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Trump, Clinton, And “The Greater Good”

I am an optimist by nature. That is to say that optimism is my default state. There are many reasons for this, chief among which is the fact that I choose to believe human beings are capable of great things. That sounds wonderful, but it inevitably gives rise to a vast amount of frustration – particularly at times when society seems determined to prove me wrong. The 2016 U.S Presidential election is a prime example – and not just because this powerful nation has selected not one, but two, problematic candidates as nominees for the Presidency.

First things first – I’m not American, so why does it matter what I think? Well – brace yourselves for a shock – it is a very small world, made smaller by the internet and 24 hour news cycles. This, combined with the fact that the individual elected to be the U.S President has the very real power to influence the lives of every person on the planet in one way or another, means that the American electoral process concerns everyone. This has become even more important in recent weeks, as the election has become defined by sexual assault. Both main candidates for the Presidency, Trump and Clinton, are mired in allegations and accusations relating to criminal offences against women – she of silencing and intimidating her husband’s accusers, and he of actually perpetrating these violent crimes.

Like everyone else, I cannot prevent this male toxicity permeating my home, and the consciousness of all that reside in it – including my sons. And it is male toxicity.  Hillary Clinton is not accused of assaulting anyone. The allegations against her are of her behaviour toward women that her husband is accused of physically attacking. She is accused of ‘enabling’ him as a sexual predator – but the predatory behaviour at issue was his, not hers.

This puts the world in an extraordinary situation. On the one hand, we could find ourselves with the leader of the most powerful nation on the planet being someone who validates the idea that women are there to be assaulted. On the other hand, the optimist in me hopes that the positive thing about this fiasco is that sexual assault is dragged from the shadows, into the glaring spotlight, and that everybody realises that the existence of rape culture can no longer be denied. That is what appears to be happening – but the further consequence of this is that, due to the prevalence of the coverage of this election, everybody is having their own, personal attitudes revealed. We are each now discovering who around us finds sexual assault tolerable, and who does not.

Donald Trump is a terrible candidate for the U.S Presidency. I firmly believe that he would not only be a dangerously incompetent and unreliable ‘Leader of the Free World’, but his election would also put the movement for social equality back decades, if not more. Disregarding, for a moment, his clear lack of knowledge and understanding of international and domestic issues, his inability to answer a question or form a coherent sentence, and his narcissistic tendencies and fixations, Donald Trump has also repeatedly proven himself to be a racist, ableist, misogynist tax-dodger who disrespects war veterans and anyone who doesn’t look like him, agree with him, or make themselves sexually available to him.

People around the world are shaking their heads in disbelief, wondering how this man in particular has managed to come so close to winning the Office of the President of the United States. I too, am one of those overseas observers, muttering to myself that if this monstrous individual is the best candidate the Republican Party could produce, how nightmarish are the rest of them? What good can possibly come of elevating this person, who behaves like a Neanderthal that woke up to find himself in 2016, with no comprehension of why people find his attitudes to be reprehensible?

The behaviour of this man – and in particular, his behaviour toward women – is making us all take a very long, very hard look at our world as a whole, and how it came to be the way it is today. The current situation demands that we reflect upon how we came to be living in a world in which a Donald Trump Presidency is a very real possibility. One of Trump’s favourite phrases is that he “tells it like it is.” Well, maybe this is the one useful lesson this serial-bankruptee can teach us. Let’s tell it like it is.

It boils down to complacency. As a species, we seem to be in the process of realising that sacrificing principles “for the greater good” doesn’t always lead you to a better place, when the “greater good” is being defined by the very people wishing to preserve the status quo of inequality. What do I mean? Well, to paraphrase the many Donald Trump “surrogates” after each incident:

“Yes, those things that Donald Trump said are offensive, but he apologised, and there are much more important things to be worrying about anyway – like ISIS.”

Excusing racist, misogynist, ableist behaviour for the sake of a different issue does two things – it dismisses the oppression of specific groups of people, and makes the statement that this behaviour is acceptable as long as there is a bigger threat to deal with. You want to talk about “distractions”? Funny how Republican Presidents are always so keen to focus on fights with big, bad foe, isn’t it? Not unlike Britain’s Prime Ministers Thatcher and Blair.

Let me be more specific, though. Every time Donald Trump says (as he did during the internationally televised second Presidential debate) that discussion about his ‘pussy-grabbing’ comments is less important than talking about ISIS, he adds to the erasure of the experience of literally millions of women around the globe – including those brutalised by ISIS. It validates the widely held attitude that women can be treated this way (violently sexually assaulted), and it is of little or no consequence. It validates the belief of many women that if they speak up, they will also be dismissed. But, let’s dig down a little deeper. Let’s look at the white male privilege which assures Donald Trump that when he brags about committing violent sexual assault, his behaviour toward women bears no relation at all to the way that members of groups such as ISIS behave toward women.

In interviews and debates, whenever anyone mentions his treatment of women (and, make no mistake, there are lawsuits and long-standing accusations that allege this could well be more than “just locker room talk”), Donald Trump’s first go-to response is to deflect onto the subject of ISIS. This is the group that – in addition to horrific acts of terror against anyone that doesn’t submit to their rule – specifically treats women as if they are property to be owned. The physical and sexual abuse of women committed by its members is well-documented, as is the establishment of a modern-day slave trade, in which women are bought and sold like cattle – their price tags often determined by their perceived attractiveness, and alleged ‘purity’. In other words, in ISIS, the value of individual women is determined by the men objectifying them for their own purposes. Where do you think these extreme actions and attitudes come from, if not the very same kernel of male privilege that informs the violent attitudes of Donald Trump – the attitude that makes him think he can determine the value of individual women by objectifying them for his own purposes, and encouraging others to do the same?

For ISIS, the aim of this abuse and domination of women is clearly the wiping out of bloodlines – just as it has been, historically, for any invading group that has ever wished to impose its rule and will on a resistant populace. For Donald Trump, the abuse and domination of women is about wiping out competition. It serves the dual purpose of eliminating women that might challenge him, while establishing himself in the dominant position among other men, in a society that capitalises on the creation of self-doubt, and the assessment of outward appearances. Make no mistake, the strategies of ISIS (along with other patriarchal terrorist organisations such as Boko Haram, FARC, the Taliban, and Abu Sayyaf), and the strategies of Donald Trump (along with non-terrorist patriarchal systems, i.e. general society in most countries in the world, and most organised religions) occupy space on the same, male-invented spectrum of the oppression of women.

Trump’s second go-to response to questions about his own behaviour toward women is to list the trespasses of former President Bill Clinton (who is not currently running for President). This is also appalling because – like the ISIS deflection, it creates this spectrum by essentially using the argument, “Well, other men do worse!” (in other words, “at least I’m on the less-bad end of the spectrum!”) Trump alleges that Bill Clinton’s actions are “far worse” than his, which immediately places a value judgement on the experiences of survivors – all the while being broadcast around the world on every TV channel and internet provider, and all the while reinforcing the same attitudes in others. It says, in no uncertain terms, “I may be on the same spectrum, but I think my end of the spectrum is acceptable.”

But, guess what? Violence against women is unacceptable. It’s unacceptable when ISIS does it, it’s unacceptable when Bill Clinton does it, and it’s unacceptable when Trump does it, too. It’s unacceptable at every perceived level of male-defined ‘severity’, and it’s unacceptable to feed into the social oppression of women by bragging about it to your buddies – I don’t care what room you’re in. The very fact that this male-invented spectrum of violent oppression exists at all is unacceptable. That stance is not ‘political correctness’, by the way. Nor is it an attack by the ‘thought and speech police’. It’s basic human decency, and if you find yourself falling short of that criteria, you may need to consider the fact that you might be part of this worldwide problem.

Misogyny is misogyny – whether it is perpetrated by a civilian, a soldier, a religious representative, a President, a business person, or an extremist. It is borne of the idea that men have the right to have physical, emotional, financial, educational, religious, and psychological power over a woman; that women have no right to physical sovereignty, and that they exist simply to facilitate the lives of men. It manifests in different ways in different cultures, in different religions, and in different places around the world – but it all stems from the same malignant place: Male entitlement.

So, what does the success of Donald Trump say about us? We are responsible for him getting this far along in the process. The Republican Party undoubtedly thought his celebrity would work in their favour in trying to recapture the Oval Office. He is a ‘celebrity’, in part, because people watched his show, The Apprentice, and were entertained by the confrontational, dictatorial style of his treatment of contestants – in the same way that all those other reality shows thrive on manufactured conflict. This ratings strategy, again, falls in with the attitudes held by the man, which have been utilised in his campaign – the enjoyment of pointing the finger at other people, and putting them down because he thinks it makes him look stronger; the sense of personal power that comes from being able to humiliate a person when they fail to please you; the rush of having power over another human being.

He’s built upon that fan-base, and campaigned to become President, largely by promising power to those that feel powerless – which, in itself has caused a further split in the electorate. The people he undoubtedly appeals to most are those who feel they have lost power as society in general has pushed further toward inclusivity and diversity – this is obvious, because Donald Trump promotes the exact opposite of inclusivity and diversity. The truth of the matter is that there are many groups in American society (and every society) that feel powerless and, in real terms, everyone is essentially powerless except the wealthy and ‘elite’. But, while women and minorities – and all the people at points of intersection between them – have always experienced actual powerlessness, it is white people that are, in general terms, socially conditioned to erroneously believe that the power is rightfully theirs.

And what of this social conditioning? What does it program everyone to do in an election cycle, where there are only problematic candidates on offer (also known as, ‘every election cycle’)? Well, it tells us to be motivated by the “greater good” – the bigger issue, the larger threat. If he can ensure continued tax breaks for the already wealthy people that are supposed to ‘create jobs’, can’t we turn a blind-eye to all that pussy-grabbing nonsense? If he can ‘make America great again,’ can’t we just forget about all that blatant and coded racism he just spewed on international TV for 18 months?

That attitude may sound very familiar. We recently heard the same about another white man – Brock Turner. If he can swim really well and bring money into the university, can’t we just give him a break on the whole ‘brutalising a woman behind a dumpster’ thing? It’s also the attitude that leads women in relationships with (alleged) sexual predators – such as Hillary Clinton and Melania Trump, for example – to remain and ‘enable’. He can achieve so many great things – can’t we just let these sexual assaults slide?

The very nomination of Donald Trump – by the Republican Party – as a Presidential candidate has forced both sides of the argument to adopt this “greater good” approach. With just weeks to go before the election is held, it comes down to the idea of voting for Hillary Clinton largely to stop Donald Trump getting the job. That’s a deeply skewed version of democracy, at best, and it has prevented the proper examination of actual policy put forth by each candidate.

Due to the actions of Donald Trump, the Clinton campaign is asking American voters to overlook her controversial email issue, her questionable actions as Secretary of State, and allegations of intimidating her husband’s accusers – for the purpose of preventing a Trump Presidency. The Trump campaign is asking American voters to overlook his misogyny, racism, ableism, questionable business practices, tax-dodging, and allegations of actually perpetrating violent assault – for the purpose of preventing a Clinton Presidency.

Forcing this “greater good” approach undoubtedly achieves an important goal for the Republican campaign. It distracts from the fact that – even taking into consideration the questions over her past actions – Hillary Clinton remains the single most qualified person to apply for the job of President in a generation, and she has continually advocated bi-partisanship and inclusivity as a way of resolving important issues.

Historically, the “greater good” tactic has originated from the desire to preserve the status quo, which means men have power and priority over women, and specifically white men have power and priority over everybody else. Historically, it has effectively silenced anybody that might be subject to these horrific behaviours, and has highlighted very clearly that there are people willing to tolerate the oppression and abuse of other human beings for the sake of securing their own personal position.

Does that also sound familiar? Yes. That’s because, historically, that’s also been the attitude of most western nations with regard to the rest of the world. And now here we are, with Donald Trump. You see, Trump makes a big deal about being a ‘Washington outsider’, as opposed to Hillary Clinton’s ‘more of the same’ – but, if we “tell it like it is”, it is Donald Trump that represents the status quo of inequality. Until now, the “greater good” has always been perpetuation of white male privilege, of which Donald Trump is the very embodiment.

It’s time the world tried something different, for the sake of all women, everywhere.



Bordering On Discrimination: Mental Healthcare & BPD In The UK and US

BPD magThis article was commissioned by BPD Magazine in December 2013, for their second issue. The periodical was the first ever printed magazine to specifically cover the subject of Borderline Personality Disorder, and launched in the autumn of 2013. Unfortunately – after publishing an excellent premiere issue packed with informative articles by mental health professionals, those diagnosed with BPD, and those caring for BPD sufferers – the magazine was abandoned by advertisers and was forced to fold before its second issue could go to print. It’s Founder and Editor, Neal Sutz, kindly gave his permission for me to publish my article – which he originally commissioned – elsewhere, so I am including it on this site to accompany my pieces on BPD.

Bordering On Discrimination: Mental Healthcare & BPD In The UK And US

As the old saying goes, “money makes the world go round”. Whether the subject is politics, education or health, everything boils down to the bottom line. But, in Western society’s scramble for global economic dominance, mental health has been left behind – even though it is the very thing needed to balance the books.

Since the introduction of the National Health Service (NHS) in Britain in 1948, the provision of healthcare in the UK and US could not appear more different. As the largest and oldest single-payer healthcare system in the world, the NHS was created solely to provide high-quality   healthcare that is mostly free, for every legal resident in the country. The provision of services is intended to be based entirely upon clinical need, as opposed to the ability to pay.

The service as a whole is governed by the NHS Constitution – a document that is non-negotiable and, in theory, cannot be changed by government without the agreement of those within the service itself – such is the status of the NHS as a veritable ‘jewel in the crown’. This constitution sets out clearly that patients have the legal right to begin their NHS Consultant-led treatment within 18 weeks of their initial referral – unless the patient chooses to wait longer, or it is deemed clinically necessary to do so. This waiting time guarantee is for both hospital-based and community-based healthcare, and if it is not possible to begin this treatment within that timeframe, alternatives are supposed to be   offered. Patients diagnosed with ‘urgent’ conditions, such as cancer or heart disease, are theoretically seen by a specialist more quickly. Waiting times are usually measured from the booking of the first appointment with a member of the Consultant-led team, and ends when treatment begins, or if no treatment is required after assessment. That is how the system is supposed to work.

While access to NHS mental health services can follow a number of different pathways – including health visitors, social workers and Accident and Emergency Departments of hospitals – if a UK resident experiences mental ill-health, their first port of call is usually their GP at their local Doctor’s Surgery. After an initial assessment by their doctor, a referral is made. Following the National Service Framework report of 2011, the NHS has shifted the provision of specialised mental health services into a community setting, so most patients find themselves working with a Community Mental Health Team. This can comprise of social workers, Community Mental Health Nurses (with specialist training),   pharmacists, counsellors and psychotherapists, psychologists and psychiatrists – with the psychiatrist usually being the senior member of the team. In theory, the approach taken today is of a multi-disciplinary nature – drawing upon skills and expertise from a wide range of departments and teams.

The Community Mental Health Teams (CMHTs) are tasked to work with people experiencing complex mental health conditions – including Borderline Personality Disorder – providing day-to-day support that allows them to continue living in their community. This approach is supposed to encompass the wider network of support available to the patient – specifically family and friends. In addition to the CMHTs, the NHS operates Crisis Resolution Teams (CRTs) who aim to treat people experiencing severe and acute psychiatric crisis and might otherwise require hospitalisation. These teams are intended to be available 24 hours a day and are expected to treat the patient in the least restrictive environment possible – preferably the patient’s own home, or nearby home-like setting. This team also establishes an after-care plan in an attempt to prevent recurrence of the crisis.

When referred for mental health assessment and treatment, these are the two main parts of those services that most patients would deal with. In theory, this is the point where a psychiatric assessment would occur, and treatment recommended and commenced. However, in the UK, the provision of mental health services is not uniform across the country in the way that most, basic physical health care services are.

If you gave birth to a child (complication-free) in the south of England, and later gave birth to a child (also complication-free) in the north of England, you would find that your experience with maternity services would be broadly similar. Appropriately qualified staff would present every choice and option at the necessary interval and offer guidance during decision-making processes. Medical appointments would be timely and undertaken by fully trained professionals, with additional treatments scheduled and completed, as required. Attempt to access mental health services in different regions, however, and you will find vastly different results. Not only can waiting times for mental health assessment vary wildly between regions, but so can the types of treatment being offered – with some regions failing to provide certain evidence-based treatments at all.

The reason for this disparity is the simple fact that, until recently, mental health was essentially a lower priority than physical health. As highlighted by the UK mental health charity Mind ( this year, the NHS constitution – while iron clad in terms of physical ailments – gave no guarantee for access to psychological therapies, nor any stipulation on maximum waiting times for such therapies.

As part of their 2013 “We Still Need To Talk” campaign, Mind discovered that 1 in 10 people referred to NHS mental health services had waited more than 1 year to access talking therapies, with half waiting more than three months – far removed from the constitutional guarantee of 18 weeks. Three in five patients were given no choice in the type of therapy they were offered, and evidence was recorded highlighting the fact that ethnic minorities and vulnerable groups found it even harder to access the right services due to cultural or language barriers. Survey data collected suggested that a disproportionate focus was placed on the provision of Cognitive Behaviour Therapy, though rarely were enough sessions provided. In fact, 11% of people surveyed by Mind stated that they ultimately had to pay for the therapy they wanted, because it was not available to them on the NHS.

Campaigning for change in response to their findings, Mind state that the more desirable situation would be the inclusion into the NHS constitution of a guaranteed waiting time no longer than 28 days – less in the case of a psychiatric crisis. They are asking for a full choice of evidence-based therapies to be offered in every region, along with equality of access for all. Essentially, Mind are advocating for mental health to be given the same requirement of quality of care as physical health.

The UK government launched the Improving Access to Psychological Therapies (IAPT) Programme, which has been praised by Mind and their partners as a positive move, helping millions of mental health patients across the country. They state it does not go far enough, however. This position gained a lot of support and media attention and, in March 2013, the UK Department of Health announced the policy, “Making mental health services more effective and accessible.” With the soundbite-friendly tagline, “No health without mental health”, this policy set out the steps the government plans to take to address the issues specified by Mind and their partners, including:

  • Prioritising better access to services and decreasing waiting times;
  • Prioritising the reduction of mental health problems;
  • Including mental health in a new ‘national measure of wellbeing’, so it is given more weight during policy creation;
  • Providing £400 million over 4 years for improved access to psychological therapies;
  • Providing up to £16 million over 4 years to combat stigma and discrimination.

While this policy announcement seems like a victory for NHS mental health services and their users, it was recently revealed – through Freedom of Information requests – that the reality is actually very different.

Within the NHS, mental health services are administered across the country by 51 mental health trusts – each covering a different region. An investigation by the BBC (“Funds cut for mental health trusts in England” – Michael Buchanan, 12 December 2013) found that despite the government guaranteeing an increase to the overall NHS budget of 0.1% in real terms during their administration, mental health trusts have experienced funding cuts of over 2% in real terms in the past 24 months. This information was based on data received from 43 of the 51 mental health trusts operating.

Simultaneously, as trusts are facing funding cuts, separate data indicates that referrals to Community Mental Health Teams and Crisis Resolution Teams have increased by 16%. Looking forward, of the 13 mental health trusts that provided indicative budget projections for the coming year, 10 of them were bracing for more cuts.

So, while the UK government are ‘talking a good game’, the resources and policy changes that they have promised are not being seen in all UK communities, as intended. Quoted by the BBC, the Care and Support Minister, Norman Lamb, stated, “It is completely unacceptable for local commissioners to disadvantage mental health in the allocation of funds to local health services. This completely conflicts with the government’s clear position that there must be parity of esteem – equality – between mental and physical health. This must be a priority for NHS England to address.”

Mental health services in the NHS, while mostly free at the point of delivery, are caught in a perfect storm of policy-based circumstance, ultimately leading to many patients falling foul of the so-called ‘postcode lottery’. If you are fortunate enough to live in one of the relatively few regions with a stronger mental health trust, and you require mental health assessment or treatment, then your case is prioritised based upon clinical need and social circumstance – if, for example, you are very unwell and have young children or dependents, you are ‘fast-tracked’. You are, in brutally honest terms, a postcode lottery winner. Across the boundary line in the adjacent region, however, a patient in the same circumstances will likely not be as fortunate.

Where does this leave those in the UK diagnosed with Borderline Personality Disorder? This disorder is classed as a ‘complex mental illness’ due to the prevalence of related co-morbid conditions. The 2009 UK guidelines issued by the National Institute for Health and Clinical Excellence (NICE) specifically do not recommend drug treatment for Borderline Personality Disorder, unless it is deemed necessary for the management of acute crisis – in which case, it is recommended that drugs are only prescribed for a period of seven days. Psychological therapies are essentially the only recommended long-term treatment, but with access either restricted or non-existent in some areas, many people experiencing BPD remain untreated until they are in crisis – further undermining any attempt at stability that a BPD sufferer so desperately needs.

In addition, even in regions where treatment is available and accessible, the lack of choice in treatment is problematic for BPD patients. With the condition often causing impulsivity, emotional dysregulation, ‘mirroring’ and ‘splitting’, mental health professionals follow strict guidelines outlining that psychological treatments for BPD must be an engaged partnership – without this patient-therapist dynamic, treatment is highly likely to be ineffective and, from the point of view of the NHS, a waste of scarce resources. Being essentially rail-roaded into a particular psychological therapy, without sufficient explanation or options given, damages this dynamic – again, reducing the likelihood of a sustainable recovery.

By contrast, the guidelines issued by the American Psychiatric Association in 2001 do recommend the use of pharmaceutical treatments in Borderline Personality Disorder, noting that there is a case for the use of SSRIs, mood stabilisers and anti-psychotic medications in treatment. While there is a notable difference in the threshold of evidence required to make such recommendations (it being higher in the UK than in the US), it is important to remember that the fundamental difference between the US healthcare system and NHS England is that in the US, care is essentially determined by the patient’s financial circumstances.

Navigating the US healthcare system is, in itself, a daunting task. Services are provided by a large number of organisations working independently of each other, and access is generally gained through insurance coverage. 18% of hospitals are operated on a for-profit basis, 20% are owned by the government, and 62% are non-profit organisations. Between 60%-65% of healthcare is provided by programs such as TRICARE, Medicaid, Medicare, the Veteran’s Health Administration and the Children’s Health Insurance Program, though most employed people are insured by their employer, or that of a family member. The government provides health insurance for public sector employees, some people have private health insurance, and some are without insurance entirely. In 2004, the Institute of Medicine (IOM) reported that “The United States is among the few industrialised nations in the world that does not guarantee access to healthcare for its population.”

The nature of this system is a contributing factor to the United States’ consistently low ranking in global surveys of healthcare quality, conducted by organisations such as the World Health Organisation (WHO) and the Organisation for Economic Co-operation and Development (OECD). In an attempt to address some of these issues, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA) on 23rd March 2010. This federal statute – highly controversial to some – was designed to bring about a significant regulatory overhaul of US healthcare, aiming to control healthcare costs, and expand coverage through both public and private insurance.

It is the issue of coverage that often causes most concern for US residents with health problems – particularly mental illness – as profit-driven insurance companies have been known to routinely deny coverage for pre-existing conditions, mental illness or addiction problems. Addressing these concerns, Secretary of Health and Human Services, Kathleen Sibelius, announced on 8th November 2013 “the largest expansion of behavioural health benefits in a generation.” The new regulations are designed to enforce the 2008 Mental Health Parity and Addiction Equity Act, and should ensure that insurance companies are required to cover treatment for mental illness and addiction in the same way as physical illness. Additionally, coverage cannot be denied for patients with a history of mental illness, where previously, patients were often left to finance the entirety of their own treatment, sometimes to the point of bankruptcy.

In a situation closely echoing that in the UK, the noises being made by the US government about mental health services and equality in access are very encouraging, but the reality on the ground remains problematic. Ensuring the expansion of healthcare coverage to fully encompass mental health is certainly a positive move, but only works if the infrastructure is present to support it. Senior mental health professionals in the US, while applauding the new regulations, have expressed concern that demand may outstrip the available resources. The message is that more qualified professionals are needed – something that requires long-term investment.

In the meantime, US patients with Borderline Personality Disorder are seeing little improvement in services available to them as they continue to face not only a postcode lottery akin to that in the UK – where treatment options depend on their geographical proximity to scarce, strained resources – but also an insurance lottery – since, although carriers are now legally required to provide cover, they can continue to do so only for preferred providers, further limiting the treatment choices available. As seen in the UK, this can pose a further barrier to recovery from BPD.

It is no coincidence that both the UK and US governments are attempting to tackle the problems in mental health service provision now. In recent years, mental health charities and advocacy groups in both countries have become much more vocal about the need for change – both in terms of treatment and support, and in the general attitude of society towards people experiencing mental illness. Necessarily, in a time of global recession, these voices have grown louder, in an attempt to ensure that mental health services remain too visible to cut. It is also the case that these governments are finally acknowledging, publicly, the fundamental truth about the benefits of a mentally healthy population – that every single aspect of a country is improved, if the population are supported to achieve ongoing mental health.

Despite their vastly different healthcare systems, the situation faced by those diagnosed with Borderline Personality Disorder in both the UK and US are broadly similar, in real terms. Far from being ‘on the border’, BPD patients are in fact in a no-man’s land – almost echoing the outdated sentiment of the diagnosis being the ‘dustbin’ label of the psychiatric world. Although sustainable recovery is possible – and has been proven to be possible – it is beyond the reach of the vast majority, due to lack of access to the right treatment.

The effect of this is often catastrophic. The nature of the illness when left untreated – with all its significant functional impairment, impulsivity, emotional dysregulation and instability of identity – increases the likelihood of the continuation of cycles of deprivation, poverty and self-harm, all of which occurs at additional cost to the state.

Individuals with Borderline Personality Disorder are more likely to require medical attention for physical ailments – due to self-harming behaviour – which places additional pressure on healthcare services. They are more likely to find it difficult to maintain employment and housing – often placing additional pressure on welfare resources. They are more likely to struggle in an educational setting – placing more pressure on schools and universities. They are more likely to suffer abuse at the hands of another person – placing additional pressure on law enforcement and, again, healthcare systems.   They are more likely to find it difficult to maintain relationships – again placing additional pressure on all social systems in cases of familial breakdown.

In the UK, where medication is not recommended for BPD, those waiting to access psychological therapies often have nothing but a telephone number for a 24 hour crisis line, to use when necessary. In the US, where pharmaceutical companies are big and influential business, and medication is recommended, those needing psychological therapies are often prescribed a cocktail of anti-psychotics and tranquilisers indefinitely, while being left to navigate the choppy waters of insurance companies and preferred providers themselves, while unwell.

The fact remains that, in spite of US federal statutes and UK government policies, millions of people with Borderline Personality Disorder – and other mental health conditions – are being prevented from fully participating in society, by being denied the means to achieve and maintain a meaningful recovery. This, in itself, is discrimination.

With more investment in the training of mental health professionals, and real investment in mental health services – as opposed to repeated budget cuts – it may just be possible to bridge the gaping divide between governmental intention, and real, quantifiable improvement. In the end, as with everything, it boils down to the bottom line, and the appropriate allocation of funds. Money makes the world go round, and it is high time that those with Borderline Personality Disorder were afforded the opportunity to fully play their part.

By Sarah Myles

Commissioned by BPD Magazine – December 2013.