Thanks to Suicide Crisis and their founder Joy Hibbins for this excerpt, the full report can be downloaded HERE > Research Into Deaths By Suicide In Gloucestershire, Report of First Six Months (June to December 2017) Headline Findings
Patients with Emotionally Unstable Personality Disorder expected to “take responsibility” for their safety.
It appeared that a level of responsibility was being given to patients with Emotionally Unstable Personality Disorder (Borderline Personality Disorder) to keep themselves safe, even when they were detained under the Mental Health Act or “sectioned” in psychiatric hospital. “Keeping safe” was used in the sense of refraining from self-harm or suicidal acts.
However, it was not apparent what preparation or help they had been given to enable them to “take responsibility” for their safety.
Having spoken to family members, there are indications that there will be more evidence of this being repeated in other cases, in inquests to be heard in 2018.
In terms of the inquests already attended:-
AF was detained under the Mental Health Act in psychiatric hospital. AF had been given a diagnosis of Emotionally Unstable Personality Disorder/Borderline Personality Disorder.
The psychiatric staff giving evidence spoke repeatedly about the need for AF to “take more responsibility” for maintaining her own safety. The coroner asked if she had “the tools” to do this.
AF had not been provided with therapies such as those referred to in the NICE guidelines for Borderline Personality Disorder e.g. Dialectical Behaviour Therapy (DBT). NICE refers to DBT as “an intensive psychological treatment that focuses on enhancing a person’s skills in regulating their emotions and behaviour. The therapy can help a person gain control of behaviours such as self-harm and substance abuse”. Psychiatric staff gave no indication of what they had done to prepare and support AF to be able to “take more responsibility” for her safety.
Therapies are particularly important as there is no specific medication. Indeed the NICE guidance (Clinical Guideline 78) states: “You should not usually be offered medication specifically to treat Borderline Personality Disorder or for any related symptoms or behaviour (such as self-harm, unstable moods and risky behaviour).”
SH had been given a diagnosis of Mixed Personality Disorder (Borderline Personality Disorder and Antisocial Personality Disorder). His family told us that they felt he had been given too much responsibility for maintaining his own safety and refraining from suicidal acts. SH was not provided with mental health care and support (such as the Crisis Team) after suicide attempts or self-harm incidents during the last few months of his life.
There was no indication at inquest that SH had been provided with therapies referred to in the NICE guidelines for Borderline Personality Disorder, including DBT which NICE states can help a person “gain control” of self-harm. There was also no indication that he had been given the recommended treatment for Antisocial Personality Disorder.
The NICE guideline on Antisocial Personality Disorder recommends psychological therapies for managing and treating the symptoms and behaviours associated with Antisocial Personality Disorder. “Group‑based cognitive and behavioural therapies help to address problems such as impulsivity, interpersonal difficulties and can help to reduce offending”.