My therapist tells me that, in some situations, beginning questions with ‘why’ can sound confrontational. I agree and try not to do it. When at meetings, and especially those at strategic level, asking a question beginning with ‘how’, ‘where’ or ‘who’ is softer and more likely to get a good response. But at these meetings, I am fighting the urge to ask, ‘why are there so many women with Borderline Personality Disorder (BPD) in prison?’, ‘why aren’t there better services for people with BPD in the community?’, ‘why don’t you do more to fight the stigma?’, and ‘why can’t you see the bigger picture?’. My therapist is right, these questions do sound confrontational and, perhaps, aggressive. However, the ‘why’ does need addressing and, as a person with BPD who has spent time in prison, I would like to use my lived experience to tackle those questions here.
Firstly, some figures. There are no definitive statistics on the prevalence of BPD in the UK, although it is thought to affect between 1 and 2% of the population. The ratio of women to men having the condition is said to be 3:1, and it is, by far, the most common personality disorder among women, both in prison and the community. It is thought that around 20% of women in UK prisons have BPD which, at the time of writing, would be an estimated 650 women. Keeping someone in prison costs around £118 per day. By these figures, then, the daily cost to the taxpayer, to keep women with BPD in prison, is £76,700.
So, why do so many end up in prison? I offended because I was desperate, frustrated and angry at the way I had been treated (or not) by the Community Mental Health Services (CMHS). I sound petulant, don’t I? I am, and I am also extremely childish. I hate myself for it, but the feelings are so very strong and powerful… Every time I think back to how I was treated, by the very people who are employed in a position to help people like me, I go through every emotion: sadness, frustration, anger, hate, suicide…
‘People with BPD struggle to manage their emotions’; to some who have the condition, this will sound like a massive understatement. The desperation felt can be unbearable, to the extent that around 70% attempt to take their own life at least once, and 10% succeed. The urge to do this can be immediate and sometimes, the feeling will not go away until we have done something extreme: screaming, self-harming, offending…
Not all people will go down this route; some learn to manage their emotions when relatively calm so that they do not experience so many crises. For those who can afford a private therapist, this can work quite well. It certainly saved me. For those who have to rely on their local CMHS, however, there is still a huge amount of stigma and misunderstanding surrounding the condition within the mental health profession. We phone the crisis team in tears, begging for help, to be told that all they can do is to phone the police, or advise us to phone 111. If we are not likely to end our own lives tonight, then we don’t need their help. If we phone again, we are attention-seeking and ignored.
There is help for some, there must be because, when it comes to mental health treatment, we live in a society subject to a postcode lottery. I live in a county that says it has established an ‘Emotion Regulation Pathway’. Some people might benefit. I hope so because the thought of others feeling as I did, being treated like I was nothing, ‘undeserving’ of their time, makes me feel physically sick. I have spoken to many people with BPD, as well as their friends and family members, and many of them continue to be let down on a daily basis.
Getting back to my original questions, is it possible that they are all inter-related? The stigma associated with BPD, the belief that we are resistant to treatment, aggressive, untreatable and a lost cause, is proffered by many health professionals, with the result that the limited funding they have is largely spent on medically treatable conditions such as depression, anxiety, schizophrenia and Bi-polar. This leads to inadequate services for those with BPD, with strict criteria for treatment and a lack of compassion. Could this be why there are so many women (and, to a lesser extent, men) with BPD in prison?
I believe the answer lies in the education and training of staff at all levels, including Psychiatrists, Psychologists, and management. Decision-makers need to understand this condition at least as much, if not more, than clinicians and support workers. A better understanding of the condition may lead to a reduction in associated stigma and to better services, thereby reducing the amount of offending and, in turn, lowering the cost to the taxpayer. But this can only happen if those responsible are willing to look at the bigger picture.