The way someone behaves on an inpatient psychiatric ward is not representative of how/ who they are at home/ supermarket/ community - as my OT colleagues have taught me the environment is a major factor in itself that makes people behave/ respond a certain way #rehabpsych

Chance for newly qualified/soon to graduate Occupational Therapists to drop in for a teams chat with some of our existing OTs about what it is like to work in Lincolnshire Community Health Services and to find out more about opportunities at the trust.

Yesterday I had an assessment with a DBT unit called Hope House run by @elysiumcare (Yes I’m naming and shaming them). I’d like to highlight 2 practices they openly brag about within their treatment for women with ‘EUPD’. 1) behavioural incentive pathway 2) blank face 1:1 observations First let’s address the behavioural incentive pathway. Here, for every week you remain free of “problem behaviours” you gain a reward. This soon tallies up with you gaining yet another incentive each week. However, here’s where the positive reinforcement stops… you could be 50 weeks into your incentives and engage in a so called “problem behaviour” and you return to week 0 with everything you have earned taken away from you. Negative reinforcing relies on fear to enforce wanted behaviours. When under chronic fear the amygdala enlarges and you are placed in a constant state of fight, flight or freeze. How is this conducive for those already living with heightened emotions? Furthermore, how can one be expected to dictate their own behaviours when these are enforced by a higher authority. We aren’t teaching people to live positive, fulfilling and safe lives. Instead we are dictating and controlling the outwards expression of emotion through fear without addressing the underlying aetiology. The “positive behaviours” are purely circumstantial. Now for blank face observations. This is where when someone is placed on 1:1 observations their support worker isn’t allowed to talk, interact or offer support. They have to remain with a “blank face” throughout. If you are distressed you can access just 15 minutes skills consolidation from another member of staff. Apart from that you are ignored and treated like a child on the naughty step. People with EUPD have most likely been through trauma. We know that invalidating environments contribute to the development of the so called PD. What is more invalidating than being ignored by someone in a position of authority who is supposed to provide emotional support? It’s reinforcing the very conditions that has led to the persons ‘disorder’ in the first place. Furthermore, NHS professionals state that “Enhanced observations must focus on engaging the person therapeutically”. Seemingly Elysium believe they are above these guidelines and as a private provider can practice their experimental and detrimental policies without question. It’s time that we call out unethical practice and hold providers who leach money out of the NHS to account. #MadTwitter