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Calling it “therapeutic” doesn’t make it any better, @Southern_NHSFT People are dying because of “positive risk taking”. We see you and your cruelty.
Also, using the phrase, “feel the fear but do it anyway” is so fucking disrespectful and cruel. “Patient X might attempt suicide after me deciding to take this “therapeutic risk” but hey, just feel the fear and do it anyway!”
Well I’m going to carry on calling out the shit attitudes from MH services towards those diagnosed with BPD. Here’s @Mersey_Care sharing their article on managing PD in primary care. Check out this advice for GP’s about medically unexplained symptoms. This shit kills.
“therapeutic risks”
Also, the gall of this doctor suggesting iatrogenic harm is caused by GP’s referring patients for further investigation of physical symptoms is just unreal.
Next up is @DPT_NHS and their booklet on working effectively with those diagnosed with a PD. On the first page, they suggest that it is staff’s own negative reactions towards a SU that “alerts them” that the SU “struggles with relationships” & has “personality difficulties”
More about how people with a PD “alert” staff....they “bring out an unusual reaction in people”
Please note the green box of text - “if you only have a few minutes and want to assess whether someone might have a PD....here’s 8 simple questions which you can ask” So yes, you can diagnose a personality disorder in less than 5 minutes.
I was told I might recover in the future if my “personality matures”. This was said to me in 2014. I see it’s still something professionals say to SU’s.
The fuck is this? I’m stopping for today now because wow, just wow..
I’m not gonna stop calling this shit out. MH Trusts keep saying how SU’s w PD Dx were treated poorly “in the past” like they’re not harming ppl now in the present. They think they’re challenging stigma but all they’re doing is perpetuating it. People are dying. We’ve had enough.
Next up is @OxfordHealthNHS and their link to “academic research on PD”. Lots wrong with this, but “difficult consulting behaviour” stands out for me.
And the last screenshot is from @TEWV regarding “emerging” borderline personality disorder, which is MH speak for “we are diagnosing children with BPD now” Leaving this here incase there are people out there unaware that BPD is now diagnosed in children
Next up, are two screenshots from documents advising staff about “therapeutic positive risk taking” and reassuring them that should it go wrong, they will be supported/defended by the Trust. One is from @GMMH_NHS and the other from @Southern_NHSFT
This is a screenshot from @westlondonnhs describing PD as manipulative (and other things) and making no attempt to explain why that’s not the case. If you look long enough, you can still see the stigma oozing out of MH Trusts. It’s still there.
MH Trusts often try to tell us that stigma is a result of people (and staff) thinking that PD is “untreatable”. But I’ve quickly found that stigma from MH professionals is actually a lot more about how they don’t *want* to provide “treatment” to PD patients.
They don’t care whether or not it is treatable. The issue is with them thinking that “these people” are “time wasters” and actually don’t deserve “treatment”. We need to call this shit out.
What else do we need to call out? Psychiatrists who think that a change from “Borderline” to “Emotionally Unstable” is enough to rid the profession of stigma. Try looking more closely at your use of the word “Personality”.
It also gets very tiring to see written pieces by MH professionals from 2020 citing the paper from 2003, about how PD is “no longer a diagnosis of exclusion” and how things “need to change”, almost as if 17 whole years haven’t passed us by.
I will call it a night now, but rest assured that I will continue to tweet in this thread as the weeks and months go by. I’m not going to stop calling this shit out.
The following screenshots are taken from @NHSHighland and their personality disorder service https://www.nhshighland.scot.nhs.uk/Services/Pages/Personalitydisorderservice.aspx
This is them hammering home the idea that people Dx PD are competent and responsible for their own actions and the consequences. Encouraging them to take responsibility is apparently necessary to enable the service to practice “positive risk taking”
Advice on reducing the chance of “splitting”. Apparently if you have a PD Dx this is what you do. Which can lead to a MH prof wanting to offer you an “overly nurturing care plan at the expense of [you] taking responsibility” and if the team disagree w each other, it’s your fault.
![Advice on reducing the chance of “splitting”. Apparently if you have a PD Dx this is what you do. Which can lead to a MH prof wanting to offer you an “overly nurturing care plan at the expense of [you] taking responsibility” and if the team disagree w each other, it’s your fault.](https://pbs.twimg.com/media/EcBqvi-XQAE9wAl.jpg "Advice on reducing the chance of “splitting”. Apparently if you have a PD Dx this is what you do. Which can lead to a MH prof wanting to offer you an “overly nurturing care plan at the expense of [you] taking responsibility” and if the team disagree w each other, it’s your fault.")
And here they are again justifying their “positive risk taking” hammering home the idea that the “patient retains responsibility for their behaviour and the consequences of that behaviour”
Here’s those 8 quick fire questions again. Seems like a lot of Trusts think this is an OK tool to use to “assess” whether someone can be Dx with PD.
This trauma history screen is apparently something they use during assessments. The first part I guess is reasonably OK but the next part, where you are asked to share more details in the boxes provided, via their prompt questions. Bit much, no? Bit on the heavy side. Ethical?
Then they move on to this questionnaire. Blimey. They really do expect you to just dive straight in there with all this sharing of your incredibly personal trauma don’t they? Bit much surely?
This was all published in 2015 & is still on the website so I assume this service is the same now in 2020. It’s getting scary how many awful attitudes I’m finding across lots of different Trusts. & even more scary is the fact they clearly don’t see anything wrong with any of it?
The next screenshots are from this leaflet on personality disorders from @CPFT_NHS written in 2018.
A list of some difficulties a person Dx with PD might have. You might “get bored quickly and end up hurting others as you try get what you want” You may also “need to feel centre stage” “do anything to get their attention” “seen as provocative”
On the “theme” of “respect” - those with a PD Dx will be “encouraged to be strong” and to “be kind to yourself and others” (what are you implying here?)
Medication - Looks like this Trust doesn’t want those Dx with PD taking any medication at all if you read this paragraph. What are the implications here?
And finally, this Trust’s take on “positive risk taking” on a specialist PD inpatient unit for women. Just so that it can be compared with the other Trusts who have been highlighted in this thread for their views on this practice:
Next up is @TEWV training for GP’s (I think?) The following screenshots are taken from this PowerPoint presentation.
I’m not going to bother highlighting relevant parts. As you can see, most of this might make you go WTAF?! It did me anyway...
The 4P’s - First up is “Pause”. The examples provided tell us a lot about what @TEWV think about people Dx with PD. None of those are acceptable responses. Sick of seeing this stuff normalised. “It’s OK guys, we do it too. LOLS”
4 P’s. Second is “Pulls” Same as above. Tells you a lot about how @TEWV feel about PD
Third P is “Patterns” (Not much more to add here) Think of it what you will.
4th P is “Professional response” In other words, respond like a compassionate human being? Respect your patients? You really need training for this shit?
And finally, this screenshot. At this point, I can’t even be arsed explaining what’s wrong here. That’s it for today! But I’ll be back again in the near future with more of the same shit.
Next up (I’m sorry? It feels like I need to start apologising now because this stuff is horrendous) is this taught module for MH professionals about “positive risk taking”
This is them suggesting that a service user’s request for extra support when feeling unsafe, is somehow only done because the person is so much distress isn’t really in distress as such, just that they view “recovery” as a risk. The fucking brass neck of them..
An activity designed to help think about risks and when it’s appropriate (or not) to take them. Using a metaphor of “driving a car”. People are dying across the UK because of “positive risk taking” and these guys think it’s appropriate to talk about it in this way..
“Reinforce the “patient role”” by presumably ringing them to check if they’re OK if they did not attend? Isn’t that just basic care and concern? Or? What’s this “patient role” nonsense?
Again - just a quick phone call to check in on a patient under your care is reframed as something negative - “demeaning and disempowering”
This slide speaks of when the “expert tells the patient what is best for them” and how that’s “incompatible with recovery” Do you guys seriously not see the irony in that? You’re not “sharing responsibility” for risk. You’re forcing it on people. You surely must see that?
That’s all from that module. Christ knows what the other modules are like. Anyway, “positive risk taking” is a dangerous, abusive practice.
OK, this is the most disgusting, shocking and horrendous thing I have read about “positive risk taking”. I cried when reading parts of this. It is from @TEWV and is about the treatment of children with a Dx of BPD. This will be a difficult read, so please be careful
I’m not going to give a commentary on what’s wrong, because it’s just too much. Other than to remind you that this is written about children.
Same as above. No commentary needed. Other than to point out again that this is written about children.
Again, so so so much wrong here. This is heartbreaking. Disgusting. Horrendous. Abusive. I’m not sure what else to say.
Absolutely disgraceful @TEWV
Everything on this page is disgusting. And this is the last screenshot from this absolutely horrendous document, written by @TEWV and still used today. Here is the link: https://www.tewv.nhs.uk/content/uploads/2018/09/Harm-Reduction-Borderline-Personality-Disorders-CYPS-Protocol-For.pdf
This by @TEWV states that “generally speaking, people make most progress in EBPD when they start to take some responsibility for their own recovery”
This is how they are treating children in distress. CHILDREN. I can’t wrap my head round this. This is ABUSE.
This is how they are treating children in distress. CHILDREN. I can’t wrap my head round this. This is ABUSE.
Dear MH Professionals who have been reading the latest screenshots from @TEWV about how to treat children in distress- is this what you believe your profession should be doing to children? Are you going to call this shit out? This is abuse. Who is going to help these children?
Next up is a powerpoint presentation made at the Crisis GP Conference in Scarborough, 2017. To help GP’s working with personality disorder presentations in Crisis. It’s from @TEWV again. I’m not actively looking for their stuff. There’s just too much of it. Ok here goes (
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There’s a lot I could point out here, but I’m going to focus on the part that says a person’s crisis provides opportunities to practice dealing with distress. That’s an awful way to talk about people in distress. But you can get away with it if that person is Dx with a PD.
Assuming that a person is responsible for their safety and well-being before you even ask Q’s about what’s going on for them. This obviously only applies to “PD” patients. Also “err on the side of caution” but only if the person is not well known? Define “well known”.
To increase a person with PD Dx being alive in the long term, decisions that increase risk in the short term can be made. GP’s generally don’t have much knowledge of PD, so I think this is a pretty dangerous thing to be telling them to do. But what do I know..
The bit on regression. Fucking rude. People who are often given a Dx of PD have suffered childhood sexual abuse, like myself. So just watch yourself OK? “Reinforces regression”. Trauma informed, my arse.
GP’s, if a “PD” patient comes to you in crisis, you don’t always have to “do something”. And if you exp doubt about MH services response, then get in touch so they can convince you that ignoring a person’s distress is an OK thing to do if that person has a “PD”
This is from 2017. Don’t know how often training like this is given to GP’s. But this is a clear example of how discrimination travels through the NHS & is deeply imbedded. If you were telling GP’s this, then developing a “new” harm minimisation protocol isn’t gonna do jack shit.
You have to properly acknowledge the ways in which you as a Trust have fucked up. You then need to contact those you’ve provided “training” to, and explain *how* you’ve fucked up. And explain what you are going to do to properly fix it. It’s not about PR. It’s about human lives.
Stigma spreads. No actually, let’s call it what it is - discrimination and abusive practice - spreads - when a blind eye is turned to it. Or when you don’t even realise you’re the one discriminating, or enabling such practices. It spreads. It will take hard work to fix it.
Also, while I’m here. A quick observation - the amount of psychologists who have been directly involved in “positive risk taking” in PD and advocating for it, is rather shocking. How does that sit with you @BPSOfficial
This is written by Steve Morgan in 2004 regarding “Positive Risk Taking”. It looks like a lot of MH Trusts have bought in to this. Reminder: This is from 2004. 16 years ago. Just one year after the 2003 “no longer a diagnosis of exclusion” crap. http://static1.1.sqspcdn.com/static/f/586382/9538512/1290507680737/OpenMind-PositiveRiskTaking.pdf?token=ElVKhX4Soz6TlFbuppAGcJTsZVI%3D
“Witch hunt” ?!?!?
“The very rare cases of true negligence”
“Rare occasions where good intentions go wrong”
“Perpetuating a situation where staff feel guilty until proven innocent”
“The very rare cases of true negligence”
“Rare occasions where good intentions go wrong”
“Perpetuating a situation where staff feel guilty until proven innocent”
MH Trusts have had at least 16 years of buying in to the abusive practice they call, “Positive Risk Taking”. No wonder they are reluctant to accept that it is harming patients. How many have died because of this? The injustice of it all makes me feel sick.
Seems as though this idea of “positive risk taking” was originally developed by Steve Morgan in 1994. He’s still actively advocating for it in 2020: https://strengthsrevolution.net/2020/01/10/why-positive-risk-taking-is-so-misunderstood/
This is hard to get my head around to be honest. I was a child being sexually abused back in 1994. All these years later and the concept of “positive risk taking” is still being used, despite many of my friends dying as a result. How many more will die? This shit has got to stop.
Professionals can stop trying to convince themselves that the level of discrimination and abuse is a thing of the past. This was written and published in 2018:
