in contact with these services during 2021-22" Image
You'll also find a notional emergency going on with 1 in 5 mental health nurses vacancies unfilled in the NHS

theguardian.com/society/2023/o…
Read 7 tweets
Sep 23, 2023
Thanks to @BPDFFS @Girl_Interrupt_ and @HoppyPelican for pointing me at this. I don't understand it very well, but I'm going to spell out what I don't understand and what I'm wondering about...
The diagnosis of personality disorder has changed. There are no 'types' any more, just personality disorder mild/moderate/severe. This paper looked at whether you could use honos scores to measure that severity.
This is what a honos section on self harm looks like.. Image
Read 17 tweets

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