Stigma and PD

My present placement is an all female acute ward in an inner-city area. We've been having a lot of new admissions on the ward after what the regular workers tell us is several weeks of consistency; people are currently playing musical beds and a lot of people are moving on, which is really nice to see. Yesterday, I had the opportunity to sit in on another ward round, and was quite surprised by the attitudes I came across, particular regarding a new patient with a personality disorder.

She had been admitted because she felt suicidal, and was clearly in a lot of distress. She was tearful and quite scared (understandably so), but from the minute she arrived the previous night, the attitudes of the nurses seemed to be that she didn't "need" to be admitted, and implicit in that notion - that she was wasting our time, taking up a bed that could have gone to somebody else more deserving of it.

At the start of the ward round, the consultant even joked that we were "in for some drama" because of her diagnosis, and to take everything with a pinch of salt.

Though everyone seemed quite dismissive of her, I've enjoyed talking to her in the limited time I've had, and in all truth, she's served as a reminder of why I wanted to get into mental health nursing in the first place.

When I told the nurse I was shadowing - not my mentor - this, she practically laughed at me. We were discussing how nursing on the ward seems to involve a lot more handling of social than mental issues, which she said was characteristic of inner city psychiatry. She felt that MH nurses need to be trained as social workers above all else, and have a firm knowledge of benefits and immigration and the like - as much as they have about medications. She was distinctly unimpressed by my concern for our new admission, shrugged, and said there was nothing the ward could offer her, and she didn't need to be there.

I think this roots back to my discomfort with the fact that psychotherapy isn't part of the acute ward environment. The patient in question is clearly in need of long-term therapy, and I understand that a short stay on any ward can't provide it, but does that make her any less deserving of support when she's in crisis?

The nurse placed so much focus on social issues that I can't help but wonder if her disinterest in this patient stemmed from an almost backwards stigma. We're taught to be socially inclusive, that people of low socio-economic status are much more likely to receive diagnoses and be found in in-patient settings. But does this mean that the needs of people who are more fortunate are ignored? This young woman has a job, a house, family who care about her - does this make her less deserving of access to our services?

I'm not sure if the distaste of the professionals I encountered yesterday stemmed from their feelings about her diagnosis or her personal circumstances, but I was uneasy either way. Appearing to have everything going for you does not mean you have nothing to be upset about, or that you can escape mental anguish. And having a personality disorder does not equate to "being dramatic" in times of distress, nor is it a less valid diagnosis than, say, schizophrenia.

I have a feeling inpatient settings might not be for me...