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On Monday
Monday morning is a worrying time because I wonder if anyone died this weekend. I work in a specialized mental health service for people who face situations that hurt, who have relationship difficulties and who often feel suicidal.
I meet a patient for the first time and together we explore why he thinks that frequent overdose is a good thing to do. He feels totally helpless and has experienced a childhood of abandonment and horrible neglect. He does not want to feel anything, maybe even die. We are talking about what has kept him so far and whether his life can still be worth living.
Tuesday
I speak to the care coordinator of the man from yesterday. He asks me why my patient shows up so much at A & E. When we teach a person that they do not count, that nothing can protect them, A & E may seem like a wise option. I leave with the feeling that there is more empathy than on my arrival. It is very common for staff members to forget adversity in the past and its impact on the present. Things are so busy for them that it's rarely time to think.
Wednesday
A patient tells me in detail the abuse she suffered at the university. I also met her family, who says she never went there. I do not know who to believe. I decide to consult my colleagues.
Later, I read an evaluation with a patient. She cries and tells me that she has been in the service for 10 years. We try to understand why it makes perfect sense that she has the difficulties she has. She is grateful.
Thursday
It's a half-day group therapy, which is my favorite part of the week. Instead of professionals teaching people with mental health problems how to deal with the situation, people who have lived through years of trauma, self-harm and who feel suicidal help each other. It's wonderful to see people develop a sense of belonging and acceptance that they have never had before, but also to see people challenge each other to the impact of their coping strategies.
A woman brings the knife with which she intended to stab herself. We plan to ask if there is a box in which we can put it. She panics about being questioned by the staff about it and is taken aback when she is nonchalantly removed from her without a word. The group discusses whether this helped. We are torn between "She can only get another one" and "But it will take time and effort during which she may change her mind".
Friday
I am at the inpatient unit at a meeting about a patient whose staff do not know how to help. Since she was admitted, she has gone from overdose to A & E and is injured alone. Everyone agrees that she is more likely to die now than before her admission.
It seems impossible to unload it. He has never been offered therapy before and there are strong reasons to send him to a specialized hospital to get it. I feel more and more unpopular when I point out the lack of treatment available in these specialized places.
Too often, we have sent people to places that promise intensive treatment and only provide means of containment. We agree to explore the options of the community but this seems timid. Nobody feels good about his job.
When the door closes on the room behind me, this patient stays in my mind. She joins others who may die over the weekend (1 in 10 people with her diagnosis will commit suicide). I go home knowing that what I did is not enough, but that's all I could do.
* Some details have been changed
If you would like to contribute to our My Work Week series on your work in public services, contact them by sending an email to [email protected].
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