Diagnosis: Emotionally Unstable Personality Disorder
Previous settings: CAMHS Inpatient Services, Residential Placements
Sarah* came to Care in Mind aged 17, after a long period in hospital detained under the Mental Health Act. Sarah had a diagnosis of emotionally unstable personality disorder, associated with intermittent significant risks to self, through overdosing and cutting. Sarah also displayed difficulties in managing her emotions, asserting her needs in a healthy way and vulnerability in relationships.
Sarah had a history of sexual abuse, abandonment and complex family dynamics. She managed her difficulties by either externalising all control and responsibility to others through taking significant risks and requiring others to intervene; or through self-reliance, rejecting and criticising care from others. Sarah struggled to assert her needs or to rely on others for consistent care. Ongoing family dynamics and difficulties served to reinforce her patterns of coping and Sarah was discharged on a CTO in order to support her to maintain her placement and prevent her returning to family.
Early in placement Sarah refused to engage in psychological therapy or to take her prescribed medication and managed other professional relationships at a superficial level with little insight into her difficulties. However, with consistent support through our specialist model of care, Sarah began to engage weekly with her clinical nurse specialist, her residential team, psychologist and psychiatrist. With time, Sarah began to develop insight into her difficulties and increased tolerance of her emotions. She also developed a greater ability to communicate her needs and appropriately seek support from her team. We also saw a marked increase in resilience during her placement.
While placed with us, Sarah unfortunately experienced two highly significant bereavements in her family. However, through this difficult time, she was able to seek support appropriately and worked with her team to process her grief in a healthier way than she would have done previously. Sarah developed increased self-compassion, and a measured approach to her needs and the needs of others, asserting herself in relationships in healthy ways.
At the end of her placement with Care in Mind, Sarah moved into her own tenancy in the community, accepting input from local mental health teams to continue to support her recovery.
Sarah’s Recovery Outcomes
Mental Health Recovery Star
Mental Health Recovery Star scores are completed at regular intervals during all our young people’s placements. The Star Chart is co-produced by the young person and staff member, covering 10 key life domains, supporting young people to chart their recovery progress.
Sarah’s overall recovery scores can be seen on the right mapped against the number of incidents throughout her placement. As described above, Sarah initially struggled to engage and the incident data shows an increase in incidents initially following her admission to Care in Mind. Ultimately, once Sarah had developed increased insight and tolerance of her emotions, she had no incidents at all during the last 8 months of her placement. This coincided with a significant increase in Sarah’s overall recovery scores; Sarah demonstrated improvement in each of the ten domains, but particularly in some of the key areas she previously struggled with, including Managing Mental Health and Trust & Hope.