At the women's prison I work at they have a new job, essentially life sentenced inmates who have had specialized training are now "observing" other inmates who are in segregation due to suicide (talk of it, paraphernalia or an attempt.) This is a controversial plan; inmates watching other inmates and when necessary calling for an Officer. The inmates who have just started this say more than anything it is boring; lots of downtime, odd shift hours- but they get paid for it and these are "mentors," in our program. I spent part of this week talking to one of these inmates about her shift last night which began at 2am and she told me about the training and what she had learned about suicidal risk factors. She did not mention the #1 risk factor for suicide, which is hard to assess as an observer- hopelessness.
From this amazing documentary interviewing people who jumped
Hopelessness is the despair you feel when you have abandoned hope of comfort
or success. I often refer to hopelessness of being in a black box and
being able to see a way out. Hopelessness is the #1 indicator of
suicide; more than age, gender or even past attempts. When someone does
not see a way out, or things improving they are more likely to hurt themselves.
The Beck Hopelessness Scale is a 20-item self-report inventory developed by Dr. Aaron Beck. It is designed to measure three major aspects of hopelessness: feelings about the future, loss of motivation, and expectations. The test is designed for adults aged 17 – 80.Individuals completing the scale are asked to answer the questionnaire based on their attitudes during the preceding week. It may be administered in written or oral form, and each item is scored with a true/false. Total scores range from 0-20 with higher scores indicating a greater degree of hopelessness.
Beck’s cognitive model of depression focuses on a “cognitive triad” which includes negative thoughts about self, the world/environment, and the future. Hopelessness is the experience of despair or extreme pessimism about the future. As such, hopelessness is part of the “cognitive triad” of depression, but it also plays an important role in predicting suicide. [source]
Although I typically advise against taking any online quizzes to determine any mental health diagnosis, there is a copy of the "test" here if you are interested to see where you might be at this moment on the scale. I would advise that if you feel you are at risk for hurting yourself you immediately call your local crisis line or go to the hospital to keep yourself safe.
I always tell client's who are suicidal, that by taking their own life they won't ever know if it gets better; their mood improves naturally, situation at home/relationship change or if new medications will hit the market. They will never know what their life is going to be like in 2 or 20 years, if they end it right now.
Earlier this week I was talking to someone on Twitter (whom has a great website for Borderline Personality Disorder) whom was feeling triggered, used her DBT skills and then went to Intensive Outpatient Program (IOP.) Many people on Twitter then had questions as well as discussed some opinions to those with BPD and pro/cons of hospitalizations. After reading a ton of research articles here are some options and pro/cons of each. I understand those without insurance may not have many options and some depend on your area:
Inpatient: Simply put admitting yourself into the hospital for a period of time. First off as a counselor who has done this with clients I have run into a few problems; 1) the psychiatric unit is full 2) the client needs to be in "immediate risk of hurting themselves and others" and one time since it was self injury and not suicide they were essentially rejected at the front door. The other issues particular to those with Borderline PD is that hospitalizations are sometimes too "cushy." In Kiera Van Gelder's book, The Buddha and the Borderline," she explains her hospitalizations in this way, "when I climb into bed, the white hospital sheets feel as cool ans fresh as peppermint." Kiera find her hospitalizations difficult as she feels too comfortable/attached and the discharges feel like yet another rejection. Hospitalizations also rarely provide any skills or groups specific to BPD and is mostly a quick stabilization for some people. Inpatient likely won't keep those who aren't at immediate risk for longer than a few days.
*The exception to the issue with Inpatient and BPD is that there are a few specific inpatient programs for those with Borderline Personality Disorder. There is a thorough list here and as always if you have money you will get the best care*
Intensive Outpatient/Partitial Psychiatric Hospitalization: These programs provide more services than most inpatient programs. For instance DBT and mindfulness groups for 3 hours a day, 3 days a week is a typical format for BPD-specific IOP programs. There are more programs that are available for BPD here and because it's short (read: cheaper) insurance is more likely to cover it. In Buddha and the Borderline, Kiera talks about MAP, a mood and anxiety program utilizing Cognitive Behavioral Therapy (MAP), she attends everyday from 7:30am-4pm. The group at her clinic includes "cognitive behavioral skills, assertive communication skills, depression and anxiety, behavioral scheduling, relapse prevention, impulse control. There is also stress management, self-assessment, mood regulation, positive events scheduling, family issues, life transition, community meetings, treatment planning and contract writing." This is a less comfortable options, plus as a counselor I like the idea of how "real world" sleeping in your own bed, and continuing to handle your life, albeit part-time. It is harder to get attached to this kind of program and it focuses on long-term goals rather than temporary medication management and nightly fever checks from nurses. IOP can vary from a week to a few months.
Respite: This option is the lowest intensity of all and not available everywhere. Respite is known as the place where caregivers for elderly or children with physical or mental health issues essentially go to "get a break." When I worked in Portland, Oregon there was a respite in some of the larger counties for mental health issues. Essentially mental health respites are typically in large houses where 6-10 clients live temporarily, it's a toss up if you share a room or not (think low-end bed and breakfast) but it is always same-sex rooms. There is typically a shared space like a living room/sitting area where people chat, read and watch TV. There is typically one case manager and sometimes (often depending on who is working) there might be a group a day, there is an open space and people can leave during the day, but need to return by curfew. The residents are typically de-escalating from a mental health issue and are looking to relax for a bit. I had a client tell me she liked respite because they made her peppermint tea when she couldn't sleep. From the respites I know they do not specialize in BPD or do any skills group- but it might be a good place if you need some "head space" to think, figure things out and a safe place to be. Respite stays vary but typically 3-7 days and include meals.
As always the first goal of any intensive treatment is safety, and if you are thinking of hurting yourself or someone else go immediately to the hospital to get well. The above options are for non-life threatening situations only.
Although I typically advise against taking any online quizzes to determine any mental health diagnosis, there is a copy of the "test" here if you are interested to see where you might be at this moment on the scale. I would advise that if you feel you are at risk for hurting yourself you immediately call your local crisis line or go to the hospital to keep yourself safe.
