It was 6.30pm. I’d spent the entire day watching the medical room – watching nurses enter and leave, unlock and lock the door. I’d been in this ward already for 3 months, I knew everything about that room. I knew where the sharps were, I knew which cupboards contained each group of meds. I had studied it obsessively. I knew that in that room was the means for me to at least harm myself, at best kill myself. At this point, I cared about nothing else, no one else. I was supposed to die, the impulse was so strong, so definite, and all I could see was that these people were stopping me from making the right decisions about my life and body.
I watched a nurse prop the door open and took my chance, I ran in and grabbed a long needle, seconds later the alarm was blaring to declare an incident, within 30 seconds all the ward staff were crowded in the room trying to get the needle off of me and restrain me, within minutes the on-call response team had arrived, my arms were pinned behind my back, someone was pushing me from behind, another was pulling me forward by the neck. I was dragged to my room, pinned to the bed for a body search, and then locked in the room.
This wasn’t the first time this happened, it wasn’t even the worst incident, far from it. I had tried to get into that medicine room multiple times already, several times I had managed to get hold of needles, and once I was able to access medication, but every time I had been heavily restrained, screamed at, pinned down by a large team of responders, dragged away, sometimes forcibly medicated.
This time, however, was a turning point. As the nurses withdrew from my room one member of staff stated, you just hurt four members of staff, people who are only trying to help you, are you happy now?
I felt the familiar wash of shame rain down on me. I had failed once again. I was still alive, and the person left in this body was selfish, obsessive, and had no consideration or care for those around her. I had once been someone who had worked hard to try and always do right by others, to be kind, and to treat people with empathy. That was all gone now. This shell of a person was not a good person. Alongside the shame, I felt so much frustration. If the staff in this hospital could see what a bad person I was, why wouldn’t they let me do the right thing and die? That way I would no longer cause pain or frustration, for anyone. Life would be easier for everyone left behind.
I’d been in the hospital for three months, and I had done a six-week admission not long beforehand, all under section. Both admissions followed lethal overdoses, the second of which had led to me being intubated, ventilated and in a coma in intensive care. The hospital had become all I knew. My world was so small. I hadn’t seen my friends or family for months due to covid restrictions on the ward. Any leave I was granted was quickly withdrawn following abscission and suicide attempts.
With each day that passed, I felt further removed from the life I had once had, and returning to that life felt increasingly out of reach. I cared less and less about the family and friends I had left behind. The closed psych ward had become my entire world, suicidal thoughts were as intense as they’d ever been, and self-harm was a daily occurrence and increasingly dangerous. Self-destructive habits and dependency and attachments to staff and fellow patients became more and more solidified
At this point, I had fully given in to mental illness, I let my brain do everything it wanted to with no resistance. In the hospital, my motivation to try and fight my urges, redress my reliance on ward staff and resist this overriding belief I am supposed to be dead had gone. The hospital was a perpetual trigger, a reminder of how desperate my mind was and how extreme my methods to self-soothe had become.
After this incident, I was sent to the psychiatric intensive care unit. Here, my care team started to understand that the hospital was not the right environment for me anymore. Yes, they had to contend with high risk in the community, but they realised the risk I posed to myself and others in the hospital was potentially higher. By detaining me in the hospital they had removed any remaining incentive for me to even try to stay alive and recover.
Plans started to be made for my discharge and within three weeks I left the hospital in London and moved home to Gloucestershire to live with my mum. Those last three weeks were perhaps the most important of my time in the unit. Finally, I started to feel that I, the nursing team, and my doctors, were working together to end my time in the hospital, and to make sure that the ending was a positive one. I still couldn’t see a future at all but with their help, I began to learn how to get through one hour, then one day, managing my mood and keeping myself safe. There was no expectation for me to do more than that – this was the starting point.
Still, now, I struggle to think about the future, my focus remains on applying those strategies to get through each moment, and then each day. I receive intensive community support to help me do that. With this help, the days turned into weeks, and then into months. There were a few hairy moments but on the whole, I managed an entire four-month period without any incidents – by this metric my risk in the community was significantly lower than it was when I was in the hospital.
Hospital treatment for people with EUPD is a complex and sensitive topic. There is recognition that hospital admissions can increase the risk for some individuals with EUPD and the NICE guidelines state:
Only consider admission to an acute psychiatric inpatient unit for the management of crises involving significant risk to self or others that cannot be managed within other services, or detention under the Mental Health Act (for any reason). When considering inpatient care, actively involve the person in the decision and: ensure the decision is based on an explicit, joint understanding of the potential benefits and likely harm that may result from admission.
On sectioning individuals with the EUPD diagnosis, the guidance states:
Ensure that when, in extreme circumstances, compulsory treatment is used, management on a voluntary basis is resumed at the earliest opportunity.
The guidelines encourage referrals for crisis and home treatment support and community resolution where possible. I agree with this recommendation. Recently I made another attempt that led to intubation and intensive care, but this time I was taken off section following the mental health act assessment and allowed to return home with crisis support. The crisis team didn’t invalidate the seriousness of the situation – they provided daily support, kindness, socialisation, and therapeutic conversations, and my recovery this time was much more effective and significantly less traumatic.
However, it is important to empathise that refusing hospital admissions alongside poor community support often leads individuals with EUPD to feel like they are being denied the support and care they need when they are experiencing an acute mental health crisis. This issue is confounded by the very real stigma present linked to personality disorder diagnosis in some mental health services.
Imagine experiencing serious mental illness and being told you would not be hospitalised, or provided with intensive community support because you were “acting out” or “attention seeking” through self-harm because of your typical EUPD feelings of “rejection” or “abandonment”. I have seen countless anecdotal accounts using these exact words, and it is understandable that in this context, refusal of inpatient treatment alongside inadequate community care would also increase the risk of harm.
To me, the answer to this appears quite simple – understand that, for some individuals, hospitalisation is not the right option; even if the perceived risk in the community is high, it may be higher still in an inpatient setting. Equally, where the hospital is not appropriate individuals should always be provided with adequate, compassionate, validating care in the community to help recover from what should be understood as a legitimate and serious mental disorder.
Ellen Watson has lots of lived experience with BPD and hospital admissions. She is a parliamentary clerk currently on a career break while she focuses on recovery.