0:00:04 > 0:00:11SCREAMING AND SHOUTING.
0:00:13 > 0:00:17One in four people will suffer a mental health problem this year.
0:00:17 > 0:00:22I just have a deep dislike of the concept of normality.
0:00:22 > 0:00:24Last year over 53,000 people were detained under the
0:00:24 > 0:00:29Mental Health Act.
0:00:35 > 0:00:38Cuts to mental health services have been higher than other acute NHS
0:00:38 > 0:00:41services.
0:00:41 > 0:00:463000 beds within the last five to six years have been cut.
0:00:46 > 0:00:48We've got five males and three females requiring
0:00:48 > 0:00:49admission this afternoon.
0:00:49 > 0:00:54I've got no beds whatsoever.
0:00:54 > 0:00:57Are we just a sort of depository for people that no one else wants
0:00:57 > 0:00:59to deal with?
0:00:59 > 0:01:02We followed staff and patients in the of the UK's largest
0:01:02 > 0:01:06NHS Mental Health Trusts.
0:01:06 > 0:01:11You're not entitled to treatment in this country.
0:01:15 > 0:01:19Things are absolutely dire here at the moment.
0:01:30 > 0:01:32Barnet, Enfield and Haringey Mental Health NHS Trust in North London
0:01:32 > 0:01:37serves nearly a million people.
0:01:37 > 0:01:40Staff are preparing the 136 suite, the holding cell
0:01:40 > 0:01:45for people have been sectioned under the Mental Health Act.
0:01:51 > 0:01:53The handcuffs will come off once you're inside because
0:01:53 > 0:01:56you've been a bit unpredictable to me, a bit aggressive.
0:01:56 > 0:01:59You're going to have a mental health assessment.
0:01:59 > 0:02:02Section 136 of the Mental Health Act allows officers to detain people who
0:02:02 > 0:02:05are a danger to themselves or the public and take them
0:02:05 > 0:02:09into protective custody.
0:02:09 > 0:02:11Cooperate with staff, start making good decisions and this
0:02:11 > 0:02:13process will go really quickly.
0:02:13 > 0:02:15You understand?
0:02:15 > 0:02:18The number of people detained in this way is now
0:02:18 > 0:02:21the highest ever recorded.
0:02:23 > 0:02:27All over the country we are seeing a real surge in the need for mental
0:02:27 > 0:02:29health services and I think that's probably down to economic austerity,
0:02:29 > 0:02:32a reduction in some of the social services because there have been
0:02:32 > 0:02:35swingeing cuts to local authorities and there have been increasing
0:02:35 > 0:02:43numbers in our population.
0:02:44 > 0:02:48The Trust has lost over a third of its beds in the last eight years and
0:02:48 > 0:02:52is running at over 100% capacity.
0:02:52 > 0:02:55For every patient sectioned, a bed must be found, regardless
0:02:55 > 0:02:59of how full the hospital is.
0:03:00 > 0:03:05Shall we make a start for Barnet?
0:03:05 > 0:03:07Heather runs the twice-daily bed management
0:03:07 > 0:03:09conference, with all eight wards in the Trust on the line.
0:03:09 > 0:03:14The purpose is to free up beds.
0:03:16 > 0:03:20One female bed?
0:03:22 > 0:03:24There's no beds.
0:03:24 > 0:03:27If there are no beds available in the Trust, each ward manager
0:03:27 > 0:03:32must nominate their least unwell patient for potential discharge.
0:03:32 > 0:03:35OK, can I just clarify you've identified the least well patient
0:03:35 > 0:03:39at the meeting this morning?
0:03:39 > 0:03:42No, the one I identified is the same as yesterday.
0:03:42 > 0:03:45I know, I appreciate that, but looking at it from our point
0:03:45 > 0:03:47of view, we have potentially five males and three females requiring
0:03:47 > 0:03:53admission this afternoon and I've got no beds whatsoever.
0:04:02 > 0:04:07Under section 136, you don't have any rights of appeal.
0:04:07 > 0:04:10I wanted to discuss transferring somebody into that bed to create
0:04:10 > 0:04:14a vacancy for this patient.
0:04:14 > 0:04:16Throughout the day, more patients are referred from GPs,
0:04:16 > 0:04:19hospitals and A departments.
0:04:19 > 0:04:24All must be found beds.
0:04:25 > 0:04:27Another one just came in, this patient was brought
0:04:27 > 0:04:29in under section 136.
0:04:29 > 0:04:32Not only does the Trust have no beds, but none are
0:04:32 > 0:04:35available in the whole of London.
0:04:35 > 0:04:37No patient is well enough to be discharged or moved
0:04:37 > 0:04:41on to a halfway recovery house.
0:04:41 > 0:04:44The Trust has no choice but to pay for a private sector bed which could
0:04:44 > 0:04:48cost up to ?1000 per day each.
0:04:48 > 0:04:54I'm just ringing to find out if you've got any female vacancies.
0:04:54 > 0:04:56The September surge, it happens most Septembers
0:04:56 > 0:04:59because of course you have all the people in the summer holidays,
0:04:59 > 0:05:02it tends to die down a bit but in September you get a massive uplift.
0:05:02 > 0:05:06We've got about 12, 13 requests for a bed today, that's getting on for
0:05:06 > 0:05:10three quarters of a ward in one day.
0:05:10 > 0:05:16I'm telling you, things are absolutely dire here at the moment.
0:05:18 > 0:05:22Trent Ward has 21 beds for patients with serious mental health problems.
0:05:22 > 0:05:26The aim is to get patients well enough to leave the ward as fast
0:05:26 > 0:05:26as possible.
0:05:26 > 0:05:33The average stay is three to four weeks.
0:05:33 > 0:05:37We treat many more people out in community settings.
0:05:37 > 0:05:40Those people who now come in as an inpatient tend to be much
0:05:40 > 0:05:45more severely and acutely unwell.
0:05:45 > 0:05:48Mel has been on the wards for nine months.
0:05:48 > 0:05:50You've been here for such a long time.
0:05:50 > 0:05:52You don't need to be here.
0:05:52 > 0:05:54She has a personality disorder and a history of drug abuse
0:05:54 > 0:05:58and suicide attempts.
0:05:58 > 0:06:00Staff want to transfer Mel to a specialist personality disorder
0:06:00 > 0:06:05unit but funding has been refused.
0:06:05 > 0:06:07We can't understand what the reason is for declining funding,
0:06:07 > 0:06:10apart from the obvious financial restraints that everybody is
0:06:10 > 0:06:16operating under at the moment.
0:06:16 > 0:06:17What's the meeting?
0:06:17 > 0:06:18It's a professionals meeting.
0:06:18 > 0:06:20What does that mean?
0:06:20 > 0:06:22They're going to discuss what happens to me next.
0:06:22 > 0:06:25What are the choices?
0:06:25 > 0:06:27Either you go to a PD unit, a personality disorder unit,
0:06:27 > 0:06:29or I could be discharged.
0:06:29 > 0:06:31I do want to go back into the community again,
0:06:31 > 0:06:34try and start again.
0:06:34 > 0:06:35But?
0:06:35 > 0:06:39There sounds like a but.
0:06:39 > 0:06:42It's going to be hard for me to settle back into
0:06:42 > 0:06:45the community again because I've been in for so long, it's going to
0:06:45 > 0:06:48be hard for me to settle back in.
0:06:48 > 0:06:51Are you worried, what are you worried about?
0:06:51 > 0:06:54I'm just worried that I'm not going to be able to cope
0:06:54 > 0:06:57on my own out there.
0:06:57 > 0:06:59The ward is not a suitable place for her long-term.
0:06:59 > 0:07:01She has to be moved out.
0:07:01 > 0:07:03Either in the community or in rehab.
0:07:03 > 0:07:05What's the next step?
0:07:05 > 0:07:08Of course we have to bear in mind she has been
0:07:08 > 0:07:12on our top delays list now for quite a while so, from a clinical point
0:07:12 > 0:07:14of view, she doesn't require an inpatient mental health facility.
0:07:14 > 0:07:16She should not be on this ward.
0:07:16 > 0:07:19She needs to be elsewhere.
0:07:19 > 0:07:21Now, the clinicians are saying that they think that this rehab
0:07:21 > 0:07:24facility is the best place.
0:07:24 > 0:07:27The commissioners are not agreeing to it.
0:07:27 > 0:07:30In the meantime, if she doesn't need to be here, can she go home?
0:07:30 > 0:07:33It is looking at the risk to herself,
0:07:33 > 0:07:36the risk to others, but mainly, the long-term view is that she is going
0:07:36 > 0:07:41to continue with this behaviour.
0:07:54 > 0:08:00The September surge is keeping the hospital at code black.
0:08:00 > 0:08:02Jonathan is on the morning bed conference, trying
0:08:02 > 0:08:05to identify patients to be moved.
0:08:05 > 0:08:08I have very ill patients.
0:08:08 > 0:08:10Sometimes it might look quiet, it might look nice
0:08:10 > 0:08:15and suddenly there will be an explosion and we have to run out.
0:08:15 > 0:08:19So the job is unpredictable.
0:08:19 > 0:08:22It depends on how the ward is.
0:08:22 > 0:08:27Because the patients are more priority than any other thing.
0:08:27 > 0:08:29It's not like fixing a broken leg, delivering a newborn baby,
0:08:29 > 0:08:31a hip replacement where people skip out of the door
0:08:31 > 0:08:33and give you boxes of chocolates.
0:08:33 > 0:08:35It's far more complex.
0:08:35 > 0:08:37You're working with people who have had multiple abuses,
0:08:37 > 0:08:41neglect in childhood.
0:08:42 > 0:08:47SHOUTING FROM OUTSIDE.
0:08:47 > 0:08:51I don't want to sit down!
0:08:51 > 0:08:53Calm down, calm down.
0:08:53 > 0:08:55Why won't you let me out?
0:08:55 > 0:08:56For 15 minutes grounds leave.
0:08:56 > 0:08:58Why not?
0:08:58 > 0:09:04Why would you stop that?
0:09:04 > 0:09:07You don't need to be shouting.
0:09:07 > 0:09:09I can't wait that long!
0:09:09 > 0:09:12I'm going to kill somebody and it's going to be you!
0:09:12 > 0:09:16You!
0:09:16 > 0:09:19Don't push me about.
0:09:20 > 0:09:22ALARM SOUNDS.
0:09:22 > 0:09:24Don't record.
0:09:24 > 0:09:33Can we move outside?
0:09:34 > 0:09:39OK...
0:09:43 > 0:09:46Yep.
0:09:46 > 0:09:49Do you have any nominations for private?
0:09:49 > 0:09:52Not at the moment.
0:09:52 > 0:09:57The ward is quite disturbed.
0:09:57 > 0:10:00I don't think any of our patients would really be fit
0:10:00 > 0:10:03for private at the moment.
0:10:03 > 0:10:05OK, out of all those disturbed people, Jonathon,
0:10:05 > 0:10:10who is your most settled patient?
0:10:19 > 0:10:22Ben has been brought to the 136 suite by police after
0:10:22 > 0:10:25threatening to commit suicide.
0:10:36 > 0:10:39Ben is already living in one of the Trust's recovery houses but he wants
0:10:39 > 0:10:43to be admitted to the hospital.
0:10:43 > 0:10:48The ward, it gives you certainty sometimes, I think.
0:10:48 > 0:10:50How would you describe your mood of the last few days?
0:10:50 > 0:10:55It's low, it's low.
0:10:55 > 0:10:58Staff need to decide if his suicidal tendencies mean they
0:10:58 > 0:11:08should find him a bed.
0:11:08 > 0:11:11They decide to send him back to the recovery house with increased
0:11:11 > 0:11:13levels of supervision.
0:11:13 > 0:11:15I think the risk is there.
0:11:15 > 0:11:18This is the second time he has come to the station
0:11:18 > 0:11:21but he is clearly seeking help.
0:11:21 > 0:11:25He knew that he was at the station, he didn't want to jump in front
0:11:25 > 0:11:28of the train and create a scene and make other people go through
0:11:28 > 0:11:30a difficult situation.
0:11:30 > 0:11:36And he is saying he doesn't want to end his life, he wants help.
0:11:38 > 0:11:41The CRHT, or home treatment team, provide one to one support in the
0:11:41 > 0:11:47community and try to stop patients having to be admitted to hospital.
0:11:49 > 0:11:51We've got people with depression, bipolar affective disorder,
0:11:51 > 0:11:53acute anxiety, paranoia, schizophrenia, suicidal patients,
0:11:53 > 0:11:58patients with self harm.
0:11:58 > 0:12:02The most important part of the home treatment team and what we do is
0:12:02 > 0:12:04actually keeping people at home.
0:12:04 > 0:12:07Not only does that have a reflection on beds and what happens there
0:12:07 > 0:12:10but it's important that people should be treated in their home.
0:12:10 > 0:12:17It increases their recovery.
0:12:17 > 0:12:20Let's get some water on the way out.
0:12:20 > 0:12:25The next day Kelly and Charlotte are on their way to see Ben.
0:12:25 > 0:12:28He hears voices and they increase quite quickly
0:12:28 > 0:12:30when he's feeling stressed or anxious and the voices tend to tell
0:12:30 > 0:12:34him he should kill himself.
0:12:43 > 0:12:46Nice and tidy.
0:12:46 > 0:12:48You're not having any thoughts today of what happened yesterday,
0:12:48 > 0:12:50going to the train station?
0:12:50 > 0:12:51No.
0:12:51 > 0:12:54You're not having any thoughts to harm yourself or anything
0:12:54 > 0:12:55like that at the moment?
0:12:55 > 0:12:56No.
0:12:56 > 0:12:58And your medication, you're not having any problems with it?
0:12:58 > 0:13:00There's no side effects or anything?
0:13:00 > 0:13:00You're just forgetting.
0:13:00 > 0:13:01Yes.
0:13:01 > 0:13:03All right.
0:13:03 > 0:13:06So it would be helpful if we gave it to you?
0:13:06 > 0:13:07Just for now?
0:13:07 > 0:13:09Yes.
0:13:09 > 0:13:15All right, my love, you take care, we'll see you tonight.
0:13:18 > 0:13:20The increased demand for mental health services and
0:13:20 > 0:13:24the premium on beds means that more and more very ill people have to be
0:13:24 > 0:13:27looked after in the community.
0:13:27 > 0:13:30At one stage the caseload was 80, I think between 80 and 90
0:13:30 > 0:13:35at one point and it is just completely unmanageable.
0:13:35 > 0:13:38One person will be going out and seeing anywhere between nine
0:13:38 > 0:13:40and 11 people in one shift and you can't do it.
0:13:40 > 0:13:43You're basically going in, checking they're OK, giving them
0:13:43 > 0:13:47medication and leaving again.
0:13:47 > 0:13:49You don't have the opportunity to sit and have some sort of
0:13:49 > 0:13:54therapeutic intervention with them.
0:13:57 > 0:13:59In case Mel doesn't get the funding for her treatment,
0:13:59 > 0:14:02doctors are preparing for a return to the community by letting her out
0:14:02 > 0:14:07of the ward three times a day.
0:14:07 > 0:14:09In the meantime, Mel's mother has come
0:14:09 > 0:14:13in to find out if her daughter will be discharged into the community or
0:14:13 > 0:14:21get the specialist treatment she and the doctors feel she needs.
0:14:21 > 0:14:23She's been institutionalised in the mental health units
0:14:23 > 0:14:26for a long, long while now.
0:14:26 > 0:14:29And I thought, when they brought up the thing, the PD unit,
0:14:29 > 0:14:34this would be her journey to get back into the community again.
0:14:34 > 0:14:37Yeah.
0:14:37 > 0:14:40The idea is to get to the root of the problem.
0:14:40 > 0:14:42It's been a lot of years what she's had.
0:14:42 > 0:14:45And a lot also depends...
0:14:45 > 0:14:48And she's never had this before, to get actually to the root
0:14:48 > 0:14:59of the problem.
0:14:59 > 0:15:02So I've no choice to go or not, I've got no choice in this,
0:15:02 > 0:15:04I've no say in this then?
0:15:04 > 0:15:06The PD unit is the same as Trent Ward.
0:15:06 > 0:15:09I will put it that way because it's a locked door,
0:15:09 > 0:15:10Trent Ward is a locked door.
0:15:10 > 0:15:12I've been in hospital ten months.
0:15:12 > 0:15:13I want to go into the community.
0:15:13 > 0:15:16Let's wait until we see whether they approve the funding or
0:15:16 > 0:15:17whether they decline it.
0:15:17 > 0:15:19One of the big concerns is if you go back
0:15:19 > 0:15:22into the community again, as your mother said, it would be a return,
0:15:22 > 0:15:27a cycle, and you would end up like this for a lot of your adult life.
0:15:36 > 0:15:38Stuart has been in and out of hospital all his life.
0:15:38 > 0:15:44He suffers from paranoid schizophrenia.
0:15:44 > 0:15:47There is a lot of madness here.
0:15:47 > 0:15:51At times it is relatively sane.
0:15:51 > 0:15:55I used to have a deep dislike of the concept of normality
0:15:55 > 0:16:02because of my experiences at the hands of medical-model psychiatry.
0:16:02 > 0:16:05It has been a painful journey for me.
0:16:05 > 0:16:11To recognise the desirability of being sane.
0:16:14 > 0:16:17With cuts to support services in the community, patients
0:16:17 > 0:16:24like Stuart find themselves more often in the hospital.
0:16:24 > 0:16:28Most of the patients do suffer psychotic illnesses so they have a
0:16:28 > 0:16:32vulnerability to flip into a sort of state that is hard to understand.
0:16:32 > 0:16:35You start wondering, well, are we just depositories for people that
0:16:35 > 0:16:39no one else wants to deal with?
0:16:39 > 0:16:44Is that a kind of social control?
0:16:44 > 0:16:48You are tormented a lot of the time that I have known you, really.
0:16:48 > 0:16:50But also fiercely independent.
0:16:50 > 0:16:54And always have been.
0:16:54 > 0:16:59You know, the struggle we have got, you know,
0:16:59 > 0:17:02is that actually the issue over the last couple of years is that
0:17:02 > 0:17:06you have not coped for more than a couple of months at a time at home.
0:17:06 > 0:17:08When you are at home on your own you become...
0:17:08 > 0:17:10You dangerously neglect yourself.
0:17:10 > 0:17:13On a number of occasions now, had you not been admitted to
0:17:13 > 0:17:19hospital against your will you would not be here talking to me now.
0:17:19 > 0:17:22It is my association with satanic cults in the past which still
0:17:22 > 0:17:23impinges on my interior life.
0:17:23 > 0:17:32It's very difficult to cope with.
0:17:32 > 0:17:35Anna is part of a team that tries to sort out support for patients
0:17:35 > 0:17:38when they leave hospital.
0:17:38 > 0:17:42They have some housing support ready for them at the right time and they
0:17:42 > 0:17:49have the right level of social care support ready for them when they go
0:17:49 > 0:17:52out, and their GP and everyone else is lined up to accept them and move
0:17:52 > 0:17:58them onwards in their pathway.
0:17:58 > 0:18:02And sometimes with some of the cuts that we have, seeing some of these
0:18:02 > 0:18:03things begin to be quite difficult.
0:18:03 > 0:18:06I will see you later.
0:18:06 > 0:18:09She also has the deal with people who are not entitled to
0:18:09 > 0:18:10social benefits or health care.
0:18:10 > 0:18:14Today she is on her way to see Augustus, an illegal immigrant who
0:18:14 > 0:18:15had a psychotic breakdown, suffering paranoid delusions
0:18:15 > 0:18:21and hallucinations.
0:18:21 > 0:18:25People believe if they come to the psychiatric hospital you will
0:18:25 > 0:18:27get everything because there is the expectation, this well-known
0:18:27 > 0:18:33saying that we do not discharge anyone into the street.
0:18:33 > 0:18:36Because we don't discharge anyone into the street, the NHS
0:18:36 > 0:18:41hospital will foot the bill.
0:18:41 > 0:18:45He has been receiving emergency treatment for the past three months,
0:18:45 > 0:18:50but he is now well enough to go home.
0:18:50 > 0:18:53It's cheaper for the Trust to buy him a ticket back to Nigeria than
0:18:53 > 0:18:55keep him in a recovery house.
0:18:55 > 0:18:59And it frees up a bed.
0:19:08 > 0:19:11The only help we can offer you today as the NHS Trust - because you are
0:19:11 > 0:19:17here with us - is to basically help you get the ticket and to send you
0:19:17 > 0:19:20to Nigeria, but you don't need money to go to the doctor because we will
0:19:20 > 0:19:24give you three injections which will last a bit of time and it will
0:19:24 > 0:19:26give you time to see how you are.
0:19:26 > 0:19:27Back home.
0:19:36 > 0:19:37Where?
0:19:40 > 0:19:44You are not entitled to treatment in this country
0:19:44 > 0:19:50unless you pay privately, everything has to be paid for privately.
0:19:50 > 0:19:54What you are getting now is what is called emergency treatment.
0:19:58 > 0:20:04It is just dire, absolutely dire at the moment.
0:20:04 > 0:20:09We have so many requests coming in for beds from the crisis teams.
0:20:09 > 0:20:11We are already full and we already have patients
0:20:11 > 0:20:13from the private sector.
0:20:13 > 0:20:17We have very little movement at all from the patient service.
0:20:17 > 0:20:20It is about trying to manage the risk of keeping patients
0:20:20 > 0:20:22in the community whilst trying to get those who are more seriously
0:20:22 > 0:20:24at risk back to a hospital bed.
0:20:24 > 0:20:27It is the fourth week of the September surge and the bed managers
0:20:27 > 0:20:31and crisis teams are battling over how to manage patients.
0:20:31 > 0:20:34Hello. Can you hear me?
0:20:43 > 0:20:45Right, OK.
0:20:52 > 0:20:54There is no way even with intensive CRHT that
0:20:54 > 0:20:56the patient could be supported?
0:21:15 > 0:21:19How are the CRHT managing the situation?
0:21:19 > 0:21:21How many times a day is he being seen?
0:21:38 > 0:21:42We cannot keep referring to the fact that we're waiting forever
0:21:42 > 0:21:46because the private sector has minimal availability and in
0:21:46 > 0:21:48the Trust we have no availability.
0:21:48 > 0:21:53We are going into unknown territory where
0:21:53 > 0:21:56the private sector is becoming full and when the private sector is full
0:21:56 > 0:21:59then we really do have to consider all of these different options
0:21:59 > 0:22:04about how to safely manage people.
0:22:04 > 0:22:07Back on Trent Ward it looks as though Mel might be on track to
0:22:07 > 0:22:11get to the root of her problem.
0:22:11 > 0:22:13She has been told she has got the funding
0:22:13 > 0:22:16for the Personality Disorder Unit.
0:22:16 > 0:22:19It will not be a short-term placement.
0:22:19 > 0:22:21So you could be looking at three, six months, nine months.
0:22:21 > 0:22:24I would not want to put a figure on it.
0:22:24 > 0:22:26I have some good news.
0:22:26 > 0:22:29They said yes to the funding.
0:22:29 > 0:22:32That is good.
0:22:32 > 0:22:35Are you happy?
0:22:35 > 0:22:39I did not want to go but I will give it a shot, you know.
0:22:39 > 0:22:41I have nothing to lose, have I?
0:22:41 > 0:22:44I haven't got nothing to lose if I just give it a shot.
0:22:44 > 0:22:51And everyone is saying that I need to go in, so they can't be wrong.
0:22:51 > 0:22:53I am just trying to fight it all the time.
0:22:53 > 0:22:55It's not good.
0:22:55 > 0:23:04I don't want to jeopardise it.
0:23:04 > 0:23:05I go out and come back.
0:23:05 > 0:23:09That's it.
0:23:09 > 0:23:09Yes.
0:23:09 > 0:23:13Love you, too.
0:23:13 > 0:23:14Bye.
0:23:14 > 0:23:15How was she?
0:23:15 > 0:23:17All right, yes.
0:23:17 > 0:23:18How are you feeling?
0:23:18 > 0:23:20A bit mixed up, but OK.
0:23:20 > 0:23:23What is next?
0:23:23 > 0:23:28I always said if I got the funding I would give it a shot and now I have.
0:23:28 > 0:23:29It's a big thing?
0:23:29 > 0:23:32Yes.
0:23:32 > 0:23:37In Enfield, it's time for Augustus to return home to Lagos.
0:23:37 > 0:23:40He suffered from paranoid delusions and hearing voices.
0:23:40 > 0:23:42Doctors are sending him home with enough medicine to stave
0:23:42 > 0:23:49off the symptoms for six weeks.
0:23:49 > 0:23:53I will give you the ticket and the bit of money that
0:23:53 > 0:23:57the Trust gave and that's all - it's not much but that's what it is.
0:23:57 > 0:23:58They only gave me ?40.
0:23:58 > 0:24:02That's not going to be enough.
0:24:02 > 0:24:09?20, ?30, ?40.
0:24:09 > 0:24:11OK?
0:24:11 > 0:24:12That is just for you...
0:24:12 > 0:24:15Thank you very much.
0:24:15 > 0:24:17When you get there, you go to the local clinic
0:24:17 > 0:24:19for them to give it to you.
0:24:19 > 0:24:22There are extra costs?
0:24:22 > 0:24:25Do they charge you to give an injection?
0:24:25 > 0:24:26Of course.
0:24:26 > 0:24:29Why?
0:24:29 > 0:24:31I have told you how people die here and there.
0:24:31 > 0:24:35I am not joking.
0:24:35 > 0:24:41I must have the capital to go to the hospital.
0:24:44 > 0:24:49Are you still feeling anxious?
0:24:56 > 0:25:00Can I just clarify that he has identified the least unwell patient?
0:25:00 > 0:25:03Nicolas, not at all.
0:25:03 > 0:25:09Daniel, no.
0:25:16 > 0:25:17It's all about capacity.
0:25:17 > 0:25:24Beds, beds, beds.
0:25:24 > 0:25:26Mel did not return from her latest leave.
0:25:26 > 0:25:33Instead she called Jonathon.
0:25:33 > 0:25:36Her main purpose of calling me was to say goodbye and
0:25:36 > 0:25:44that was quite difficult to take.
0:25:44 > 0:25:48But I tried my best and I spoke to her and finally she said that she
0:25:48 > 0:25:52will not talk to me any longer and she banged the phone down on me.
0:25:52 > 0:25:53We called the police.
0:25:53 > 0:26:01Fortunately the police found her and brought her back to the ward.
0:26:01 > 0:26:04You went out and you did drink and drugs?
0:26:04 > 0:26:05Yes.
0:26:05 > 0:26:11Then what happened?
0:26:11 > 0:26:14Then I found myself on the roof.
0:26:14 > 0:26:24I was contemplating whether to jump or not.
0:26:24 > 0:26:28It seems that everyone wants this PD unit and I don't seem to want it.
0:26:28 > 0:26:35Everyone is rooting for me to do it.
0:26:35 > 0:26:37I'm not sure if I'm ready to talk about things
0:26:37 > 0:26:41from the past, you know?
0:26:41 > 0:26:50I think if I go there and open up it might affect me a bit badly.
0:26:50 > 0:26:56What do you fear for Melanie?
0:26:56 > 0:27:00We fear that she could become a revolving-door patient.
0:27:00 > 0:27:06And I only hope that that is not...
0:27:06 > 0:27:12The final result in her life.
0:27:12 > 0:27:16I hope so.
0:27:16 > 0:27:17I'm sorry.
0:27:17 > 0:27:20Don't worry.
0:27:20 > 0:27:25LAUGHTER
0:27:25 > 0:27:31That's a difficult question.
0:27:31 > 0:27:33I don't really like these questions.
0:27:33 > 0:27:35OK.
0:27:35 > 0:27:42It's a tough job.
0:27:42 > 0:27:46You wouldn't want to think about a bad end for your patient.
0:27:46 > 0:27:47You have to not think about it?
0:27:47 > 0:27:54I really do hate it.
0:27:54 > 0:27:58It does not make me comfortable but personally I feel that we
0:27:58 > 0:28:04as nurses, our best hope is to give people hope.
0:28:04 > 0:28:07We need more investment.
0:28:07 > 0:28:12Mental health is not like some of the other services
0:28:12 > 0:28:14in the health system.
0:28:14 > 0:28:18We are really having to do very complex management and there are
0:28:18 > 0:28:21concerns about risk and protection and often trying to stop people
0:28:21 > 0:28:21from harming themselves, actually.
0:28:21 > 0:28:26Far more than harming anyone else.
0:28:26 > 0:28:29If we carry on just trying to meet the demand and other services are
0:28:29 > 0:28:36diminishing then yes, life is going to be really tough.