Q. I am a care worker in the UK, one of a team the provides daily support for a 26 year old lady, who has been diagnosed as having a mild learning disability (Mental Handicap in US ?) and a borderline personality disorder. She lives almost completely independently in a practical sense, relying on us for mostly emotional/social support.

She believes that she suffers from some sort of psychiatric disorder/mental illness. She is unaware of her BPD diagnosis as her psychiatrist, mental health nurse and other health professionals who put together her care package have decided it is better that she does not know. They say that she is obsessed with mental illness and given her diagnosis she would research the subject and suddenly develop a whole new range of symptoms. I would agree that she has a keen interest in mental illness (and at her own admission 'weird stuff') and may indeed mimic or copy symptoms or traits that she does not have already. This withholding of her diagnosis worries me on several levels :

That it is fundamentally unethical even if there may be negative effects of her knowing;

That if she were given a diagnosis (which she is desperate for, she constantly asks 'what's wrong with me, I am ill aren't I) that it may even reduce her 'obsession with mental illness; Finally that she is being denied the opportunity to research her own illness and make use of literature and support groups.

Her 'care' team constantly block any requests she makes to attend therapy groups.

I have raised my concerns with my supervisor and his supervisor but they made it quite clear that they don't want me to 'rock the boat'.

I am left with a feeling that this can't be right. I would be grateful if you could take some time to comment/advise on what I have said.

A. I wholeheartedly agree with you. For years, consumers of mental health services have been treated this way. Many states in the US have instituted patient rights laws that require mental health professionals to discuss the diagnosis and treatment plan in depth before providing any treatment. I think this is a great first step. Unfortunately, many psychiatrists, psychologists, and therapists have taken a very paternal role when it comes to providing mental health treatment.....the "father knows best" approach" I call it. They think they are doing the patient a favor but, in reality, they don't want to take the time and go through the trouble of explaining a very complex disorder or provide the patient with good information about the disorder and treatment. This is usually a sign of the mental health professional's incompetence and laziness. It certainly is not a part of any ethical practice guidelines. So, I applaud you for not accepting this approach as ethical. However, dealing with the politics of your workplace is a different story. Good luck.

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