02:34, September 02 181 0 theguardian.com

2019-09-02 02:34:05
My working week  'A patient thinks her landlord will stab her': my job as a mental health nurse


I work as a mental health nurse in a GP practice. Today I assess four new patients and do two follow-ups for patients I have seen before.

The first patient doesn’t attend. The second complains about the long waiting times – about a month, which is fairly typical, and on par with the waiting list for physiotherapy and other specialities. She has been seen by psychiatrists and diagnosed with an emotionally unstable personality disorder; she disputes this and wants an autism spectrum disorder assessment.

She also tells me the online group she is part of told her not to leave the appointment until I prescribe mood stabilisers for the diagnosis she says she doesn’t have. The whole appointment lasts an hour, which is the amount of time we have allotted for each new assessment.

The next patient tells me their paranoid schizophrenia means they can’t work. There is no note of this in their records; they are adamant they were diagnosed “in Wales” but can’t remember the hospital or team. They ask for some very potent short-acting medication, which was the only thing that worked last time. Given its exceptionally high rate of misuse and the unclear clinical picture I refuse to prescribe it, and he walks out after giving me a piece of his mind.

The last patient is a man with obsessive compulsive disorder. He tells me he is no longer washing her hands in scalding water and shows me her healed hands to prove it.


I have a day with my team to sort out admin, decompress, and plan what changes need to be made. This is a highlight of the working week and an opportunity to make sure I don’t lose perspective after being away from other mental health professionals for the other four days. We talk about staff retention and start to create a list of staff we can pinch from other services (who themselves are already short-staffed). Being in a rural locality means there is not much in the way of new staff for services.


I start at 8am, and have seven assessments and two follow-ups scheduled. I don’t get to have lunch today.

One patient tells me he is depressed following his release from prison due to sex offences against children and asks for a letter to support him requesting a house move. He lives in the countryside but wants to move back in to the city as he feels lonely. It’s an issue to be sorted out between housing services and probation, so I signpost him to them.


Four new assessments, and two more follow-up appointments. I have around half a dozen tasks from GPs with various questions about medication, treatment plans, and diagnosis.

One patient has read a self-help book I recommended and is now able to go outside without always having panic attacks. Another tells me she plans on moving to Bristol as they have better services for patients.


A colleague at the surgery is struggling with their mental health, which we talk about during lunch. One patient demands a referral to secondary services or they will kill themselves. I know this will be rejected – there are lots of threats of suicide. Two other patients have responded well to antidepressants, but now have to wait 25 weeks for therapy.

The final patient of the day tries to convince me that her landlord is going to stab her tonight. I weigh up a crisis referral but decide against it. Instead, I go home for 48 hours of worrying until I can check her notes next week and see if there has been any contact over the weekend from A&E, the police, or the crisis team.

If you would like to contribute to our My working week series about your job in public services, get in touch by emailing sarah.johnson@theguardian.com

  • In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found atwww.befrienders.org.