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Returning to work following a BPD crisis
Posted Monday 25 July 2011
This is a guest blog by Sharon Howard.
I have just completed my second week back at work after my latest BPD crisis. Making the step to return to work was a difficult one. I was terrified of not being able to cope; what people would think of me (many of the people I work with know why I was off, my BPD is 'out-of'-the-bag' so to speak) and just the whole process of working in general. But, I had to do it; I knew this since I first handed in my sick note in April.
I also knew that I had to do it sooner rather than waiting (as I had intended) until I started to get some help for my condition. After all I still have no idea if or when any therapy/help for my BPD will actually materialise... The longer I left it the harder it would be to go back, and not only that but the less likely I would be to actually return.
I had only been in the job 3 weeks when I had my crisis and ended up in A&E after an overdose. Now, after 2 months of trying to sort myself out, I'm just about coping but still not receiving any help despite having had a private psychiatric assessment because the NHS waiting list is so long.
At my last visit to occupational health the doctor suggested I shouldn't return to work, but I knew this would be a huge mistake. Firstly, leaving now would make it harder to get another job later; secondly, I knew I needed an anchor — something positive to occupy me and keep me from slipping back.
There was of course the problem that while I have good days where working will be fine, I'm still also having bad days where I will struggle. Occupational health tried to use this to further encourage me to leave, under the suggestion that should I struggle and end up having more time off sick I may end up falling foul of disciplinary procedures and end up being forced to leave. Well, I'd rather that and know I tried than give up without a fight!
Another thing was the knowledge that my not wanting to go back to work was actually another symptom of my BPD — I was looking for another career change, to do anything rather than face my fears. So, challenging myself not to let the BPD win and prove I can do this was another motivator to just get on with it and return to work, ready or not...
So, I'm back at work, currently just 3.5 hours a day 3 days a week, with a review each week to see if I am ready to add more to this. I felt very awkward returning but no-one was condescending or treated me with kid gloves. No-one said anything about my time off, they just seemed genuinely pleased for me that I had returned. Of course, as I was new to the job anyway, it's like starting again — I hadn't really learned my role before I went off.
The first few days were hard, I looked for reasons not to go in, then getting angry with myself for not wanting to go. The compulsion for self-harm became immense, but luckily rather than acting on it I told someone about it: a big step for me!
The last couple of days I haven’t struggled with anxiety and fear as much, hopefully this is a sign that I am starting to adjust back into it…I have a long way to go and I'm still scared about whether I can really handle this, but I will keep on trying - what else can I do? I'm not really a quitter.
Sharon Howard
Sharon was diagnosed with BPD last year and blogs about her experiences. You can also follow her on Twitter @SharonHoward09.
Find out about your rights as an employee, how to survive working life and the support you can get from your employer.
48 Comments
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Well done you, you know to keep yourself occupied and you are trying to get yourself help. I too struggle with bpd and have never been able to hold a job down due to mood swings, i'm 20 (been diagnosed for about 18 months) and have had 5 jobs... the lonngest kept job was 11 months... infact due to mood swings i am unable to hold anything regularly going...
it also sounds like your employer is supportive to you too, which is always a big step for anyone with mental health struggles.you go girl =) stay positive, i'm going to read your blog now =)
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Hi Danielle,
Thank you, it is a struggle and I was really worried that I was going back too soon, but it seems to be going ok. Just taking it one day at a time :) Hope you manage to get a job you can handle when you are ready! Hope you enjoy the blog :)
Sharon -
I had time off sick with my anxiety (fortunately only a few days) in only the second week of a job I was so excited about having got. At that point only my manager and one new colleague knew what was wrong. That colleague was on leave when I came back, but the post-it note on my desk from her saying "welcome back" meant the world. I had one more short period off sick a month later, and nothing since. I've now been in the job for 11 months and sticking with it was the best thing I could have done - I love it.
Good luck with yours, and I really hope you get the support you are waiting for. Do you have a supportive GP? Mine's amazing, and I found even just the reassurance of speaking to him, while waiting for other treatment and for medication to start working, was really helpful.
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I really enjoyed reading your interesting blog. I think some of the things you describe will be familiar to people going back to work after any mental health crisis, not just BPD.
It's a really good point that sometimes, things are not as bad as we imagine they will be, and getting back to work can be a benefit.
From my experience, though, I feel it's important to remember that having time off is not a bad thing. I tried to keep working when I was acutely unwell, and I just got worse. Time off may be needed, like with any other illness. -
Hello
I think its really brave to go back to work, and for those who can manage it, it is a really helpful thing to achieve. I have bpd and I work part time on a farm, just 3 days a week. This is all I can safely manage long term for now, but it helps me, and my self esteem/self worth. I continued to work when I really should have had time off, and sometimes work is really difficult to manage with bpd.
The best thing for me is having a supportive employer who'll listen to me (though it took the beginning of disciplinary produres for days I didn't work as well for me to completely open up with her). Also the professionals working with me are trying to help me stay in work, as I really enjoy my job. Keep up the good work, I hope it continues top help you :)
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well done that is a massive achievement hope i can get there soon. I am lucky I now have a fantastic care coordinator but things are still very difficult love and hope
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Hi Snooks
Thank you, I'm glad to hear you are doing well. Unfortunately due to moving house near the end of last year my new GP does not know me very well and hasn't been very supportive so far. I have started seeing a therapist privately - not the best solution as my wages are just paying for that and not much else (thankfully I have a supportive partner whose income is good enough for covering the rest!) -
Hi Claire,
Thank you, I guess even people who have been off work ill for long periods even without it being mental health issues might have similar concerns!?
And yes I agree, having time off is not necessarily a bad thing - sometimes you need to put yourself first! :) -
Hi Tanya and Ruth,
Thank you.
Well done to you also Tanya :)
Ruth, good luck to you, hope you get there soon :) -
Hi Sharon,
Your story sounds so familiar. I am in my second week of my phased return after 4 months off work with depression.
It's really difficult and Im struggling with it more than I thought I would, but part of me also knows my illness makes it worse, because I want to run home, go to bed and hide under the covers, but Im beginning to realise you cant live like that.
Your story was really inspirational, I hope my return to work proves to be as successful as yours is appearing to be,
Good luck with it :-) -
Hi fairy_wings
Good luck, keep with it. I know how you feel! I still feel like that some days, the phased return really helps so you can just add that little bit more as you feel ready for it. I'm sure your return will be successful, I still worry that I'm going to fall off the tracks again, but I'll cross that bridge if it comes to it! :) -
Hi Sharon,
Its great that you have a very supportive employer who is balanced in making sure your health is important as well as your productivity.
I only wish my ex employer had been the same. I worked there for 13yrs but after a crisis( i like that term. It sounds more appropriate than 'sick') i was off for almost all of 2010. I was wanting to get back to work but occ health advised me not to.
On my last visit to them they told me i was unfit for my role and my employers would help look for an alternative role.
On my return my boss wasnt interested and i felt like i was an inconvenience. She wanted me back full time as soon as i met her. It terrified me. I literally begged for a phased return as recommended by Occ Health.
But was faced with having to get back into it or lose pay. And had to find a new role in 16 weeks or my employment terminated.
When i found new roles i had to go through all the same assesments and interviews as everyone else. Even though i was originally told i only needed to apply as i had already done the jobs in the past. I was even asked questions about my mental health and how it would affect me. Then to be told i hadnt got the job as id failed on a 'technicality'
In the end i got depressed again and felt hopeless as i was getting no support from work.
My contract was ended in march and my union are taking them to tribunal for unfair dismissal and discrimination.
I would like to mention the company but as its going to tribunal i cant. But by the end of november after its done i hopefully will be able to, along with good news of how it turned out! -
Hi Col,
Sorry to hear about your difficulties with your employer. I am on reduced pay, they are just paying me for what I work, which is fair enough to me, but might be an issue for other people to cope financially. good luck with your tribunal, it sure sounds like a case of discrimination and unfair dismissal - hopefully the tribunal will see it that way too! x -
I think you're incredibly brave for going back to work. I also have BPD and have been off of work for a long period, firstly because I am not in a position where I can manage it, but also because I have been on an incredibly long waiting list for therapy. I am now receiving treatment (DBT) which is a long and painful process. I only hope that once this long course of treatment is over I can return to work and for once feel comfortable and able to manage.
Bravo to you though!
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Thanks Daniel, I know what you mean about long waiting lists! I've gone private in the end, psychotherapy - but still hoping to get DBT at some point. It's only becuase my fiancee and employers are so supportive that I have been able to manage going back to work this soon. hope you get there when you are ready :)
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Sharon, thank you for your blog, it raises interesting points about mental health and employment.
Your colleagues are commendable, they clearly see the person and not the label. This is so crucial because having people beleive in you despite your problems makes a world of difference. Too often employers are only too keen to rid someone once they are aware of mental health problems and that only compounds the problems people face. Work is very important for being part of society, being ill is no crime and I would like to see a society that recognises this basic truth
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There's a real problem for people with a PD diagnosis in securing support now because the focus in severely cut time limited services are now illness diagnoses - depression/psychosis/bipolar. Some CMHT's refuse to work with people with a PD diagnosis. They can do so on the basis that 'specialist' services exist to cater for people with a PD diagnosis however they often only cater for those who can make use of MBT or DBT. Service users experiences of these interventions vary and some BPD specialists such as Bateman state that DBT is not that great for BPD. Some of these specialist services often won't take people considered to be 'high risk' and therefore don't work with those who have suffered a lot of damage because of rubbish services. It's really difficult to challenge the considerable stigma and discrimination when lead professionals are clearly scared or unconfident of their abilities, this is when we hear of them making blanket statements about the possible 'danger' to service providers doing one to one therapy with people with a PD diagnosis. This is of course utter nonsense but I believe the incompetence and prejudice of lead professionals is one part of the problem, but equally, I believe the rationing of services most markedly to people with a PD diagnosis is often done in an underhand manner - by pathologising a whole patient group i.e. we can only offer groups because you are too dangerous to work with individually.
It's appalling.
Sadly Occupational Health can reflect clinical stereotypes and let people down and employers, well I'd expect them to live down to expectations - the point is - the most toxic discrimination emanates from the medical profession itself and making personality "disorders" more 'understandable' is not going to change the above.
Well done you Sharon for persevering and I wish you very well in your current post and with your tribunal case, I really hope you get a good result. -
Yes, indeed an all to common story. I to live with BPD and although have since been back in work for 14 years still have the same problem if I have to take time off sick with it. Brain Heamorrhage.......broken limb......child birth no problem but mental health!!!!
Occupational Health and HR departments live in there own world as do the government. HOW are individuals expected to lead meaningful lives in employment when line managers can be helpful but are driven by beurocratic departments that basically have no ideas on recovery principles.
I remain positive and see each setback as a 'blip' but the shadow that enhances stigma is work polieies and procedures on dealing with a person taking time of sick. I even wrote to my local MP on this issue and received nothing but a standared reply not addressing the question at all. Why is the UK so biased when it comes to work and mental health. I have a 2;1 honors degree and have worked high up but still my condition is thrown back in my face if I dare to admit mental ill health may require a few days off.
As the government continues to push individuals into work how effective is this if the support is often not there. Maybe the plan is really to bring back the old asylums which could be built to save the government tons of money in benefits or sick pay.
When oh when will someone look at RECOVERY in a holistic manner. I work in mental health now and consider myself a good role model after years of sick some time ago. Every day I hear the same stories of lack of co-ordination of services and very little encouragement given to people that they can indeed recover. What causes my 'BLIPS' is often not my condition but societies attitude to it.
Time to Change really needs more funding and employers need to change. -
Hi Linda,
Thank you, you raise a very interesting point about being ill being no crime, in some circumstances it would seem criminals get more 'help' to enable them to work than people who are ill... -
Hi Mindreader,
Thank you for your comment. You explain the problems with 'professionals' attitudes very well, I have already wtnessed some of this myself! Hopefully my private therapist doesn't have these beliefs, so far she seems very understanding.
(btw, it is commentor Col who is going through a tribunal, thankfully my situation hasn't been that bad!) -
Sorry Sharon, I got goggle eyed! You should have this support on the NHS though..
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Thank you In Recovery, you are so right about the whole lack of coordination and higher level support. I also have a 2.1 BSc, but have not been able to utilise this to gain a 'career' to date. My current role was supposed to be my 'stepping stone' towards making use of my degree, but I now wonder if that will ever happen :(
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Hi Mindreader, no problem. I know I should be getting treatment on the NHS but I'm still on a waiting list, not heard anything from them at all, I need help now not next year - if it wasnt for the support from friends, family and work the waiting list could have been 'too late' completely - if you get my meaning... :/
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perhaps the public need educating about what a pd is. To me its what it says on the tin. A disordered personality. That statement does not imply any danger. Although of course some might be dangerous as might be some people from any other group. A disordered personality is obvioiusly someone who is confused about who they are and what normal behaviour is etc. and needs help in order to reconcile the various parts of themselves. Which might be counselling or talking to people at bus stops or whatver.
If they have been assessed as ready for work then it shouldn't be any of the employers business to judge them. Unless they've been wrongly assessed for work that is in which case someone needs to sue the people who assessed them.
I'm all for service users getting the opportunities they want whether its to work or to not work if thats what they need.
thanks for listening
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Hi Katie,
I agree about educating people, but I think the issue is that people only 'choose' to learn aboout these things if it affects them personally in some way or they want to work in the field. But, even people educated about PD (the professionals) label us as 'dangerous', whether due to the supposed 'harm' we pose to others wih our behaviour or the 'damage' we do to therapists trying to treat us. -
Hi Sharon,
Thank you for sharing your experience and for being so frank. Mind’s ‘Taking care of business’ campaign is working hard to raise awareness of these issues and transform attitudes to mental health in the workplace – and your blog is an important part of that.
I was concerned to read about the comments from the Occupational Health professional you mentioned who seems to have tried to encourage you to leave to avoid facing possible disciplinary action or even dismissal if you then had high sickness absence. Many organisations do have sickness absence procedures with triggers for disciplinary action if someone exceeds certain absence levels in a given time period. However, it is best practice among many employers to disregard sickness absence where it is related to a disability – doing this is often a ‘reasonable’ adjustment for an employee with a disability.
This would be something to discuss with an employer after a period of sickness absence but also as soon as disciplinary action was mentioned, and it would also be a good idea to get advice at that point. While an employer can still take steps to dismissal if ill health or even disability means that someone cannot do the job, if an employer was to dismiss an employee for unacceptable sickness absence where the absence was linked to disability, there is a risk that the dismissal would be unfair and the employee may have a good claim for unfair dismissal or disability discrimination.
If you ever need advice then Mind’s Legal Advice Service can advise on this type of situation by phone or email. You can find out more here: www.mind.org.uk/help/advice_lines#legal
I wish you all the best in your return to work and I hope it goes well. You have a very positive and determined attitude and that, coupled with the support of your colleagues and employer, will stand you in good stead. Also there are lots of useful resources on the Mind website which you can find here: www.mind.org.uk/work/employees
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Hi Katie,
I agree about the public needing to be educated, but I think the bigger problem is them not wanting to know or understand. Unless there is a problem of mental health concerns closer to home people don't want to know the truth, and some professionals encourage the stigma by labelling us 'bad' and 'dangerous' themselves making it hard for us to get the help we need as they themselves do not want to work with us :( -
This is part of the problem Katie - the whole concept of PD, it's a deeply flawed concept which psychiatry uses to exclude and denigrate people. It needs to be removed as a diagnosis, not made more 'understandable'. If people's NEEDS were responded to and difficulties described in plain English in a person's own words without it being viewed through a PD telescope I think people would do a whole lot better. It's the meaning of the diagnosis which has been constructed which is the problem, not the people labelled as such. The meaning of the diagnosis is not a biological fact it's been constructed to identify anyone psychiatry doesn't like or want to assist, or doesn't fit into 'illness' diagnoses, it's little more than a clinical insult. People deserve better than this. I know some are happy with the concept of their diagnosis and even find it helpful but I believe overall the benefits do not outweigh the negative consequences for many, who are treated badly as a consequence and their needs not attended to.
It's the most vilified diagnosis, people diagnosed as PD get a bad deal from services. -
Thank you Emma, hopefully I won't need it but at least now I know that if I do end up having more time off due to my BPD then I shouldn't worry about the possibility of disciplinary procedures. If it comes to that I will be sure to contact the Mind legal advice team :)
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Well said Mindreader! :)
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I wonder if because it begins with p its associated with psychopath. Wjat it it was called a character disorder. well that could be misunderstood as well.
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Dear Mindreader, since working in mental health after my initial illness I to am saddened by how services often give little hope to individuals diagnosed with PD. Often they are pushed from service to service. I have met many people with this label and really have found that self care group work has been fruitful. Never give up hope as pschiatry just loves to label people. I rarely went out the door for a number of years and reached the abyss but now I use my lived experience to benefit others and see them achieve personal goals. Psychiatry still has a long way to go to relinquish the medical model and realise it is the holistic approach that works and giving people insight that things will improve.
At my worst all hope was gone and I have kept one photograph from that time period. I never look at it now but it is history and the way forward is being positive even when thigs kick us down. -
Thanks Sharon, we have to keep pushing these arguments forward because I feel so sad when I see services making people police and pathologise themselves. It's not on!
Katie, BPD has been referred to as the "female psychopath", Antisocial PD being the contemporary equivalent for men.
In Recovery, sigh yes..I doubt we will see the DSM relinquished in our life times but I hold the hope that we could help pave the way towards a future where people won't be defined as PD, psychotic, Bipolar etc. A future where we use plain english language and services are based on need not labels. -
I've said this many times before but I think the PD label is particulary dangerous. It is not viewed at as mental illness but at the same time individuals are left with a deeply stigmatising label that is associated with the worst kind of behaviour. I've even heard it suggested by a psychiatrist that mass murderer Brevik probably had PD. The 'bad' not 'mad' theory is highly damaging to people who already think they are worthless, have rock bottom self esteem and seek help. There could be many reasons why people arrive at this stage in their lives and to have it confirmed by experts that actually you are 'bad' (not their words I know) because you have a dodgy personality and therefore you are untreatable does untold harm to the pysch of the person affected. I predict especially in this climate more and more people are going to be labelled in this way not least because services will not be able to cope with demand brought on by stresses of life. I really would like a medical journalist to take up this issue because it is not just a mental health issue it is a social one and I beleive there are political reasons why this label is being used. It denies autonomy and confidence in individuals and encourages them to look inward rather than outward. The Govt do not want significant challenges to their rule on a united front, by labelling more and more people they can undermine such action
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Hi Linda,
Thanks for your comment. I agree the label is not helpful and when they start throwing it at dead celebrities (Amy Winehouse) and murderers (Brevik) it just makes things worse for those of us who have to live with the label :( I also agree there is ikely to be an increase in the nmber of people being diagnosed with this so medical proffesionals can dump us on the 'trash heap' of life to avoid treating/helping us. The things you say about it being a political tool and social issue as well as a medical, mental health issue also ring true. A 'quality' reliable medical journalist who can see and report the truth would be a great advantage to our cause! -
I’ve contacted Mind's campaign team to ask if they might be able to run a campaign related to personality disorders and some of the issues that have been raised here (such as the horrible stigma that surrounds this diagnosis in particular, attitudes of mental health professionals, portrayal in the media etc.)
Sharon, it's fantastic you've been managing to go back to work given how difficult things have been for you.
When I suffered a bad spell of depression in the past, I had to take several months off work and it felt so difficult, I thought I'd never be able to go back and get on top of things again, but I started off gradually doing a couple of afternoons a week and took one day at time, and it was so good getting back into the routine of 'normality' and such a relief to know that I could cope again. It really felt like I was never going to get there. Good on you for challenging Occupational health! I had a similar situation where I was told to take more time off, and a set amount, but I was adamant that I wanted to go back but do what I could and ease myself into it and it's definitely paid off and I think it helped me feel more empowered and more in control of things. I was also really lucky to have a very supportive manager. Definitely just take one day at a time and do what's best for you and don't worry if you have the odd setback, just go at your own pace. Keep up the good work!
Take care,
Fiona -
Hi Fiona,
Thanks for your comment, i think a campaign by Mind would be really good! Great idea :)
I'm still just doing 3 afternoons, 5 hours each now and for the moment this is enough, especially as I'm off soon for almost 3 weeks for holidays. When I go back after my holidays I will see if I feel like adding more hours/days, but I still won't push myself, what I'm doing now is 'comfortable' and theres no rush in my opinion! :) -
maybe it should be called a disordered personality rather than a personality disorder. To take the p out of it. I don't see how its not a mental illness. Its diagnosed by a psychitatrist ( another p!) just they don't always respond to medication which means that it can't be put into a neat little box I guess that is what its about
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Hi Katie,
BPD is sometimes referred to as a disordered personality, which isn't really a more helpful description as it implys that there is a 'problem' with your personality. BPD is a mental illness that requires a lot greater understanding than it currently gets. -
True, psychiatry loves boxes and labels. Rosenhans' Psudo-Patient study from the 1970's proved it. Students were asked to turn up at hospital emergency departments claiming to hear voices......All were diagnosed as having schizophrenia when in fact they were so called 'normal people'. They were told to make notes of their experiences and hey-ho they were then defined as being paranoid for making these notes! Bet they couldn't get students to do that now as we all know the labels stick!
We just have to prove people wrong in their misunderstandings of mental health. I think of my Bipolar Disorder as a working battery positive at one end and negative at the other like my moods, but together they work just like a battery and provide the power I need for every day living. No one knows the sheer hell we have to live with unless they have been there themselves. Psychiatry needs to understand recovery is possible given the right all round support. What often prevents this recovery is 'society' that places brick walls in the way.....Lets break it down like the Berlin Wall and stop this still blatent prejudice in the work place. The UK health system must pull away from the medical model at a faster pace and include more focused recovery services and support to enable not hinder recovery. -
In Recovery - I second that notion, the UK health system needs a major shake up to bring it into this century and provide the services that are needed!
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I thought maybe we could try to work what it sh ould be called. one reason for labels is that although they sound a bit false its to show the difference between teh mental health problem and just what normal people go through anyway.
what if I brainstormed it? a personality puzzle. a jigsaw personality. or just an adult with special needs perhaps?
I don't think that disorder necessarily means there is something wrong. maybe thats how peple read it. to me it means something that needs help to sort out into a more comfortable whole.
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Hi Katie,
Nice idea, but I doubt they will change the name regardless how good an alternative we could come up with :/ Maybe when the new DSM comes out they will have 'altered' the name to something more suitable. -
altered - now theres another idea! an altererd personality
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Hi Sharon,it's so interesting to read about your return to work and i'm pleased it's going well,i too am in the middle of a phased return(i have depression and have been off 7mths)work are very unsupportive of this and don't really know what to do with me,the next few weeks i increase to 5 mornings a week but they don't seem to understand that a seven hour day doesn't really fit this,i feel like i'm going mad,is it me?
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Personality disorder labels are as mindreader said in their brilliant comment on 29 July at 16.25, just a clinical insult. They destroy lives and the chance of having a decent future.
I do not reveal anything about my psychiatric 'history' on job applications as I know I won't get a job if I do. My GP notes are basically a list of accusations, all unproven, such as I hit someone, attacked someone, lied about childhood abuse, etc. I have had to take jobs out of town and have a long commute to work as I dread meeting someone locally who'd 'blow the gaff' and reveal my psychiatric past.
I am being forced to live like a criminal when I don't have any convictions, arrests or cautions. I was the victim of many crimes but this is disregarded.
All my encounters with psychiatry were very negative; they were very angry with me and I was seen as attention seeking, immature and wanting to control my family.
I'd like to have had a good job and moved on with my life but the personality disorder has left me scraping around at the bottom of society doing rubbishy jobs. I am so unfulfilled and frustrated.
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Hi I'll be okay
Sorry to hear you are not having a very good phased return, I think some employers just kind of give this 'lip service' rather than it being a real phased return! I am standing my ground on sticking at 5 hours per day 3 days a week as this is 'enough' for me at the moment, but I can already feel the tension building like they are expecting me to increase this quicker and be full time again very soon - although I don't think I will return to full time at all (at least not for the foreseeable future). I hope you can convince you employers to let you go at your own pace! Good look :) -
Hi Dymphna
I understand your feelings of frustration and being unfulfilled. I wanted to go to medical school, but I daren't even apply now as I know I don't have a chance with my medical records will destroy my dreams even if I have the strength to get through the many other hurdles and long hours of training. I guess it takes a long time to find 'good' experiences in the psychiatric services, I hope you manage to find some positives eventually :)
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