Britain's Mental Health Crisis Panorama


Britain's Mental Health Crisis

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SCREAMING AND SHOUTING.

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One in four people will suffer a mental health problem this year.

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I just have a deep dislike of the concept of normality.

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Last year over 53,000 people were detained under the

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Mental Health Act.

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Cuts to mental health services have been higher than other acute NHS

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services.

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3000 beds within the last five to six years have been cut.

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We've got five males and three females requiring

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admission this afternoon.

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I've got no beds whatsoever.

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Are we just a sort of depository for people that no one else wants

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to deal with?

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We followed staff and patients in the of the UK's largest

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NHS Mental Health Trusts.

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You're not entitled to treatment in this country.

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Things are absolutely dire here at the moment.

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Barnet, Enfield and Haringey Mental Health NHS Trust in North London

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serves nearly a million people.

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Staff are preparing the 136 suite, the holding cell

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for people have been sectioned under the Mental Health Act.

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The handcuffs will come off once you're inside because

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you've been a bit unpredictable to me, a bit aggressive.

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You're going to have a mental health assessment.

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Section 136 of the Mental Health Act allows officers to detain people who

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are a danger to themselves or the public and take them

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into protective custody.

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Cooperate with staff, start making good decisions and this

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process will go really quickly.

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You understand?

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The number of people detained in this way is now

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the highest ever recorded.

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All over the country we are seeing a real surge in the need for mental

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health services and I think that's probably down to economic austerity,

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a reduction in some of the social services because there have been

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swingeing cuts to local authorities and there have been increasing

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numbers in our population.

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The Trust has lost over a third of its beds in the last eight years and

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is running at over 100% capacity.

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For every patient sectioned, a bed must be found, regardless

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of how full the hospital is.

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Shall we make a start for Barnet?

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Heather runs the twice-daily bed management

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conference, with all eight wards in the Trust on the line.

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The purpose is to free up beds.

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One female bed?

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There's no beds.

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If there are no beds available in the Trust, each ward manager

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must nominate their least unwell patient for potential discharge.

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OK, can I just clarify you've identified the least well patient

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at the meeting this morning?

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No, the one I identified is the same as yesterday.

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I know, I appreciate that, but looking at it from our point

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of view, we have potentially five males and three females requiring

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admission this afternoon and I've got no beds whatsoever.

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Under section 136, you don't have any rights of appeal.

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I wanted to discuss transferring somebody into that bed to create

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a vacancy for this patient.

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Throughout the day, more patients are referred from GPs,

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hospitals and A departments.

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All must be found beds.

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Another one just came in, this patient was brought

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in under section 136.

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Not only does the Trust have no beds, but none are

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available in the whole of London.

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No patient is well enough to be discharged or moved

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on to a halfway recovery house.

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The Trust has no choice but to pay for a private sector bed which could

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cost up to ?1000 per day each.

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I'm just ringing to find out if you've got any female vacancies.

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The September surge, it happens most Septembers

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because of course you have all the people in the summer holidays,

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it tends to die down a bit but in September you get a massive uplift.

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We've got about 12, 13 requests for a bed today, that's getting on for

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three quarters of a ward in one day.

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I'm telling you, things are absolutely dire here at the moment.

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Trent Ward has 21 beds for patients with serious mental health problems.

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The aim is to get patients well enough to leave the ward as fast

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as possible.

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The average stay is three to four weeks.

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We treat many more people out in community settings.

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Those people who now come in as an inpatient tend to be much

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more severely and acutely unwell.

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Mel has been on the wards for nine months.

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You've been here for such a long time.

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You don't need to be here.

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She has a personality disorder and a history of drug abuse

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and suicide attempts.

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Staff want to transfer Mel to a specialist personality disorder

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unit but funding has been refused.

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We can't understand what the reason is for declining funding,

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apart from the obvious financial restraints that everybody is

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operating under at the moment.

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What's the meeting?

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It's a professionals meeting.

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What does that mean?

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They're going to discuss what happens to me next.

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What are the choices?

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Either you go to a PD unit, a personality disorder unit,

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or I could be discharged.

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I do want to go back into the community again,

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try and start again.

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But?

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There sounds like a but.

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It's going to be hard for me to settle back into

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the community again because I've been in for so long, it's going to

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be hard for me to settle back in.

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Are you worried, what are you worried about?

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I'm just worried that I'm not going to be able to cope

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on my own out there.

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The ward is not a suitable place for her long-term.

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She has to be moved out.

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Either in the community or in rehab.

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What's the next step?

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Of course we have to bear in mind she has been

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on our top delays list now for quite a while so, from a clinical point

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of view, she doesn't require an inpatient mental health facility.

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She should not be on this ward.

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She needs to be elsewhere.

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Now, the clinicians are saying that they think that this rehab

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facility is the best place.

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The commissioners are not agreeing to it.

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In the meantime, if she doesn't need to be here, can she go home?

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It is looking at the risk to herself,

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the risk to others, but mainly, the long-term view is that she is going

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to continue with this behaviour.

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The September surge is keeping the hospital at code black.

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Jonathan is on the morning bed conference, trying

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to identify patients to be moved.

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I have very ill patients.

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Sometimes it might look quiet, it might look nice

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and suddenly there will be an explosion and we have to run out.

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So the job is unpredictable.

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It depends on how the ward is.

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Because the patients are more priority than any other thing.

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It's not like fixing a broken leg, delivering a newborn baby,

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a hip replacement where people skip out of the door

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and give you boxes of chocolates.

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It's far more complex.

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You're working with people who have had multiple abuses,

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neglect in childhood.

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SHOUTING FROM OUTSIDE.

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I don't want to sit down!

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Calm down, calm down.

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Why won't you let me out?

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For 15 minutes grounds leave.

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Why not?

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Why would you stop that?

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You don't need to be shouting.

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I can't wait that long!

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I'm going to kill somebody and it's going to be you!

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You!

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Don't push me about.

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ALARM SOUNDS.

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Don't record.

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Can we move outside?

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OK...

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Yep.

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Do you have any nominations for private?

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Not at the moment.

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The ward is quite disturbed.

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I don't think any of our patients would really be fit

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for private at the moment.

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OK, out of all those disturbed people, Jonathon,

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who is your most settled patient?

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Ben has been brought to the 136 suite by police after

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threatening to commit suicide.

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Ben is already living in one of the Trust's recovery houses but he wants

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to be admitted to the hospital.

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The ward, it gives you certainty sometimes, I think.

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How would you describe your mood of the last few days?

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It's low, it's low.

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Staff need to decide if his suicidal tendencies mean they

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should find him a bed.

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They decide to send him back to the recovery house with increased

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levels of supervision.

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I think the risk is there.

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This is the second time he has come to the station

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but he is clearly seeking help.

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He knew that he was at the station, he didn't want to jump in front

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of the train and create a scene and make other people go through

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a difficult situation.

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And he is saying he doesn't want to end his life, he wants help.

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The CRHT, or home treatment team, provide one to one support in the

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community and try to stop patients having to be admitted to hospital.

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We've got people with depression, bipolar affective disorder,

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acute anxiety, paranoia, schizophrenia, suicidal patients,

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patients with self harm.

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The most important part of the home treatment team and what we do is

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actually keeping people at home.

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Not only does that have a reflection on beds and what happens there

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but it's important that people should be treated in their home.

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It increases their recovery.

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Let's get some water on the way out.

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The next day Kelly and Charlotte are on their way to see Ben.

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He hears voices and they increase quite quickly

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when he's feeling stressed or anxious and the voices tend to tell

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him he should kill himself.

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Nice and tidy.

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You're not having any thoughts today of what happened yesterday,

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going to the train station?

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No.

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You're not having any thoughts to harm yourself or anything

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like that at the moment?

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No.

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And your medication, you're not having any problems with it?

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There's no side effects or anything?

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You're just forgetting.

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Yes.

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All right.

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So it would be helpful if we gave it to you?

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Just for now?

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Yes.

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All right, my love, you take care, we'll see you tonight.

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The increased demand for mental health services and

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the premium on beds means that more and more very ill people have to be

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looked after in the community.

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At one stage the caseload was 80, I think between 80 and 90

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at one point and it is just completely unmanageable.

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One person will be going out and seeing anywhere between nine

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and 11 people in one shift and you can't do it.

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You're basically going in, checking they're OK, giving them

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medication and leaving again.

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You don't have the opportunity to sit and have some sort of

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therapeutic intervention with them.

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In case Mel doesn't get the funding for her treatment,

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doctors are preparing for a return to the community by letting her out

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of the ward three times a day.

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In the meantime, Mel's mother has come

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in to find out if her daughter will be discharged into the community or

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get the specialist treatment she and the doctors feel she needs.

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She's been institutionalised in the mental health units

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for a long, long while now.

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And I thought, when they brought up the thing, the PD unit,

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this would be her journey to get back into the community again.

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Yeah.

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The idea is to get to the root of the problem.

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It's been a lot of years what she's had.

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And a lot also depends...

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And she's never had this before, to get actually to the root

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of the problem.

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So I've no choice to go or not, I've got no choice in this,

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I've no say in this then?

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The PD unit is the same as Trent Ward.

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I will put it that way because it's a locked door,

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Trent Ward is a locked door.

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I've been in hospital ten months.

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I want to go into the community.

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Let's wait until we see whether they approve the funding or

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whether they decline it.

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One of the big concerns is if you go back

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into the community again, as your mother said, it would be a return,

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a cycle, and you would end up like this for a lot of your adult life.

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Stuart has been in and out of hospital all his life.

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He suffers from paranoid schizophrenia.

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There is a lot of madness here.

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At times it is relatively sane.

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I used to have a deep dislike of the concept of normality

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because of my experiences at the hands of medical-model psychiatry.

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It has been a painful journey for me.

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To recognise the desirability of being sane.

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With cuts to support services in the community, patients

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like Stuart find themselves more often in the hospital.

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Most of the patients do suffer psychotic illnesses so they have a

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vulnerability to flip into a sort of state that is hard to understand.

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You start wondering, well, are we just depositories for people that

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no one else wants to deal with?

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Is that a kind of social control?

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You are tormented a lot of the time that I have known you, really.

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But also fiercely independent.

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And always have been.

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You know, the struggle we have got, you know,

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is that actually the issue over the last couple of years is that

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you have not coped for more than a couple of months at a time at home.

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When you are at home on your own you become...

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You dangerously neglect yourself.

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On a number of occasions now, had you not been admitted to

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hospital against your will you would not be here talking to me now.

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It is my association with satanic cults in the past which still

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impinges on my interior life.

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It's very difficult to cope with.

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Anna is part of a team that tries to sort out support for patients

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when they leave hospital.

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They have some housing support ready for them at the right time and they

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have the right level of social care support ready for them when they go

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out, and their GP and everyone else is lined up to accept them and move

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them onwards in their pathway.

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And sometimes with some of the cuts that we have, seeing some of these

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things begin to be quite difficult.

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I will see you later.

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She also has the deal with people who are not entitled to

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social benefits or health care.

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Today she is on her way to see Augustus, an illegal immigrant who

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had a psychotic breakdown, suffering paranoid delusions

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and hallucinations.

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People believe if they come to the psychiatric hospital you will

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get everything because there is the expectation, this well-known

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saying that we do not discharge anyone into the street.

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Because we don't discharge anyone into the street, the NHS

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hospital will foot the bill.

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He has been receiving emergency treatment for the past three months,

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but he is now well enough to go home.

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It's cheaper for the Trust to buy him a ticket back to Nigeria than

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keep him in a recovery house.

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And it frees up a bed.

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The only help we can offer you today as the NHS Trust - because you are

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here with us - is to basically help you get the ticket and to send you

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to Nigeria, but you don't need money to go to the doctor because we will

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give you three injections which will last a bit of time and it will

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give you time to see how you are.

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Back home.

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Where?

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You are not entitled to treatment in this country

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unless you pay privately, everything has to be paid for privately.

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What you are getting now is what is called emergency treatment.

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It is just dire, absolutely dire at the moment.

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We have so many requests coming in for beds from the crisis teams.

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We are already full and we already have patients

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from the private sector.

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We have very little movement at all from the patient service.

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It is about trying to manage the risk of keeping patients

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in the community whilst trying to get those who are more seriously

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at risk back to a hospital bed.

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It is the fourth week of the September surge and the bed managers

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and crisis teams are battling over how to manage patients.

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Hello. Can you hear me?

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Right, OK.

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There is no way even with intensive CRHT that

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the patient could be supported?

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How are the CRHT managing the situation?

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How many times a day is he being seen?

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We cannot keep referring to the fact that we're waiting forever

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because the private sector has minimal availability and in

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the Trust we have no availability.

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We are going into unknown territory where

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the private sector is becoming full and when the private sector is full

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then we really do have to consider all of these different options

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about how to safely manage people.

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Back on Trent Ward it looks as though Mel might be on track to

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get to the root of her problem.

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She has been told she has got the funding

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for the Personality Disorder Unit.

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It will not be a short-term placement.

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So you could be looking at three, six months, nine months.

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I would not want to put a figure on it.

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I have some good news.

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They said yes to the funding.

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That is good.

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Are you happy?

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I did not want to go but I will give it a shot, you know.

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I have nothing to lose, have I?

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I haven't got nothing to lose if I just give it a shot.

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And everyone is saying that I need to go in, so they can't be wrong.

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I am just trying to fight it all the time.

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It's not good.

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I don't want to jeopardise it.

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I go out and come back.

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That's it.

0:23:050:23:09

Yes.

0:23:090:23:09

Love you, too.

0:23:090:23:13

Bye.

0:23:130:23:14

How was she?

0:23:140:23:15

All right, yes.

0:23:150:23:17

How are you feeling?

0:23:170:23:18

A bit mixed up, but OK.

0:23:180:23:20

What is next?

0:23:200:23:23

I always said if I got the funding I would give it a shot and now I have.

0:23:230:23:28

It's a big thing?

0:23:280:23:29

Yes.

0:23:290:23:32

In Enfield, it's time for Augustus to return home to Lagos.

0:23:320:23:37

He suffered from paranoid delusions and hearing voices.

0:23:370:23:40

Doctors are sending him home with enough medicine to stave

0:23:400:23:42

off the symptoms for six weeks.

0:23:420:23:49

I will give you the ticket and the bit of money that

0:23:490:23:53

the Trust gave and that's all - it's not much but that's what it is.

0:23:530:23:57

They only gave me ?40.

0:23:570:23:58

That's not going to be enough.

0:23:580:24:02

?20, ?30, ?40.

0:24:020:24:09

OK?

0:24:090:24:11

That is just for you...

0:24:110:24:12

Thank you very much.

0:24:120:24:15

When you get there, you go to the local clinic

0:24:150:24:17

for them to give it to you.

0:24:170:24:19

There are extra costs?

0:24:190:24:22

Do they charge you to give an injection?

0:24:220:24:25

Of course.

0:24:250:24:26

Why?

0:24:260:24:29

I have told you how people die here and there.

0:24:290:24:31

I am not joking.

0:24:310:24:35

I must have the capital to go to the hospital.

0:24:350:24:41

Are you still feeling anxious?

0:24:440:24:49

Can I just clarify that he has identified the least unwell patient?

0:24:560:25:00

Nicolas, not at all.

0:25:000:25:03

Daniel, no.

0:25:030:25:09

It's all about capacity.

0:25:160:25:17

Beds, beds, beds.

0:25:170:25:24

Mel did not return from her latest leave.

0:25:240:25:26

Instead she called Jonathon.

0:25:260:25:33

Her main purpose of calling me was to say goodbye and

0:25:330:25:36

that was quite difficult to take.

0:25:360:25:44

But I tried my best and I spoke to her and finally she said that she

0:25:440:25:48

will not talk to me any longer and she banged the phone down on me.

0:25:480:25:52

We called the police.

0:25:520:25:53

Fortunately the police found her and brought her back to the ward.

0:25:530:26:01

You went out and you did drink and drugs?

0:26:010:26:04

Yes.

0:26:040:26:05

Then what happened?

0:26:050:26:11

Then I found myself on the roof.

0:26:110:26:14

I was contemplating whether to jump or not.

0:26:140:26:24

It seems that everyone wants this PD unit and I don't seem to want it.

0:26:240:26:28

Everyone is rooting for me to do it.

0:26:280:26:35

I'm not sure if I'm ready to talk about things

0:26:350:26:37

from the past, you know?

0:26:370:26:41

I think if I go there and open up it might affect me a bit badly.

0:26:410:26:50

What do you fear for Melanie?

0:26:500:26:56

We fear that she could become a revolving-door patient.

0:26:560:27:00

And I only hope that that is not...

0:27:000:27:06

The final result in her life.

0:27:060:27:12

I hope so.

0:27:120:27:16

I'm sorry.

0:27:160:27:17

Don't worry.

0:27:170:27:20

LAUGHTER

0:27:200:27:25

That's a difficult question.

0:27:250:27:31

I don't really like these questions.

0:27:310:27:33

OK.

0:27:330:27:35

It's a tough job.

0:27:350:27:42

You wouldn't want to think about a bad end for your patient.

0:27:420:27:46

You have to not think about it?

0:27:460:27:47

I really do hate it.

0:27:470:27:54

It does not make me comfortable but personally I feel that we

0:27:540:27:58

as nurses, our best hope is to give people hope.

0:27:580:28:04

We need more investment.

0:28:040:28:07

Mental health is not like some of the other services

0:28:070:28:12

in the health system.

0:28:120:28:14

We are really having to do very complex management and there are

0:28:140:28:18

concerns about risk and protection and often trying to stop people

0:28:180:28:21

from harming themselves, actually.

0:28:210:28:21

Far more than harming anyone else.

0:28:210:28:26

If we carry on just trying to meet the demand and other services are

0:28:260:28:29

diminishing then yes, life is going to be really tough.

0:28:290:28:36

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