Psychiatric Interviews for Teaching: Self-Harm

[@whilberwhateley1209]

The Actor playing patient here is doing a great job. It’s different for us all but the weariness comes through. I was helped but broken open and left to survive by one experience. Pillar to post. The next steps were not there.These connections are important and it’s so exhausting to re live it so many times.

[@maria-luciaraffinatore]

Ok, I can give more insight in this case(the psychiatrist). I work in the medical field. She is not actually a psychiatrist that has regular patients, she is a liaison psychiatrist. What she does is to talk to the patients admitted in a psych ward or hospital, to pinpoint the best approach or treatment for the patient. Once this has been established, then the patient will be directed to the psychiatrist (internal or external)that can best help the patient in questions. For example, some doctors might have more insight in manic depressive patients, versus one that might have more experience with patients affected from schizoaffective disorders. Hope I helped:).

[@daviddouglasstanley]

The fact that this patient made a connection with the clinician only to be told that she will have to be passed on to another clinician is just reinforcing the issues of abandonment and trauma history I feel is an issue for her. I don't think the intake process in this case is helpful because it reinforces a schema around abandonment.

[@sarocturtlegaming7306]

thankfully in this case it's an actress but I 100000000000% agree with ya

[@Habs_08]

The difference between a Psychiatrist and a friend, it really matters. But I guess they can use other words than "right" but they're not here to agree or disagree with their feelings they're here to give some insights. You don't say stuff like "you're gonna be alright" or "don't give up". It's not a motivational seminar.

[@LifeLoveDreamMusic]

It seems to me very cruel to not continue seeing her, even just for checking how it is going with the "proper" service. Just look at her face the moment she's told she's going to be sent to someone else. Right after having said that she never really felt listened to. Her face is just scrumbling and she starts closing up and that's a shame because she just started to have hope again...

[@fishandwhiskers]

Don't worry, just an actress :)

[@MrRizon83]

Michi Tedford But this being taught as procedure so it's going on somewhere in real life.

[@mudfan1010]

You should look up what the liaison service usually does!

[@annehoffman5995]

It's consistent with her diagnosis - Borderline Personality Disorder. In this hypothetical meeting, the psychiatrist is modeling a healthy boundary that actually supports Jane's treatment. Allowing her to come back and break the typical norm that this psychiatrist uses with all other patients would go against her treatment and enable behaviors that are making her unwell. People with this diagnosis often feel abandoned in situations that are fairly routine for people without the diagnosis.

[@emmafrost13333]

@@annehoffman5995 I understand from the perspective of the doctor why they do this. But it's not really what the patient needs in this case. I think it's quite bad in this case in particular to do so. She clearly needs at least one person in her life so she can feel stable. They should give her a one weekly visit for long-term, maybe a few years, who will first give her the assurance that there is one person once per week who will always be there to listen to her, and after a few months they should start help her create new real relationships and maintain them. But I've noticed in the UK the system doesn't provide this service and it actually may be more damaging to the patient.

[@MegaSmallbear]

right...right.....right......

[@laurabattle638]

I can relate to her when she says she's always being past from pillow to post and that nobody listens to her

[@trapezeoidthreelobed7683]

Hold on

[@pigthecat2752]

This is so sad it looks like she wasn’t ready to talk about this

[@Vuadanee]

i'm on a spree of watching these vids lol

[@Ayesha______]

Same. It’s almost like I want to trigger myself 😃

[@curtisfranks2451]

As someone who has done these very things as showcased by the actor patient and can say I no longer do nobody and I mean nobody or nothing is worth self harming yourself . It's a realization I came to slowly. I was holding back my thoughts and feelings over certain things because I thought they would not be valued. Now I can say for certain I will express my openly and anyway needed to so that I will be heard. I dont hold back my thoughts. You have to come point where you simply could care less what people think or say about you. You have to get to a place where self care is top priority. Not to be self centered or selfish. When one takes care of themselves on all levels of their being most all else comes in place. People simply aren't worth hurting yourself over and I learned the hard way. Be you and live your life.

[@eileendoherty2836]

Curtis Franks so true thank you 🙏🙏🙏

[@Ashrubel]

The therapist is not "abandoning" her... Jane is too rapidly forming attachments, and then internalizing the detachment upon being pushed away. The therapist here has a specific job. Nobody can do everything...

[@jojoUK120]

+Shane Lopez It could be a rapid attachment, or it could be that she's asking for continuity of care. After all, she's already told her story to several in A+E, now this Psych, and is now being expected to go through it all with at least one other. Each re-telling causes harm. So far there has been no benefit. Also it is likely given the service user's age that she's had lots of experience of assessments, and if this psych has been unusually professional and thorough in her questioning it would be logical that she wants to stick with the best.

[@Ashrubel]

She says at about 10:11, that this is the only person who has actually sat and listened... Listen to her telling of her story about her relationship... it is only a few weeks into the relationship, and she has quite an attachment with the fellow. I do not know many people who can even KNOW somebody well enough in just a few weeks... And she is asking him to move in... that likely pushed him away quite a bit. This is a classic performance of one of many disorders that include rapid attachment... The one that sticks out for me is Borderline Personality Disorder. She hits all the markers...

[@jojoUK120]

+Shane Lopez I think you're right that the brief sexual relationship shows signs of rapid attachment, but I think you're also right to say that this can be a symptom of several disorders, not just the one flagged in the blurb. I'm not saying it's the wrong diagnosis, just that a diagnosis of any specific disorder is premature at this stage. Eg. I remember gales of laughter when one particularly famous bipolar sufferer, admitted for manic psychosis, was diagnosed by duty as schizophrenic. For what it's worth i agree that it's right of the psychiatrist to stick to the rules and not see her again, but because of the nature of the post rather than any assumption about whether or not it's a rational request. ps: it's good to have the discussion!

[@SassyMa_]

Exactly, and well said!

[@SassyMa_]

@@jojoUK120 Your wrong talking therapy is the best medicine...

[@cesarsalinas4092]

To be honest I struggle opening up to my counselor. Because of a school. Mentor and it has given me trust problems

[@noradosmith]

A perfect enactment of a borderline personality

[@carolinefrost1103]

I have bpd and can really relate

[@AcidOnTheStreet]

@@carolinefrost1103 Same truly BPD this

[@danhibiki3359]

Self harm is not only a young people issue. I am middle aged and still struggle with literally not beating the hell out of myself.

[@Kim-md8bg]

she seems more focused on her cutting then the reason behind it

[@misspinkpunkykat]

My brother had a girlfriend who would threaten to OD everytime he tried to end the relationship and she actually would. My parents were always having to drive her to the ER.

[@bjb29407]

i can't believe how much the dr talks. she shold start with an open ended question.

[@xxxxxNeMxxxxx]

i don't know how much more of these video will come, but damn i'm gonna watch all of them

[@Elbereth141]

They're both wearing microphones. I think you can be happy that this was acted (and very well acted too).

[@christyfortune9112]

It also makes me sad that she won't continue to see her considering she has felt like no one else has listened, which I believe is a legit concern and I have seen in the field myself- pts have told me that. But then I read that it was the psychiatry ED- meant for crisis management. While I feel her pain, it's understandable that her job role- possibly full time- doesn't allow time or in the job description to take on regular patients. I am more curious about the case study though- I'm thinking hx of PTSD & codependent personality disorder. I was also considering BPD or possibly malingering/or factitious d/o. The acting was excellent, I wish they made this specific duo into a case study series for practicing psych evals.

[@ChrisSmith-pe8rm]

This is very accurate, exactly what they do; it's never consistent, it is just passing you from person to person who doesn't really show any care whatsoever. And they all have this weird thing with hand gestures, they gesture too much, and ask the same questions over and over. This sort of thing could be sorted at the GP, most of the assessment appointments appear useless.

[@UNAI.EMERY.]

10 years later it's the exact same

[@beeleerosie]

As a mental health patient formally diagnosed with BPD (now in remission for many years) though I still.have very severe episodes of depression and I am now diagnosed with Bipolar type 2. I.have to say the psychiatrist is right. The woman in the video is forming an attachment to people far too soon. The role of the psychiatrist here is to refer her in to the correct services to help her with her diagnose. A good medical professional.must have a good amount of empathy (which they often do not) but also.be able to set clear boundaries . They are not your friends but they do have a duty of care.

[@cybernautadventurer]

If mental health treatment is a maze, then treating BPD is like the great labyrinth of the minotaur.

[@BlastinRope]

BPD is the labrynth, narcissistic personality disorder is the minotaur

[@nancywharton9359]

I get so tired of going from therapy to therapy.

[@zeecaptain42]

OFC it´s acting - But It´s some really amazing acting! Fantastic!

[@susantompkins4254]

I love watching these videos, they are a good help to me. Thank you

[@wackywhitty]

This is so true with how cold and uncaring the mental health care system is

[@isuripalagasinghe3904]

Our teacher just showed this video and asked us to write our diagnosis .we said it's BPD she just laughed at us and said completely wrong.we felt like total idiots

[@jordanmetzler3436]

What was the diagnosis?

[@skyegraham6953]

I'm going with CPTSD

[@alexscott3273]

It's EUPD or borderline PD. Says in the description.

[@bjb29407]

she says "right" too often

[@forgetfulstranger]

suicidal ideation doesn't equal suicidal. You have to do a risk assessment on the patient and decide what to do from there on.

[@shantilane5873]

This is brilliant and reward blessing to me as been an RN completing my COVID_19 refresher course funded by federal government through Australian collage of nursing.

[@BlastinRope]

Collage

[@ZoeF.O]

@@BlastinRope Such an obvious typo, doesn't need to be addressed.

[@DC-dy4ji]

realistic scenario and well handled thanks

[@radhikapatel8065]

Mental health conditions is a serious mental illness it can make them self harm which is due to abuse , different types of bullying if a bully who don’t belong into a neirboughood.

[@nancywharton9359]

I am so so sorry

[@faithoffaith]

Why are they interviewing her for a Personality Disorder? The questions seem to be directing to that but why? She could be presenting with Depression, just because you come in with a main issue of Self-harming behaviour, voices, break up of a relationship doesn't mean it is a PD. There are people who a depressed and self-harm, equally you could be SH without having Mental Health problem. I think the title is really misleading as well it's like saying Self-Harm = BPD If it is what they're interviewing her about than why not title it 'Psychiatric Interviews for Teaching: Borderline Personality Disorder'

[@xiaoluxu8680]

because she started cutting herself since teenage

[@JBnx94]

They are treating her for self harm because that is why she was in hospital for. The borderline personality disorder is a comorbidity. The self harm means that her condition is worsening and requires a change in her treatment or the start of treatment if she wasn’t receiving any before. You are right in saying that not all people with BPD self harm but that is what she is currently presenting with.

[@anon6056]

She needs helppppp. I'mma say she has childhood trauma and needs support to overcome the failure her parents were. It can get better even if you were set up for disaster

[@MsShellynj]

I scratch myself these other days

[@cherrycoke3665]

How are you doing now?

[@maliafunaki8600]

Hi, does anyone know what Jane thought of process is like in this video?

[@hollylarison1893]

She looks completely drained

[@susantompkins4254]

I think they should keep seeing them until the clients are able to cope better with there life?s ...I would...

[@logerbad19]

With someone who has ideation like that, he needs to have intensive services not just being passed around

[@JBnx94]

logerbad19 suicidal ideation does not mean that they are currently suicidal

[@Pure_Imagination_728]

I'm going into psych and pre med to become a psychiatrist and I'll tell you in my practice all you'll hear is straight talk and straightforward explanations and answers. I don't regurgitate everything I say like this psychiatrist does. Its about the patient, sometimes following protocol doesn't always work.

[@2009hdj]

That's very noble, but sadly very difficult to implement in practice. There's a reason why us health care professionals have to use limiting and impartial answers; it's because you encounter a wide variety of very troubled people, many who need boundaries and a professional psychiatric relationship in order to get better. Some will not be able to hear "straight talk". As a psychiatrist, you will encounter people who are extremely unwell, and really, the vast majority of illnesses are neurological, not psychological, requiring pharmacological, interventional and holistic care. If you're looking for a career that will allow you to be more motivational and no-nonsense, psychology or counselling might be a better choice, as you will be dealing with clients with more "straight-forward" personal and psychological issues (stress, relationship problems, etc). Good luck for your future though, I can tell no matter what path you choose, you will be a caring health professional :).

[@MsHburnett]

I hope the patient is an actor

[@umwha]

Why does the psychiatrist pass her on? They shoudo stay together.

[@manjularohanthi2442]

what about using confidentiality statement before starting?

[@heliotrope6217]

Why these are actors?

[@MsBee73]

Boderline personality

[@morp8047]

MsBee73 and possibly dependent personality disorder.

[@Pure_Imagination_728]

MsBee73 I was also thinking a Comorbidity of Borderline Personality Disorder and Dependent Personality Disorder, the self harm more falls in line with the borderline diagnosis.

[@ilil835]

Morp , why dependent p.d.? because of the ending?

[@PlanbSk8terX14]

bpd

[@roseault6335]

Absolutely NOT borderline personality disorder !

[@kianayu7676]

Check out my video on bullying and self-harm!

[@sueydasueyda6970]

Is it ok many times underlined cuting her wrists?

[@RainRemnant]

I do love that clinical question list when someone's emotions are running high, have talked to so many therapists and psychiatrists and that part is so offputting.

[@trapezeoidthreelobed7683]

They have a list, and they are definitely going through it

[@kimroy6640]

It may be the way the provider does things but this should have been explained to the patient before she poured her heart out. To lead someone into a trap like that and then smash their hopes and esteem to pieces is very cruel.

[@UNAI.EMERY.]

Bonkers to rhink a decade on and absolutely nothing in this video has changed

[@SuperWarking]

Um, so this is done post intial eval right? If not thats a pandoras box waiting to blow up in someones face...

[@emmab8318]

I have this.. They think they help.. It NEVER helps...

[@jannewillockx1063]

+Emma Brock (DarkNemesis) what would help?

[@aizenosaimafidon1119]

+Emma Brock (MysticalPotato) I agree what can help? They can't exactly enter your mind to find out, help them out, what calms you down after an episode. How do you stop yourself from an episode short-term? Following unto this how could you turn this into something that could help you long term? You don't actually have to answer. Thy're quite personal questions, you could speak to someone you trust about it. Maybe that would help. Sorry if this is annoying just delete it lol. I'm a budding psychiatrist and don't believe in just prescribing medicine. In fact I don't believe in prescribing medicine at all. Just talking to the patient, getting to know them and stuff.

[@fullmetalsnowflake2508]

+Mystical Potato Queen be careful with self-fulfilling prophecies :) but it's true that they can only help you help yourself with this kind of stuff. Have you tried cold-showering? The shock can help get the noise down, I don't feel like it puts things behind me quite as well but it's brought my bio-oil expenditure down significantly

[@mamamiabenjamia]

these don't seem real to me. the patients are either actors, putting on a show or very uncomfortable with all of this.

[@FreeThePorgs]

How "real" is this?........

[@ArionaMew]

I hope this is staged. I don't think it's legal to record real appointments

[@pearl8661]

ArionaMew This is an educational video with actors.

[@darlyne3564]

What’s the distinction to be understood by hearing the voices inside or outside?

[@leahsadler1637]

to ascertain auditory hallucinations or not. When someone can hear something that isn't there from the outside, it's an indicator of auditory hallucinations. When someone hears something from the inside, it may be more of an indicator of derogatory thinking. Both have different styles of treatment and different diagnosis pathways. The actor states these voices are people she knows inside her head, she knows they're not there (has insight) and they make negative comments towards her. Hearing voices inside the head can be common for people with BPD, and her other signs and symptom profile does not necessarily match a psychotic disorder. Hope that helps!

[@williamfoley5687]

I used to like peanut butter and jelly

[@jojoUK120]

The blurb is Way too quick to diagnose!!!! One 12min assessment is not enough to rule out other diagnoses (eg Bipolar, other types of personality disorder etc.), nor to rule out other reasons for wanting to stick with the same Psychiatrist (eg, they're better than the last 20 I've seen, or not wanting to see yet another white upper class man.)

[@JBnx94]

little jo this is a preliminary mental state exam. It’s not meant to diagnose. It’s meant to determine what her current state of mind is, which doctor she should see and whether or not she should be admitted to hospital or treated as an outpatient. Diagnosis comes later. It takes more than one session to diagnose. It could take weeks before she gets a diagnosis. But even still any mental health professional can give a preliminary diagnosis just from this 12 minutes. The questions she’s asking fall into a preset template that the doctor is mentally filling out and each question she is asking is ruling things out. Have a look at the MSE template and you will realise why the doctor is doing and saying what she is saying

[@melissais]

is this stuff real?? :o

[@melissais]

Thanks for the comment. I found it it was actors after I read some comments that day I watched this. Best of ;luck with your condition!! Take care! :)

[@rugby543211]

Karis Braithwaite How do you know they are actors?

[@rugby543211]

Karis Braithwaite I don't know, it definitely would be unethical to film them and use the video with out permission, but perhaps when the patients became sane they gave their consent. It could be a more accurate representation for students if they were watching this than actors. However i suppose it is quite likely they used actors.

[@zillogical]

Ok so she said voices which indicate a type of schizophrenia - so why isn't that mentioned here? loL

[@vanillah8890]

fake

[@N38DD]

Borderline Personality Disorder.

[@ZoeF.O]

Based on 12 minutes of talking with liaison psychiatrist?!

[@ChrisSmith-pe8rm]

This is very accurate, exactly what they do; it's never consistent, it is just passing you from person to person who doesn't really show any care whatsoever. And they all have this weird thing with hand gestures, they gesture too much, and ask the same questions over and over. This sort of thing could be sorted at the GP, most of the assessment appointments appear useless.

[@ggockma20]

In general I think it’s to get information and quickly screen for suicide plans/ hx of mania/ trauma/ major depression. The major treatment would be supplying pt resources, therapy , and if warranted medication. Some individuals specialize in psych whereas the gp may have just a couple months worth of education. It would be a tragedy for someone with little experience take on a person on the verge of suicide/ mania and not respond properly... that’s why they are often passed along.. not because the gp does not care.