'My patient brings the knife with her into therapy with group therapy' | Society

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Monday

Monday morning is a worrying time I wonder if anyone has died over the weekend. I work in a mental health service specialist for people who cope in ways that hurt them, have difficulties with relationships and often feel suicidal.

I meet a patient for the first time and together we explore why he thinks overdosing feels like a good thing to do. He feels totally undeserving of help and has lived through a childhood of horrific neglect and abuse. He regularly wants to feel nothing, perhaps even die. We talk about what has kept him alive so far and what life can ever feel worth living.

Tuesday

I talk to the care coordinator about the man from yesterday. He asks me why my patient is turning up at A&E so much. When someone is taught they don't care, nothing can protect them, A&E can seem a sensible option. I leave feeling that there is more empathy than when I arrived. It is really common for staff to forget about adversity in people pasts and how it impacts on the present. Things are so busy for them there is rarely time to think.

Wednesday

She tells me in detail about the abuse she experienced at university. I have also met her family, who say she never went. I don’t know who to believe. I decide to consult my colleagues.

Later I read through an assessment with a patient. She cries and tells me that she's been in services for 10 years. We work out why it makes sense. She's grateful.

Thursday

It’s a half-day of group therapy, which is my favorite part of the week. People who have lived through years of trauma, self-harm and feeling suicidal support each other. It’s wonderful to see people’s sense of acceptance and acceptance

A woman brings in the knife she intended to stab herself with. We plan to ask whether there’s a box we can put it in. She panics about being interrogated by staff about it and is bemused when it´s nonchalantly taken off her without a word. The group debates whether this has helped. We’re coming between “She can just get another one” and “But that will take time and effort during which she can change her mind”.

Friday

I on the inpatient unit at a meeting about a patient who staff don’t know how to help. Since she was admitted she went to A&E, to harming herself when alone. Everyone agrees she is at greater risk than dying now than before she was admitted.

It seems impossible to discharge her. She was offered therapy before and there is a strong argument to get a hospital specialist. I can feel myself getting more unpopular when I point out the lack of therapy available in these specialist places.

Too often weve people to places that promise intensive therapy and offer little other than containment. We agree to explore community options but it feels half-hearted. No one feels like they're good at their job.

When the door closes on the wall behind me, that patient stays in my mind. She joins the others who might die over the weekend (1 in 10 people with her diagnosis will kill themselves). I drive home knowing what Ive done isn't enough, but it was the best I could do.

* Some details have been changed

I would like to work on my job in public services, get in touch by emailing sarah.johnson@theguardian.com

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