Borderline-personality disorder patients can’t trust mental health services

How can we expect borderline personality disorder patients to trust mental health services when the staff don’t trust them? Establishing trust is a huge ask for patients who have experience damage at the hands of others. Yet we punish psychiatric patients by giving them a label that enables others to carry on treating them like dirt

Psychiatric staff demonstrably move away from and feel less emotionally connected to people who have been given this label

I am struggling with a paradox. How come theories of borderline personality disorder (BPD) recognise that there may be good historic reasons for mistrusting figures of authority, yet brutally insist on submission to certain potentially quite toxic ideas to get any help?

Borderline personality disorder is a psychiatric diagnosis given to people who experience things like a fear of abandonment, unstable relationships, extreme emotional turbulence, rage and disconnection. As a diagnosis, it lacks scientific reliability and validity to such an extent that even psychiatric nosologists (those who classify disorders) are somewhat embarrassed that it continues to be used.

Yet this is not the only reason why so many wish to bin this label. BPD has always been a synonym for the “difficult patient” in psychiatric speak. It is connected with terms like “attention-seeking” and “manipulative” which allow staff to paint a picture where patients “wilfully” pit people against one another. People who have been diagnosed with BPD are positioned as too sexual, too clever and too aware of their actions to deserve care, interest and respect.

BPD is all too often experienced as a dustbin diagnosis by patients, staining on one’s entire personality and reinforcing early messages from outside that one is unlovable, wrong, defective or too much. Nothing could be less true of the brave and brilliant people I know personally and professionally with this diagnosis, all of whom are survivors in every sense of the word.

They are survivors because many of them are struggling in life after traumatic early experiences such as childhood sexual abuse or, say, having been bought up by an adult with a narcissistic parenting style, who used the child as a plaything to enact his or her own wishes and punished any attempts the child made to develop him or herself as distinct. These kind of childhood experiences – and a thousand others including sociocultural ones such as that of misogyny – leave the soul locked in a psychic tumble dryer desperate to get the cycle to stop but unsure how.

Psychiatric theories and treatments of BPD emphasise that escaping such pain is possible through restorative, healing, interpersonal experiences in psychotherapy, changing the landscape of one’s inner world. Treatment protocols emphasise that this takes time and skill given the need to establish something some theorists call “epistemic trust”. This is the capacity to feel safe enough to take in knowledge and experience new ways of relating to one’s therapist.

Establishing trust is a huge ask for most patients who have been damaged by others – be that patriarchal culture, parents or other figures of authority. I have yet, 25 years into my career, to meet any patient whose defences in relation to the other – be that dissociation, attacking, freezing, befriending or ridiculing – are not understandable. With the life histories most psychiatric people have, it is logical to presume these interactional patterns will continue and that the other, in this case psychiatric services, may harm, misrecognise or abuse the sufferer or find it impossible to bear them and disappear. Yet we punish psychiatric patients for these all too understandable reactions by giving them a label that enables others to carry on treating them like dirt, while doubling our blaming on patients for not willingly submitting with gratitude.

As I have written out before, the diagnosis of borderline personality disorder incurs what the philosopher Miranda Fricker called an “epistemic injustice“. With BPD, this means that the character of the speaker – the patient – is slurred and written over with the word “disorder” such as to affect how their speech and actions are interpreted. When survivors try to transmit this fact to staff, it is often considered to be “projection”. However, the literature here is clear as day and firmly on the side of survivors. Psychiatric staff demonstrably move away from and feel less emotionally connected with people who have been given this label.

It is paradoxical, surely, to expect patients to open themselves up to new, more trusting ways of relating to the other if the other proves themselves untrustworthy by only allowing access to such spaces via accepting an ideology that positions the patient as less credible as a speaker. Is it any wonder patients kick off when placed in such a double bind?

To move forward we must ensure as a first priority that mental health services are trustworthy. And to do this, we must listen to survivors who have been telling us for decades now that the diagnosis of borderline personality disorder is an irreversible stain on the soul. Otherwise, how can we expect people to to trust us at all?

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Has the DWP covered up its role in claimants’ deaths?

Has the DWP covered up its role in claimants’ deaths? Labour, the SNP and Greens demand answers.

Has the DWP covered up its role in claimants’ deaths? Labour, the SNP and Greens demand answers.

The Department for Work and Pensions (DWP) is facing allegations of a “cover-up” over the deaths of welfare claimants, possibly linked to its controversial Work Capability Assessment (WCA).

The DWP: covering up its role in people’s deaths?

As the website Disability News Service (DNS) has been investigating and documenting, the DWP is facing a possible scandal. Labour, the Lib Dems, the SNP and the Green Party are all demanding answers from the department. Green co-leader Jonathan Bartley said the situation had “all the hallmarks of a deliberate cover-up”.

It involves the DWP’s alleged failure to hand crucial evidence to the head of two independent reviews into the WCA. The missing evidence includes, according to DNS, two coroners’ reports that:

followed the deaths of two men with mental health conditions in 2010 and 2013… Each warned of further such deaths if changes were not made to the WCA.

Missing reviews

The WCA is the process the DWP uses to decide whether claimants are ‘fit-for-work’ and therefore entitled to certain benefits. It has been dogged by controversy; not least when a study by Oxford and Liverpool universities found that an “additional” 590 people taking their own lives was linked to the WCA process.

The DWP allegedly also failed to give Dr Paul Litchfield, who published reviews into the WCA in 2013 and 2014, its own internal peer reviews. These, as John Pring from DNS noted:

must be carried out by civil servants into every death ‘where suicide is associated with DWP activity’.

One of the aims of these reviews is to ‘determine whether local and national standards have been followed or need to be revised/improved’, so DWP would find it hard to explain why they would not have been shown to Litchfield, whose job it was to review how the WCA was working.

DWP has admitted that at least seven peer reviews written in 2012 mentioned the WCA, and there are almost certainly more that were written by the time Litchfield wrote his final report in late 2014.

Both Labour and the Lib Dems told DNS they would be writing to work and pensions secretary Esther McVey over the matter. The SNP said it would be “seeking answers” from the department.

The DWP says…

The department told DNS:

As we’ve previously said, this was an independent review, and DWP provided information alongside other stakeholders – on request.

Any evidence used was referenced in the review.

A “deliberate cover-up”

But the situation has left Bartley incensed. He told DNS:

If the [department] failed to show Dr Litchfield vital documents linking the [WCA] with the deaths of benefit claimants, [the] DWP are clearly implicated in a cover-up.

If he was shown them but didn’t mention them in his reports, then so was he.

This has all the hallmarks of a deliberate cover-up over the fatal impact of the assessment on sick and disabled people.

Theresa May awarded Litchfield a CBE in June.

So, has the DWP intentionally covered up its involvement in claimants’ deaths? Currently, there are certainly more questions than answers.

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Windrush man who suddenly died did not access healthcare for two years due to immigration concerns

It’s terrible how the Tories have treated the windrush-migrants’ descendants, but then they  treat everyone with the same disdain [unless you have millions]


A Windrush man who suddenly died did not access healthcare for two years due to immigration concerns, inquest hears. Dexter Bristol, who died of heart failure earlier this year, was under ‘extreme stress’ and hadn’t visited his GP since August 2016 due to issues with his uncertain immigration status, court hears.

He died suddenly after being classified an illegal immigrant had refrained from accessing healthcare for nearly two years before his death due to immigration concerns, a pre-inquest review has heard.

Dexter Bristol, who came to the UK from Grenada aged eight, collapsed and died from acute heart failure in the street outside his home in Camden on 31 March. He had been sacked from his cleaning job and then denied benefits because officials did not believe he was in the country legally.

It has now emerged that, according to medical records submitted to the coroner, the 57-year-old had not accessed health services since August 2016. His uncertain immigration status prevented him from going to the GP, according to his solicitor at the time.

READ MORE

Barrister Una Morris, representing Mr Bristol’s mother and sister, told a pre-inquest review that Mr Bristol had been under “extreme stress” having been subjected to “racist and xenophobic” hostile environment policies.

Witness Jacqueline McKenzie, a lawyer who had been working to obtain a passport for Mr Bristol prior to his death, said in a statement submitted to the court that in the months before he died he would often complain to her of feeling unwell, saying it was down to the pressure of having to prove his immigration status.

“When I suggested he find a new doctor, he said his GP was racist, and that he couldn’t apply to change surgeries unless he could prove his immigration status. I saw him getting more and more upset and stressed by the ongoing process to prove he was a British citizen,” she said in the statement.

Records show Mr Bristol had carried out a job search for hotel cleaning jobs or porter roles in 2016 with Maximus, a company working on behalf of the Department for Work and Pensions (DWP) to help people find work. But it was noted that he didn’t have his Right To Work document.

A Christmas card sent to his retired NHS nurse mother, 76-year-old Sentina, four months before he died, read: “This whole thing is making me bitter and hateful and nobody wants to be that way for ever.”

The court also heard that Mr Bristol was not identified as someone being at high risk of heart failure before the issues with his immigration status.

“He went through his entire life as a British citizen. It was only in 2016 that these matters started to come into question. We have to look into the background.”

When Mr Dolman questioned the relevance of the additional documents, she said: “The point is if somebody is under extreme stress that can have an impact on their health.”

The coroner reserved his ruling on the scope of the inquiry but said the full inquest would take place over two days at a date which has not yet been set.

Speaking after the hearing, Ms Bristol said: “The coroner has said he will conduct a full and fearless investigation and as Dexter’s mother I expect this will include looking into the Home Office Windrush policies.”

Deborah Coles, direct of charity Inquest, told The Independent she believed the “unique” circumstances of the case justified a broader inquiry into the circumstances of Mr Bristol’s death.

“These are exceptional circumstances. The concerns about the impact of the Windrush scandal on people’s physical and mental health have to be explored. It’s in the public interest.

“If the government is taking seriously the impact of their hostile environment policies, then that should include where people have potentially died prematurely as a result of the hostile environment.”

It comes after Ms Bristol told The Independent she was convinced the stress and anxiety her son experienced as a result of immigration controls contributed to his death, saying she watched him become so frustrated that he began to “lose his mind”.

With no access to legal aid and having spent all of her savings on Mr Bristol’s passport documents and then his funeral, the former nurse is having to crowdfund in order to afford legal representation so that questions are asked about the stress her son experienced.

You can donate to help Ms Bristol raise funds for legal representation here.

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Universal Credit blamed as over 1million people are fined for mistakenly claiming free prescriptions

Universal Credit rollout bungle blamed as over 1million people are fined for mistakenly claiming free prescriptions. Labour has slammed the Government and claim they have been “penalising ill people” by failing to inform them of entitlement. The bungled Universal Credit rollout has been blamed for more than a million people being fined for mistakenly claiming free prescriptions.

Labour accused Government of “penalising ill people” by failing to inform them of entitlement after moving to the all-in-one benefit. Helen Goodman blasted the Department for Work and Pens­ions and called on Employment Minister Alok Sharma for refunds.

 

Fines can be as high as £100 per prescription. The MP said: “This is the minister’s fault.“They should not penalise ill people because of their shambolic rollout of Universal Credit.”

Not all claimants qualify for free prescriptions and eligibility can change based on how much they earned in a given assessment period. But there is no automatic system to tell them whether they qualify. Even ticking the wrong box on the form can lead to a fine.

Just 35,000 people were penalised in 2014, the early stages of the delayed credit rollout.

Ms Goodman said in a letter to Mr Sharma that it was often also unclear if those who do not qualify can get NHS Low Income Scheme aid. She said: “The system should automatically alert a claimant and clearly inform them.

“These fines are… huge sums for people on low incomes.”

A Gover­nment spokesman said: “We have not yet received the letter. When we do, we’ll respond in due course.

“Universal Credit claimants are informed of potential entitlement to support with NHS charges via monthly payment statements.”

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Watchdog’s ‘issues of concern’ over regulator’s treatment of PIP complaints

PSA logo

A regulator has been told there are “issues of concern” about the way it deals with complaints against health and care professionals, including those who write dishonest benefit assessment reports.

The Professional Standards Authority (PSA) agreed in January to look at concerns about the way regulators deal with complaints about nurses, physiotherapists and paramedics who carry out personal independence payment (PIP) assessments for the outsourcing giants Capita and Atos.

It agreed to act after being contacted last year by disabled activist Mark Lucas, who has twice appealed successfully against the results of what he believes were dishonest PIP assessments.

Hundreds of disabled people have come forward over the last 18 months to tell Disability News Service (DNS) how assessors working for Atos and Capita wrote dishonest PIP assessment reports on behalf of the Department for Work and Pensions.

Many also raised concerns about the apparent refusal of the Health and Care Professions Council (HCPC) and the Nursing and Midwifery Council (NMC) to take their complaints about these assessments seriously.

Only this week, Lucas received an email from HCPC, explaining that it would not take any further action over his complaint about an occupational therapist who had assessed him for PIP.

He believes the assessor deliberately downplayed the seriousness and frequency of his seizures, but HCPC told him it did not believe this had happened and even if it had, “it would be considered a minor error, which would not be capable of amounting to an allegation of impaired fitness to practice”.

Lucas has twice been found ineligible for PIP following assessments, but on both occasions was later awarded eligibility for the PIP standard daily living rate after appealing to a tribunal.

Frustrated at HCPC’s failure to take another complaint about a PIP assessor seriously, he contacted PSA – which reviews the work of the regulators of health and care professionals – last year.

PSA incorporated Lucas’s concerns into its annual review of HCPC, which found this month that the regulator was meeting only four of the 10 required standards for the way it deals with complaints against healthcare professionals, including those who carry out PIP assessments.

Last year, before Lucas contacted the regulator, PSA had reviewed 100 complaints made to HCPC, including a small number relating to PIP assessments.

David Martin, PSA’s concerns and appointments officer, said the 2017-18 review “concluded that there were issues of concern about the HCPC’s process across all of its activity”, in relation to fitness to practise.

These concerns include the way it deals with the initial stages of the fitness to practise process, and how it determines if there is a “case to answer” against a health and care professional.

Among PSA’s concerns are that HCPC makes it too difficult for complaints about a healthcare professional to be accepted into the fitness to practise process, while other cases are closed at the initial stage instead of being referred to an investigating committee panel.

Martin said HCPC had confirmed that PIP assessment work “should be considered in the same way as any other professional activity of its registrants” and that its procedures “require it to fully consider the concerns it receives about PIP assessors”.

He said: “The HCPC was clear that it considers registrants, acting as PIP assessors, are exercising their professional judgement.

“It therefore considers that allegations of misconduct or lack of competence when carrying out PIP assessments could constitute a fitness to practise concern to be investigated in accordance with its usual process.”

He said HCPC was now “undertaking an action plan” to address the concerns PSA has raised about its fitness to practise processes, and that PSA would probably review further HCPC cases in detail over the next couple of years.

A similar annual review by PSA of NMC is due to be published later this year.

An HCPC spokesman said: “The PSA audited a sample of 100 of our cases as part of their review of our yearly performance review in 2016-17.

“While a small number of these cases related to PIP, the audit was not specifically looking at HCPC’s handling of PIP cases.

“HCPC registrants who are employed in assessor roles are recruited because of their skills and experience as registered health professionals. Therefore, their work and conduct needs to comply with our standards.

“If in the course of conducting a PIP assessment a concern is raised regarding a registrant’s fitness to practise, ie lack of competence or misconduct, then this will be investigated following the same robust and thorough processes and applying the same tests as concerns raised in relation to any other area of a registrant’s practice.

“We have also provided input into the PSA’s review into how regulators approach fitness to practise concerns in relation to PIP assessments and have confirmed our view that the PIP assessment process requires the registrant to employ their professional competencies.

“This year we continued to meet the majority of the PSA’s Standards for Good Regulation.

“Although we did not meet all the standards relating to fitness to practise, the PSA has acknowledged our on-going work to improve our performance in this area and stated that we have made ‘significant progress during this review period’.

“We continue our programme of improvement work to address the issues that were previously identified.”

But Lucas was heavily critical of PSA’s efforts to address his concerns.

He said PSA was “a joke” and a “toothless quango”.

He said: “I am not happy with the way PSA have treated me and it is behaviour that I have been subjected to on many occasions over the last few years.”

Lucas said that complaints processes are “designed to abuse” disabled people because they first “promise the earth”, then “forget” the complaint, and finally “communicate the result from the complaint in a letter with preapproved techniques of neutralisation and consolatory phrases like ‘we realise you will be disappointed’”.

He said: “This experience of the last few years has given me anxiety over making complaints.

“I have spent much time and written many letters, but it is all for nothing because organisations like the PSA are just for show.”

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A note from the [DNS] editor:

For nine years, Disability News Service has survived largely through the support of a small number of disability organisations – most of them user-led – that have subscribed to its weekly supply of news stories. That support has been incredibly valuable but is no longer enough to keep DNS financially viable.

For this reason, please consider making a voluntary financial contribution to support its work and allow it to continue producing independent, carefully-researched news stories that focus on the lives and rights of disabled people and their organisations.

Please do not contribute if you cannot afford to do so, and please remember that DNS is not a charity. It is run and owned by disabled journalist John Pring, and has been from its launch in April 2009. 

Thank you for anything you can do to support the work of DNS…

Esther McVey DENIES Universal Credit has been too brutal

MCVEY1Tory Esther McVey DENIES Universal Credit has been too brutal – despite revealing yet more climbdowns to come. The Work and Pensions Secretary admitted she is “working on” changes that are “still needed” to the six-in-one welfare system – five years after it launched

Tory welfare chief Esther McVey today flatly denied Universal Credit has been too brutal – despite unveiling yet more climbdowns over the flagship benefit. The Work and Pensions Secretary admitted she is “working on” changes that are “still needed” to the six-in-one welfare system – five years and a million claimants after it launched.

They include more support for the self-employed and possible changes to the “taper rate” to let people keep more of the money they earn. But she refused to say the system had been flawed – or if she backs ex-welfare chief Iain Duncan Smith’s call to pump in £2billion a year more.

Mr Duncan Smith made his call after money was sucked out of the system before it launched in a move that will leave hundreds of thousands of families worse off. Asked by the Mirror if her climbdowns showed the system as rolled out was too “harsh” or “brutal”, she said: “It was very very slow as we rolled it out so we were monitoring as we were rolled it out.

“So no, it wasn’t, and we’ve stopped and changed it as we went along.” MORE LIKE SHE MAKES IT UP AS SHE GOES ALONG!!!!

Supreme Court Hears Final Challenge Against Controversial Single Parent Benefit Cap

A hearing challenging the government’s controversial benefit cap reduction enters its final day today. After a battle through the legal system, three lone parents are bringing a final challenge against the “brutal benefit cap” imposed on them by the Department for Work and Pensions.

The Supreme Court will be asked to rule on whether the revised cap breaches their right to be free from discrimination.

What is the Benefit Cap?

Changes to the benefits system were brought into place in 2013, under the Coalition Government. There have been a couple of amendments to the legislation since, but in practice, the scheme limits the amount people can receive in benefits unless they are working at least 16 hours a week.

Currently the maximum amount of benefits that those working less than 16 hours per week can receive totals  £23,000 in London, and £20,000 in the rest of the country.

The cap was first introduced alongside the bedroom tax, which penalised benefits claimants living in a Housing Association home with a ‘spare’ bedroom.

The bedroom tax was declared discriminatory and unlawful in January 2016.

Who is Bringing the Case to Court?

mum with young children

The claimants are two women who are single parents outside London and have been unable to find work. They have children of various ages, including children under 2.

One, with four children, lost entitlement to £80 a week, while a mother of five, who has three children with significant health needs, lost £110.

Why Does the Benefit Cap Discriminate Against Lone Parents in Particular?

benefit cuts young boy

The lone parents in this case argued that, with such young children, it was harder for them to find work than for others, especially as free childcare is only available in some circumstances for those with children aged between 2 and 4.

This has resulted in a lot of young mothers tasked with juggling a minimum of 16 hours work a week while caring for their children.

An estimated 26,000 lone parents with children under the age of two have been affected by the benefit cap since it was introduced in 2013, reported the Guardian, while Full Fact notes that 40,000 single parents have been affected in total.

These parents are losing on average £50 a week, according to Channel 4 News.

The cut has been described as a “brutal ” by Shelter’s CEO, Polly Neate. “This appeal offers a glimmer of hope for the thousands of single-parent families suffering because of the brutal benefit cap,” she said.

The History of the Case So Far

the high court has ruled on the sir cliff richard case

The case has not been a straightforward one.

The High Court ruled in favour of the lone parents in June 2017.

Presiding judge Mr Justice Collins said that the restrictions imposed by the Work and Pensions Secretary cap were discriminatory, declaring that “real misery was being caused to no good purpose”.

But the decision was overturned by a two-to-one majority at the Court of Appeal in March 2018, which found that there was no discrimination against the claimants, since lone parents with children under two did not, said the Court, in practice face substantially greater difficulties that lone parents with older children in obtaining work.

The Court of Appeal said it was therefore not unreasonable of the government to fail to give them an exemption from the benefits cap.

It is this decision that is being challenged this week in the Supreme Court.

Moving Forward

As today’s hearing shows, the parents haven’t given up the fight yet.

Lawyers for the parents intend to prove that the cuts have “drastically reduced housing benefits, leaving lone parent families across the country unable to afford basic life necessities to care for their children”.

After two days of testimonies, the proceedings conclude today.

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