363 - 369 Perspectives

Richina Foggo

COMS 369 L02           

In my first year of University I was studying to become a nurse. I was placed in the psychiatric unit for my clinical practicum, and it was there that I began to put names and faces of individuals to one of the most ambiguous mental illnesses: Borderline Personality Disorder. Patients would be placed and held in the psychiatric unit after doctors and staff worked hard to bandage up the self-inflicted cuts and stitch the deeper ones. Some patients had their stomachs pumped. A drip was hooked up and intravenous drugs administered.

But what is Borderline Personality Disorder and whom does it affect? My goal is to bring awareness to this disorder; strike conversation regarding the current ‘hands-off’ approach our health care system exercises in dealing with individuals with Borderline Personality Disorder; and share the challenges individuals with mental health conditions face as a result.

The National Institute of Mental Health characterizes Borderline Personality Disorder (BPD) as impulsivity, chaotic relationships, instability of emotions, blurred identity and a propensity for self-violence. Like many other mental illnesses the exact cause remains unknown. Similarly, social and family factors are thought to play roles. However, BPD appears to have a high degree of “heritability,” confirming the likelihood of it being a brain disorder. Clem Martini (2011) describes Borderline Personality Disorder as the “ugly duckling of the mental health care system… it is stigmatized and ignored. And then one day it hits home.” (p. 39). Martini (2011) also shares his personal experience:

As the patient stabilizes she/he is transferred to the psychiatric ward for assessment. You feel some faint hope. You feel you will have someone to help you/ an advocate. A guide. But that’s where you’re wrong. The assessment comes back as Borderline Personality Disorder. The patient is not kept for treatment. Instead you’re made to understand that the hospital offers no particular treatment, A provincially funded clinic provides therapy, but there’s a six month waiting list. In the meantime, there will be no assistance. Your son/daughter/sister/brother is released into your confused and thoroughly uninformed, unqualified, unprepared care. (p. 38).

Martini’s story highlights just some of the obstacles family members and individuals with Borderline Personality Disorder face as a result of our existing health care system.

           

          Alberta’s Mental Health Act permits involuntary detention and admission to a hospital for examination and treatment against an individual will if their life appears to be at risk. (Martini, 2011, p. 40). But Borderline individuals are exempted from this act. Furthermore, as Martini notes, there are publically funded clinics, however there is a six-month waiting list. Ultimately, this leaves family members left to deal with the at-risk, distressed individual. But there are no answers regarding what to do for the next six months until a therapy session can be scheduled, or what to do if he/she gets too anxious or angry. And what about the next time he/she tries to take his/her own life again? Is it just that the liability of the unwell individual and potential guilt becomes the caregivers responsibility?

          Another way in which Borderline Personality Disorder warrants this ‘hands-off’ response is the outreach programs available for family members of those with BPD. Martini (2011) introduces the Mental Health First Aid program, “which offers the layperson a kind of fast recognition and first treatment for mental illnesses. It was modeled upon the standard first aid program that was so successfully developed to deal with physical emergencies.” (p. 40). The philosophy of the program was that laymen with little information could offer the necessary immediate intervention that would allow the mentally ill patient to survive in the short term until more informed, better-trained treatment could take place. (C. Martini, 2011, p. 40). Martini (2011) says “in the world of medical emergencies, this makes complete sense… it has given rise to a variety of procedures meant to keep the patient alive and well…until better informed, better prepared medical resources are made available.” (p. 40). The problem here is that in many mental illness cases, you are not only the first aid, but also the second, third and only aid. Indeed, you may be the initial aid but the situation, responsibility, and care giving is likely to be bounced right back to you. Using Martini (2011) to conclude, “its worth nothing that the majority of suicides don’t occur in medical facilities. They occur elsewhere, back in the homes of caregivers trying to make sense of the situation… who have often requested assistance and received none. And consequently, when deaths occur, the responsibility is theirs. And the pain and long-term struggle to cope with the ensuing guilt will also be faced alone.” (p. 40).

            

          The piercing reality of mental illness is that too often individuals do try to kill themselves. And too often, these individuals are successful. “One million people die through suicide each and every single year. That is about 2 every minute.” (Martini, 2011, p. 41). It is obvious that our current health care approach is not an effective way in dealing with, or preventing probable repercussions of mental illness. If we are aware of the potential deadly outcomes mental illness can have, why are our efforts and measures used in dealing with illnesses, such as Borderline Personality Disorder, so dismal? Martini (2011) proposes, “people find strange comfort in believing mental illness is the illness that happens elsewhere”. (p. 41). According to Health Canada, 20 percent of Canadians will personally experience a mental illness in their lifetime. This could be your loved one. This could become your reality. If it was your significant other admitted into the psychiatric ward: bandaged, stomach pumped, and fighting for their life, what efforts would you call for?

           

For more information

Martini, C., (2011). Alberta views. Edge of the Edge. 38-41