A look into Borderline Personality Disorder (BPD)

© Sarah Dale

Sarah Dale

Sarah Dale is a citizen rep in Powys – an unpaid volunteer who sits on the Powys Mental Health Planning & Development Partnership to share the voice of lived experience. As a citizen rep Sarah previously sat on the Wales Mental Health & Wellbeing Forum (formerly the National Mental Health Service User and Carers’ Forum).

Sarah has also worked incredibly hard over the past few years as a regular contributor to the Engage to Change group, which is a sub-group of the PMHPDP. This group was established to "more widely promote the Mental Health Planning and Development Partnership’s activity, to proactively challenge any stigma associated with mental health and to collect "service user" views / experiences, co-ordinate resolution and feed back on resulting change to people using services."

And during the Covid-19 pandemic Sarah has also created and delivered a hugely valuable training session on Self-Injury Awareness to many of those working in the provision of statutory mental health services in the county. Sarah is absolutely passionate about raising awareness of mental health issues and brings an honesty and openness to the work which allows greater understanding for all those watching / reading / exploring more about these issues.

© Sarah Dale

Sarah's experience of Borderline Personality Disorder (BPD)

Sarah's latest project is an indepth look into Borderline Personality Disorder to promote during Borderline Personality Disorder Awareness Month this May.

"You are probably wondering... "what is Borderline Personality Disorder? And you are not alone. This is the response I get when I tell people I have BPD, and yet I still haven't been able to accurately explain what the disorder is, and how it affects me. 

The reason you probably haven't heard of the disorder is that most people with (BPD) have experienced a lot of stigma. Often being described as 'manipulative', 'attention seeking' and 'incurable'. You have probably seen over the years, celebrities opening up about their depression, anxiety or bipolar disorder, thus more people are speaking up about their own struggles.

However, no one wants to talk about the more 'scary' or 'shameful' issues like self-injury, eating disorders, psychosis and personality disorders."

After exploring What is BPD? Sarah considers why it has this particular name, what it's like to have BPD, some of the feelings that people with BPD experience such as extreme emotional instability, fear and abandonment, and people's struggles with a sense of identity. Sarah then turns to the positive side of BPD and explores the empathy and compassion that people with the condition experience, plus an often increased creativity. To finish off Sarah debunks some of the commion BPD myths, such as that people with BPD are incurable and / or attention seeking.

You can read the whole piece, A Look into Borderline Personality Disorder (BPD), on our Powys Mental Health website.

If you have any queries for Sarah, or experiences to share, then do pop them in the comments' section below.

© Sarah Dale

Read more from Sarah

Sarah has written for this blog previously on:

The Wales Mental Health & Wellbeing Forum – an update

Together for Mental Health consultation - a Powys view

On the Experts by Experience panel

And on the PAVO Health & Wellbeing blog:

Self Injury Awareness 

You can also catch up with Sarah on her Facebook page - Sarah Mental Health Rep.

Citizens Advice Powys - supporting mental health inpatients

Yasmin Bell is the Chief Officer at Citizens Advice Powys, the charity which “provides the advice people need for the problems they face and improves the policies and practices that affect people's lives.”

The charity recently launched a new pilot project to benefit the inpatients on the mental health Felindre Ward at Bronllys Hospital in South Powys. We spoke to Yasmin to find out more about this important work.

Tell us more about the project

Owen Griffkin, the Powys Patients’ Council facilitator, and the Occupational Therapy (OT) team on Felindre Ward, had been talking to us over the last year about setting up an inpatient advice service. We want to support patients with various issues which are acting as barriers for them wanting to return home and on their recovery process generally. We will continue supporting them once they are at home.

One of the OTs said that some patients, escorted to their homes on day release, had become more anxious upon arriving at a freezing cold home and finding a huge amount of mail / bills. It’s not a very welcoming scenario!

In the long term we would ideally provide support so that people don’t go on the ward in the first place.

How does the support work?

We did a similar project on Felindre Ward about 10 years ago and staff remembered how useful that was supporting people on their recovery journey. At that time a Citizens Advice advisor from Brecon went onto the ward to see people. With Covid we are using video appointments. The ward has iPads available and supports patients to access the platform and then we take it from there.

There’s quite a lot of work we do with the team before we meet the client – every individual can be different. Some people can be uncomfortable about speaking to someone about their issues. In that case the OT will work closely with us to find out what kind of help is available before going back to the person to give a flavour of the advice that could be provided. This usually results in the person then taking an appointment and with a better insight of what help can be provided.

Some of the original project outcomes included – less hospital staff time spent on advice issues, improved patient engagement with treatment, reduced barriers to patient discharge, clients feel more able to stay in their own home and in control of their lives, and improved mental health. The support enables independence, self-management and clients receiving all benefits they are entitled to.

Why was the work of Powys Patients’ Council invaluable in setting up this project?

Owen and the PPC volunteers had been speaking to people on the ward and through this helped identify the need for a direct advice service to support people.

We’ve had a lot of positive comments. One patient said: “I had an appointment with Citizens Advice today and they were excellent. They were able to help with my pet and some money issues.”

How is the project funded and for how long?

This pilot project is funded by a recent Powys Teaching Health Board Small Grants scheme. It lasts for 4 months so will end at the end of May. Through this pilot we will determine the level of demand and the feasibility of the service.

Tell us about some of the everyday issues facing people on the ward and how your service can help?

We identified that it was particularly important to help patients report their change of circumstances with regard to any benefits. Once discharged their benefits can be reinstated with our help. Citizens Advice Powys can also take responsibility for contacting any third parties and putting a hold on any action pending, for example, debt repayments, until that person is able to deal with them. It’s also important to inform the third party that Citizens Advice is helping the person.

We also make sure people are getting all the right benefits – we carry out an Income Maximisation Check – looking at the person’s whole situation. In many cases it can be quite complex – other benefits can be triggered or stopped. We act to make sure there is no detrimental impact on the person.

What is Attend Anywhere?

That is the video platform we use – it is used by the NHS across Wales for consultations with specialists. It’s similar to Zoom or Microsoft Teams but it’s almost like an office set up with a reception, and five interview rooms. It does mean people can have a family member or support person with them in the interview. Language interpreters, including British Sign Language interpreters, can also be included as part of the free service we provide.

Has Covid had an impact on people’s concerns / issues?

There has been a huge increase in people receiving Universal Credit which is a very complex benefit – so people do need support with this. Employment enquiries have also gone up. We are encountering people who have never had to claim benefits or ever had financial difficulties before – so people could become patients on a mental health ward because they’ve never had to deal with that level of poverty before.

Issues are much more complex than they were ten years ago. For example, with a debt client, the level might be the same but the client may owe debts to numerous different creditors where previously it would have been one or two. Then there is the added issue where creditors sell the debt on and on – and trying to unpick it all is a lot of work.

Covid has also added a level of frustration through not being able to get through to departments they need to speak to like the Department for Work & Pensions and energy providers. We can help speed up the process.

We also support people on three-way video or telephone calls with the Citizens Advice advisor doing all the necessary work whilst the client sits in the call. There is no cost to the person themselves for this support.

If people don’t receive the support they need, what could happen to them?

People who have been stressed previously can feel much more optimistic and calm about the situation. Long term if we receive continuation funding we would like to start looking at whether people go back into the hospital if they have received support. If issues have been going on too long it is harder to resolve them so we want to do more preventative work, help people understand what we do and just basically say – don’t be scared about getting in touch.

If we are supporting someone with a Personal Independence Payment (PIP) claim we have to talk about their physical and mental health. We also support people through tribunals and hearings. People open up and perhaps admit for the first time some of the issues facing them which can be very traumatic for them to accept.

What are Citizens Advice Powys’s main priorities outside Felindre Ward?

It’s about early intervention, about making sure our services are accessible and available to everybody in different ways and working out the different access options. We want to build a service where we don’t assume everyone wants face to face or telephone. So we offer video also, some web chat, and contact by email. We want to raise awareness and stop people getting to really complex situations – it’s about averting a crisis.

Which other Powys organisations do you work closely with to provide support to people?

This is happening more than ever before. We’re working with Accessibility Powys to facilitate appointments and advice sessions that are accessible to people with physical or sensory impairments – trying out different methods and equipment. There are a lot of people out there who, if not in receipt of this service, would not have had any advice. There are people who have been shielding and isolating who have not had any support for the past year or so.

In the last 3 months we have had a 20% increase in formal referrals (statutory and third sector agencies) and also seen a 50% increase from mental health teams. So we’ve done a lot of raising awareness sessions – every Wednesday we invite someone to come and talk to our team about the work they do which has been really beneficial – this means we can signpost to other services confidently too.

What are the main challenges of the project?

Client engagement is one of the biggest challenges generally if someone is struggling with their mental health. Sometimes people feel less anxious if they can turn their video off. So it can be small things that help. We try and think outside the box constantly to come up with a solution that works best for that person.

Some of the appointments can be lengthy so we split them into two sessions. If it’s a complicated PIP application you could spend up to 3 hours on that – so it’s managing the length of the appointment to suit the person.

Another challenge is ensuring we have all the right consent forms and paperwork completed. The OT team on the ward have been acting as our administrators in respect of these. It’s still a benefit to them though as they can then concentrate on the work they do best and leave the advice for us. It’s all about team work! So that’s a positive really!

Tell us about some of the most rewarding aspects of this project

The feedback from patients has been very rewarding: for example, one man said after receiving support he felt he was able to go home and contact the utility company and sort out the issue himself. (We would, of course, follow up afterwards to ensure it all worked out).

Knowing that people understand where they can seek help and are better able to manage.

One person was helped to reinstate a PIP claim and said of the advisor: “She was very kind, clear and helpful about my concerns. I found this extremely helpful over a subject I have been worrying about over the last years.”

When you are not working for Citizens Advice Powys how do you enjoy spending your time?

I do a lot of coastal path walking. My aim is to walk the whole coastal path of Wales. So far I’ve done a third of it.

I also volunteer as a Cadet Leader for Newtown Police Cadets and assist the cadets doing their Duke of Edinburgh Award. I recently completed my DoE expedition assessor qualification.

If you want to find out more about Powys Citizens Advice you can contact Yasmin by ringing 01686 617641 or email: manager@powyslca.org

Mental Health Awareness Week 2021 - Nature

Jen Hawkins, PAVO Health & Wellbeing Officer - wild swimming

“Nature is our great untapped resource for a mentally healthy future” The Mental Health Foundation

The theme of this year’s Mental Health Awareness Week (10 - 16 May 2021) is Nature.

The Mental Health Foundation, the charity which has hosted the annual Mental Health Awareness Week since 2000, explains why Nature is the chosen theme:

“Nature is so central to our psychological and emotional health, that it’s almost impossible to realise good mental health for all without a greater connection to the natural world. For most of human history, we lived as part of nature. It is only in the last five generations that so many of us have lived and worked in a context that is largely separated from nature. And it is only since a 1960s study in the United States found that patients who were treated in hospitals with a view of nature recovered faster, that science has started to unpack the extraordinary health benefits.” You can read more here.

Most of us have felt much closer to nature over the past 12 months during the repeated Covid lockdowns, including those of us in our Health & Wellbeing team at Powys Association of Voluntary Organisations. The Mental Health Foundation’s research shows that during the pandemic “45% of us reported that being in green spaces had been vital for our mental health.” During this awareness week they will be showing how “even small contacts with nature can reduce feelings of social isolation and be effective in protecting our mental health, and preventing distress.”

We are particularly lucky in Mid Wales - nature is all around us - sometimes in its grandest forms, but also more subtly on every doorstep, even in the middle of our town centres, nature is always in evidence and there to lift our spirits.

Here’s how we have connected with nature over recent weeks and months.

Jen Hawkins - PAVO Health & Wellbeing Officer

I’ve always loved swimming outdoors, we never called it anything other than swimming when I was growing up but now there are a lot of different names for outdoor swimming as it’s become more popular, especially during the last year with indoor pools and gyms closed. Open water, cold water, wild, are all ways of describing the experience but they don’t really come close. There is something so incredibly peaceful about being totally immersed in water and surrounded by natural beauty. 

The coldness of the water makes sure you are nothing but totally present and in the moment, there simply is no other option. Being aware of the movement of a current or tide, watching falling leaves skim the surface, sharing the space with visiting swallows and swifts in the summer, listening to early morning birdsong, or the drone of a dragonfly next to you, all contribute to the experience. I’ve never swum through the winter before but decided to try this year after reading about the research into mental health benefits.The coldest temperature I’ve managed was 3 degrees, the feeling after coming out from that swim was something close to euphoric. It’s definitely something I’m going to keep up and try as many different locations as possible. It’s lovely to feel that sense of being held and all being well with the world.

Clair Swales - PAVO Head of Health & Wellbeing

This tree outside our house always signals the start of spring and longer, brighter days to come. The pink blossoms always give me so much joy and make me smile. Spring time walks remind me to be grateful for nature, which has its own special way of telling us that no matter what life throws at us we can rejuvenate and renew ourselves. Like the Fifth Step to Wellbeing - pay attention to the present moment. For me it’s paying attention to what nature is telling us at any given time.

Jackie Newey - PAVO Mental Health Information Officer

Every week I go on a local walk in the hills around Llanidloes, or the town itself, and look for wildflowers for the weekly #wildflowerhour challenge on Twitter (also Facebook and Instagram). I’ve learnt so much about wildflowers and nature from the wonderful #wildflowerhour online community. It is one of those unique outdoor-online combos that has proved so successful. 

The walk is an escape from the everyday routine of work, family commitments and the mundane chores of life. It gives me an opportunity to focus purely on the lovely native plants growing all around us at all times of the year. It is as much about my wellbeing as it is about recording nature and learning how to identify the quite subtle differences between wavy and hairy bittercress! Some of my favourite finds have actually been throughout the depths of a hard, cold winter around Llanidloes town, where against all the odds wildflowers such as the beautiful ivy-leaved toadflax, wild strawberry and shepherd’s purse thrive in sheltered nooks at the base of shop doorways, walls and in brownfield sites. Finding these beauties at this time of year (the challenge in winter is to find 10 wildflowers in bloom) is such a boost to my mental wellbeing. I can highly recommend trying this treasure hunt with a difference - and celebrating our feisty yet beautiful nature!

Lucy Taylor - PAVO Startwell Development Officer

Being outside is important for us all, from the fresh air and the feel of freedom it gives, to more measurable benefits in terms of health and activity. Being outside is especially important for children as sometimes the opportunity to go out is not in their hands. Just playing outside, doing what they want to do, is calming, inspiring and healthy.

Playing on the beach on a nice sunny day what could be better for anyone? A lot of adults need to regain the ability to play, to relax and do things that do not have a purpose, but just for their own enjoyment.

Let's go fly a kite!

Owen Griffkin - PAVO Mental Health Participation Officer

It was wonderful to see some new additions on the lake at Llandrindod on a special birthday walk with my dog Honey (5 today!) Along with the Muscovy ducks, terrapins and occasional guinea fowl that have taken up residence there. It has become a really lovely place for a walk.

Sue Newham - PAVO Engagement Officer

Since June last year, I have been walking every morning with my husband, doing a circular route which takes in the riverside in Newtown. It’s been great to see the changes through the seasons. Last week, we saw a goosander doing a flapping/ skating dance across the surface, presumably to panic the fish and enable him to catch one. This morning, so many spring flowers were visible. 

Walking in green spaces has improved my feelings of happiness. The colours in nature seem restful somehow. The other good thing is that we often see the same people out walking, so we have the opportunity to chat and we are getting to know some of them by name. That’s nice too. The picture is from a walk in February - a shadow selfie!

Andrew Davies - PAVO Health & Wellbeing Participation Officer

Me and my wife and my 2 girls try and get out in nature as much as we can, we are very lucky to live in such beautiful surroundings and it helps us reconnect as a family. The girls love to run and play when we are out and about and it is so good for us as parents to see them grow and explore.

We'd love to hear about how you connect with nature. Let us know in the comments below how nature has impacted on your mental health and wellbeing.