How to cope with someone with erratic behaviour due to a mental health issue

Why don't I get notifications anymore until 5 days after people have posted??

I apologise, this is a very long one, but has been quite cathartic writing it down. Actually as it ended up 4 pages long I have had to cut it down ....

My daughter had BPD and she committed suicide on the 24th November. It has been dreadful, and I carry a lot of guilt.

She was 29 and had been with the MH services since she was 9! Sadly she didn't get diagnosed until 2019, by which time a lot of damage had been done, and it wasn't until around 3 months ago that she was finally 'upgraded' to get more intensive support from the MH team. Previously she had been told by psychiatrists that she hadn't had enough trauma to have BPD, to go and have a bath and go swimming, light candles etc. Since she died I have found things that she had written that I hadn't seen before - she was very eloquent.

"Today I got a blessing and a curse in exactly the same moment. A blessing, because after years and years I’m finally being understood and my feelings have been validated. A curse, because it’s a life sentence diagnosis and an ugly one at that.

Borderline Personality Disorder will be with me for the rest of my life - be it long or short. It may well be what ends it. This complex psychiatric illness has no cure, and can sometimes be resistant to treatment but I am going to try my hardest to try and make life easier for me and those close to me.

I wanted to share this to help raise awareness for the illness that has haunted me for over a decade, and to fight the stigma attached to BPD and other mental illnesses.

This still doesn’t feel real."

On 3rd October this year - "I don’t want this. I never did. I wanted to have purpose. Love my loved ones and not burden them. The life I am living feels like anti-life. What is the only thing that can defeat the anti-life?

“Hope. I am hope.” - Neil Gaiman

But where has it gone? It gets dimmer everyday."

One of the big things for people with BPD is abandonment, or the fear of it. Over the years it happened a few times for her - When she was a teen and my health started to go downhill and I was in and out of hospital a lot, she stopped going to school, was very hard to live with - she just would not help me after surgery etc and just seemed to make life deliberately difficult. Eventually, I was unable to cope, and despite several 'warnings' that it would happen, she had to go back to live with her father. He was abusive with me, and became abusive with her, and didn't really handle it at all well. The police were called on her many times, several of which, despite him being violent with her first, she was the one that was taken away and put in a cell. She was terrified of the police as a result.

He then actually threw her out, the last thing she needed, but she went to live with a friend of mine and her husband, and quite frankly did much better; then One weekend when her an her boyfriend of over 2 years came to see me, and he just left her - she lost her home, her job and her boyfriend in an hour. It was a very nasty way to do it, but he did say to me "how do you leave her?" and I could see his point .... but she was abandoned once more. Still undiagnosed but obviously not right she started with the local MH services, but it was little and not very often.

It then transpires, after leaving school with 2 GCSEs in art and drama, that my daughter was EXTREMELY bright, and she receives 5 "Unconditional" offers to read not a degree, but a Masters Degree, in Equine Science! So trots off to Uni in the next county (losing her MH help, but didn't want to lose her GP so could not sign up with the MH team there, but there was a Nurse on campus who did help her quite a bit). She did her first year at a 1st level, and got a letter of commendation from the Head of the University. Over the summer (more like May to September, she found herself what she claimed 'was the best job in the world' - helping farriers to hold some of the UK's most prestigious racehorses, belonging to HM Queen, Sir Andrew Lloyd Webber etc. These horses were yearlings who came out of the fields in August, feral and unhandled, and they went there to be broken in for racing. Within a week of 250 horses arriving, she knew what they looked like, their names if they had one by then, most hadn't; their sires and dams names, and where they were on the yard ... whilst the rest of the staff would be shouting 'where's that brown horse?' others would shout 'ask C' and she would know exactly which horse and where it was! She had a remarkable brain and almost a photographic memory for things she was passionate about. She went back into her 2nd year and something snapped in her - I didn't find out about until she was going back for her 2nd term, that actually she hadn't done her 1st term. She had become agoraphobic, couldn't concentrate, didn't do her assignments etc. so she decided to defer for a year, and came back home once more. Again, life wasn't great for her or me trying to deal with each other, but she went back to her job, and at least we had some money coming in.

Then Covid hit us - I was CEV, and she had bad asthma so she had to stop work in case she brought something home or got it herself. So we were stuck in the house together with little to do, no-one to see, and once we were released, her boss, who had managed without her and as he paid more expensive wages, made her redundant , or in her eyes a useless-piece of shit, another kick in the teeth which made her worse again. At one point I was dragged onto the floor and had to call my pendant alarm as she was being aggressive and I couldn't get up. The operator heard her (she was screaming uncontrollably at me and picked up a knife - not to do anything to me with it, but to self harm, and the operator called the police. Again, they took her away, locked her up, and stopped her coming near me for months, and despite me saying I wanted NOTHING to happen, the CPS took it onto themselves to caution her - another kick in the teeth, and when cautioned, they lied to us and said it could be appealed, when it couldn't. We complained about her treatment as a mentally ill vulnerable young woman, but to no avail. This sent her in a downward spiral once more, as she believed she would never get another job. During this time though, she was not allowed to come near the house, she spent a bit of time on her sister's sofa, but as she had 2 young children, some of the things she said and did weren't good for them to see, culminating in a suicide attempt when her sister said she had to go - more abandonment, more self-harm, more suicide attempts etc.. Her only option now was to either go homeless, or go back to uni, which she did, but once more, she couldn't cope with the stress, and ended up coming back home again after a serious suicide attempt, where, had she not been found, she would have died.. By this time I had moved house and my other daughter, SIL and 2 DGDS were living with me, so we were very squashed in, tried to borrow money to make the house suit us all, but couldn't - the little girls were seeing their Auntie basically living in one room all day, and although she tried not to react, she did find them very irritating and occasionally shouted at them. During this time [I moved 12 months ago], she began stealing my medication. Whenever myself and her sister were out, she raided my cupboards and hiding places where I had hidden my Oramorph and Diazepam. Problem was, as these are medications I only take when I am in crisis, when I needed them I would find empty bottles and packages instead, She kept saying 'I'm sorry' - but this could have caused me a lot of problems. Once she downed 2 whole bottles of Oramorph, and it didn't kill her. She was only allowed to have her medication weekly. But to get away from the demons and voices in her head (always her voice, telling her to kill herself, she didn't deserve a life etc), she would take the whole lot in one day, then be withdrawing from some significant antipsychotic drugs until the next time. Eventually, my youngest daughter "evicted herself" and managed to get a tiny, grim housing association house at the end of October. In those last few months, she FINALLY got 'upgraded' with the MH services, and started to get some more targeted intensive help, and was starting to feel a little better - was making plans for Christmas and her 30th birthday on the 28th of this month with her best friends. BUT she was only able to think like that if she could quieten her demons and thoughts of self harm etc, so she stole something off me which hadn't even crossed my mind .... as I said previously she was very intelligent, but some very intelligent people do seem to lack any common sense, and the one thing she could not do - was numbers. What she stole from me gave her, in one hit, a dose which gives me a much, much smaller dose every hour for 3 DAYS, and the way she took it, was therefore a fatal dose. I do think however this time it was accidental - there were no notes (on her 2 previous serious attempts there were) her Asda food shop, ordered the day before arrived when all the police and paramedics were here, and we were receiving parcels for Christmas for days on end ... except mine, typical! Everyone else got one but me, however, I am quite difficult to buy for!

There will be an inquest in the next few months, I know what did it, but what I don't know and worry about is if it was quick, I suspect so, and hope so?

We then had to battle with her father for the next few weeks as he was paying for the funeral (took her death for him to turn up for the first time in 2 years) He did things out of pure spite to upset me and even her, saying things like "it's not a wedding", won't let me have a copy of her service to allow me to grieve in my own way, would not let her best friend see her in the Chapel of Rest, (in case she put a photo of her on Facebook! In whose twisted world would that even happen?) She was devastated as apart from me and her sister, she was in contact with her daily. He actually threatened us with not being able to have her ashes back. He even said "It’s not intended to be a jamboree attended by many who will never have even the most remote appreciation of the significant difficulties that I faced for many years in dealing with Catherine’s behaviour" ... pure nasty, am sure he has a NPD too. Once this is all over, and he no longer has any control over us, he will be getting the suicide note she wrote to him in 2019 (there are also some she wrote in Jan 2022, but I haven't seen those and am unsure if there was actually one to him) He will enjoy that as she tells him what she think of him and what he has done ... hopefully when he is sitting in Church on Sundays he will be mulling her words over, over and over forever - the sanctimonious nasty piece of work.

It has been a rocky 30 years, but being with MH services for 21 of them and not getting any significant help until the last 3 months of her life, was just disgraceful. NOT the fault of the individual workers, but the deliberate underfunding by this corrupt, lying Govt.

She was so talented, her smile could light up a room, she was caring, funny, infectious, passionate and her beautiful singing voice could be heard from the shower ... she never had to use a mic when acting or singing. Her sister said at her funeral that you would even hear her in the toilets in the Royal Albert Hall with the hand dyers on, which got a laugh! One of my proudest memories of her was when she sang 'Another Suitcase in Another Hall' from Evita - a lady from the audience came up to us and said "I have been waiting for you to come out as I just have to tell you I have never heard that song sung so well, better than Barbara Dixon" .... she beamed.

I used to liken it to 'living with an adult toddler'. There was a new group in my area for families dealing with BPD (NHS), which happened on zoom that I was signed up for, but in 2020 I had 3 more surgeries and couldn't handle doing it - we were talking about me getting back in touch with them only recently.

She spent her days upstairs, and some days I hardly saw her, but I knew she was there and she knew I was there. I feel very alone now ....

Allsorts, I stopped communicating.

We used to get on so well. He had done some drugs and had poor MH but we talked a lot, about everything. Until he started taking DMT (otherwise known as ayahuasca, much publicised at the moment because Harry has apparently taken it)

I was so ignorant about this drug (and about many drugs actually) but recently read that it causes paranoia and anger... that certainly fits with what I was on the recieving end of.

There is no easy answer. It's not the first time I've felt at risk, but I am easily triggered because of abuse in my past. I think you have to do what feels right for you. I don't take it personally, it's the drugs damage and MH- but everyone has their limit and I reached mine, sadly.

I've posted on page 1 but to repeat probably a reliable start

www.mind.org.uk/information-support/helping-someone-else/carers-friends-family-coping-support/support-for-you/

Allsorts there are some online sites such as bipolar.uk and others listed by the Nhs which might prove helpful.

I don't think a return to huge institutions is at all advisable. I do think looking at the original intentions behind those institutions and how they were intended to work, before they became overcrowded dumping grounds for socially unacceptable people, could be valuable. The original intention was that patients would have a place of safety and be given jobs which might help them, provide them with work which was physical and productive, and at the same time create a community which was self supporting. Gardening and agricultural work were considered to be helpful and being away from everyday stresses was ought to be healing. They never really worked the way they were intended to, but I do wonder if some people with MH would benefit from time in a caring and supportive environment maybe communes would be a good idea.

In the 1950 and 60s one of the groups of people put into mental hospitals were the elderly and confused. As a child I vividly remember encountering a crocodile of old ladies being taken on a walk round the grounds of our local hospital. They began waving and shouting at me and I was terrified. I realise now they were just rather unfortunate old ladies, but at the time I thought they must be dangerous.

Yes, not to the huge old institutions, but...cutting acute wards wholesale has caused immense problems.I watch the excellent "Ambulance" series on BBC 1 as well and notice the time now spent on MH calls for people who clearly need acute beds before they can be treated in the community.

Its true that staff shortages are the same all over the NHS of course, but article after article points out that if there were a 25% cut in beds in other significant sectors - can you imagine the public furore?

I realise this isnt directly addressing the O/P - ie how to cope with long term N and D, but it is indirectly addressing it, because of lifelong stories of people coping because their N and D has spent chunks of time as an inpatient when needed - and that has shrunk beyond recognition.

That’s the point I think Wyllow3, it’s the cumulative effect of many years of underfunding that’s got is to where we are now. The strategy was, and is right, but the implementation is no longer possible within the resources. In the early days, funding was tight, but services were on the whole safe and protective of service users. Given a return to huge psychiatric institutions isn’t the way forward, more needs to be invested in training urgently.

Well, absolutely, Glorianny.

Beds wise - the cuts are greater in my area (its known for it) but here is a 2021 report comparing the situation then to 2010.

If you go back just a bit further then it's substantially more.

www.theguardian.com/society/2021/jul/05/number-of-nhs-mental-health-beds-down-by-25-since-2010-analysis-shows

There was a report in 2011 which blamed the failure of care in the community on lack of funding. Of course it was a good policy but one thing is certain if you introduce a policy for the wrong reasons and then fail to properly fund it you practically guarantee its failure.
www.nationalelfservice.net/publication-types/policy/care-in-the-community-has-failed-the-most-vulnerable-says-new-think-tank-report/

Casdon that’s maybe part of the problem? I’m looking at how Cuba runs its health system and training immediately jumps out as a having a different model. Truce?

ronib

Iam64

ronib, psychiatrists need general medical training. There are well established links between physical and mental health. Psychiatry gets a lot of criticism , a lot of it unfair

5 years medical schools
1 year hospital
Plus I think in excess of 2 years psychiatric training
I respect psychiatrists very much. I think 8 years plus is a long time to spend in training and wondered if training could be shorter? Given the huge shortage that is.

I think the short answer to that question is no. It’s only after they qualify as a doctor that people decide which branch they want to specialise in, most will try out several different areas before they decide, as it’s a huge decision, affecting the rest of their career.

Wyllow3

Ronib, the number of Acute Wards in my area has been reduced from four in 2010 to one. Do the maths.

Wyllow3 I think we are talking at cross purposes. There’s a world shortage of mental health nurses. It’s not confined to the Nhs.

I don’t know why the number of wards has been reduced from 4 to 1 in your area.

Iam64

ronib, psychiatrists need general medical training. There are well established links between physical and mental health. Psychiatry gets a lot of criticism , a lot of it unfair

5 years medical schools
1 year hospital
Plus I think in excess of 2 years psychiatric training
I respect psychiatrists very much. I think 8 years plus is a long time to spend in training and wondered if training could be shorter? Given the huge shortage that is.

ronib

‘Casdon - only 50% of GP's do a Psychiatric placement as part of their training - I suspected this from discussions, but have just looked it up to be sure.‘

That means though that there are mental health trained doctors available in every GP practice. If you think about the role of a GP, they have to cover every possible specialty, it’s not unreasonable for someone to be trained in, say Obstetrics and Gynaecology, and someone else in Psychiatry, surely?

One nurse telling you about staffing on his unit told you the truth as he saw it I’m sure, but what he didn’t mention by the sounds of it is that the reason there weren’t nurses to fill the vacancies on his ward was that not enough nurses are trained, that many who are trained leave because of the pressure of the job, etc. and of course, nurses choose where they want to work.

To help someone with a mental health problem you need assessment and treatment quickly, almost impossible, if prescribed medication is prescribed many won’t take it for long periods. You usually become a target with violence for example, you can’t reason with a person if they become violent or if they get an idea in their head that is pure fabrication.. all time is centred on this person to the detriment of everyone else in the house. They can be extremely selfish as everything is about them, they don’t seem to see you’re exhausted and not coping yourself.mmmm
We need more GP’s and especially those interested in mental health but I can’t see that happening.

Ronib, the number of Acute Wards in my area has been reduced from four in 2010 to one. Do the maths.

ronib, psychiatrists need general medical training. There are well established links between physical and mental health. Psychiatry gets a lot of criticism , a lot of it unfair

The reports refer to mental health nursing only

Wyllow3 the ward manager at a London psychiatric hospital told me this.

I have just done a very quick Google search and there are studies supporting my view.

Where did you get that information from Ronib? I've watched it deteriorate since 2006 due to year on year cuts in funding. I've watched several "re-organisations" in the local Trust, each one cutting resources - inpatient beds, community care centres, drop in centres for User and Carer support, OT and other "necessary" roles cut altogether (remaining OT's now work basically as nurses), numbers of Psychiatrists cut, numbers of workers cut, psychologist numbers cut, people being taken on as temporary locums, contracts not the more expensive permanent contracts, workers moved around at short notice meaning work relationships falter, admin workers cut

and all this with increasing numbers of referrals each year.

Its probably about time I told you why I know so much: I'm a trained psychotherapist and in the past worked in Community Mental Health support in SSD but have also been a Service User since 2002 (depression and anxiety, not bi-polar or a PD) I have been a governor on the local trust. In addition, a lot of Quakers (I'm one) work in Mental Health, and I've discussed it all at length. I've been an inpatients, had electric shock treatment, has a long and fortunate time psychotherapy, attended drop in centres, been to OT groups - every word I'm saying is accurate.

I've just got divorced from an abusive man - violent words, and a great deal more and who has bi-polar and a PD but would not let himself be treated beyond a certain point despite my efforts which of course were as effective as they might be given I know the system well.

Casdon - only 50% of GP's do a Psychiatric placement as part of their training - I suspected this from discussions, but have just looked it up to be sure.

Aveline

There is a colossal problem in funding for mental health services despite what someone once said to you ronib!
People are not machines and all conditions perhaps especially psychiatric and psychological conditions are not necessarily fixable. It's is an extremely complex area.

Am only too aware that people are not machines and that not all mental health problems are treatable. In fact my own gp shared with me that a close relative with bi polar had died whilst in a recovery care home. He had committed suicide. This gp also said that no family had escaped from having at least one member with mental health problems. Everyone is affected.

The nurse in charge of a mental health ward said that it was difficult to find staff and it wasn’t a budgetary issue, rather he has a full budget, but rather a reluctance to work in this area. Therefore no trained staff!

ronib

Casdon I was told that there’s not a funding problem in mental health, the real problem is very few people want to work in mental health. It’s the Cinderella service.

I will always regret not trying to qualify as a psychiatrist but I wasn’t nearly smart enough or rich enough to go through a very prolonged training. I don’t really understand why a psychiatrist needs a full training in physical health when the reverse is not true. I mean a physical health physician is not trained to be a mental health specialist…

I don’t know who told you there isn’t a funding problem in mental health ronib, but they certainly weren’t telling the truth. It’s true that there are recruitment difficulties, in older adult services in particular, but the main factor is funding - not enough training places, not enough roles in some branches, particularly psychology.

I’m no expert on psychiatric medical training, but I know that GPs do a training placement in psychiatry as part of their training programme. GPs are the only doctors who have training in a wide variety of specialties after the initial degree, so for example a general surgeon would know very little about, say ENT, or Diabetes. In that sense, Psychiatry is no different to other specialties.

There is a colossal problem in funding for mental health services despite what someone once said to you ronib!
People are not machines and all conditions perhaps especially psychiatric and psychological conditions are not necessarily fixable. It's is an extremely complex area.

Casdon I was told that there’s not a funding problem in mental health, the real problem is very few people want to work in mental health. It’s the Cinderella service.

I will always regret not trying to qualify as a psychiatrist but I wasn’t nearly smart enough or rich enough to go through a very prolonged training. I don’t really understand why a psychiatrist needs a full training in physical health when the reverse is not true. I mean a physical health physician is not trained to be a mental health specialist…

Glorianny

rnib if you have such long experience of MH issues you should realise that the treatment of these conditions in this country has two conflicting issues to deal with. One is the lack of proper funding because Thatcher found a way of cutting costs which was termed "care in the community". The other is the traditional way of treating some MH issues was not only seen as abusive but actually harmful and certainly unacceptable and in conflict with human rights. I'm speaking of course of electric shock treatment, which was seen as a common way of treating what was then termed manic depression well into the 1970s.
Growing up with a father who was diagnosed with the condition when I was in my teens I was fortunate in that he was never violent but very emotionally manipulative.

In answer to the OP I can only tell you what my mother was told when my father was diagnosed and she asked his psychiatrist how she should treat him and deal with him. He said you treat him like anyone else who is ill, when he shows symptoms you deal with him as if he was ill and accommodate those, when he is well you treat him like anyone else and perhaps explain to him how he has made you feel. But don't feel you have to change your behaviour to suit him.
I don't think that will really help with the violence. As I said my father was never really violent.
I hope you manage to find a way. I'm pleased we can now discuss MH issues openly.

I don’t agree with your summary of why mental health services moved to a care in the community model Glorainny. The former model was huge psychiatric hospitals operating as self contained communities, which effectively removed people with mental health issues from society. I disliked Thatcher as much as I’m sure you did, but to blame her for moving away from huge institutions to a community based model which was kinder and more appropriate for a majority of people with mental health conditions is wrong.

The problem is that due to a lack of funding, and consequently, staff it has now moved too far to community based care, and some people who need inpatient care and intensive support are unable to access it - but that isn’t the fault of the model itself.