Scaffolding

Psychiatrist: We’re concerned about how you will deal with Autumn.

Self: Yeah. So am I. So is everyone.

P: Do you have anything to look forward to over the next few weeks? Something in the not-so-distant future that motivates you to keep going?

S: Yes.

P: Fantastic, that’s really good to hear. What is it that you’re looking forward to?

S: The scaffolding being taken down.

P: Sorry, scaffolding? What do you mean by that?

S: From my kitchen window I can see the pub and behind-to-the-side of the pub is the church. The pub has a load of scaffolding up around the back and it’s covered in these bloody great dust-sheets, and I’m waiting for the scaffolding to be taken down so that I can see the whole church from my window where I sit and have my coffee and cigarette every morning. I will be so pleased when I can see the church in a clear, direct line without the scaffolding ruining it. I think I’ll cry when that scaffolding comes down. That church has been there since the 1200s.

P: Right. That’s not exactly what we meant. We meant, like, a birthday or a holiday or a day out, something to stay alive for, like a date or event to keep you moving forwards.

S: Yeah, I have that: the scaffolding.

P: *exasperated sigh*
Fine, whatever. Okay. Fine. When is this scaffolding coming down exactly?

S: I don’t know.

P: *stares blankly*

S: I asked the landlord but he said he didn’t know. I think the scaffold firm have forgotten about it.

P: What makes you think that?

S: It’s been up since last summer and nobody’s worked on the building for a year now. I worry it may be there forever.

P: I see. So you’re looking forward to something that may not happen.

S: Correct. But I hope that it will happen because I really, really want to see the whole church from my window, and I hope it happens soon.

P: You hope it happens soon.

S: Correct.

P: Right.

S: *looks around the room*
Why are none of you writing this down?

P: Because it’s not a proper target.

S: It’s a proper target to me, so fuck you.

P: And you’re looking forward to this scaffolding coming down?

S: Very much so.

P: Fine. Anything else you’re looking forward to?

S: No.

P: Nothing? No birthdays, holidays, events? No special occasions coming up to keep you alive through Autumn?

S: No. Just the scaffolding.

P: Just the scaffolding. Okay. Which may or may not happen.

S: Yep, just the scaffolding that may or may not happen.

P: Great.

S: I’d like to go home now, please.

P: Hang on. Actually, could you just wait outside for 2 minutes while I discuss your care plan with my colleagues?

S: Sure.

*…*

P: Right, basically, you’re a “high-risk suicide” patient but there’s nothing we can do to help you with this. It’s up to you, after all. We can’t stop you from killing yourself. We can’t be there all the time. We know you won’t let the HTT into your flat if they visited you and you’re hard to keep tabs on anyway.

There are no beds available around London, Hertfordshire, Essex, Surrey, Kent… there’s a bed in Plymouth but even if we send you there there’s nothing any of the nurses or doctors or psychiatrists can do for you apart from watch you 24 hours a day, 7 days a week which will frustrate you immensely, and you’re highly likely to become violent or abscond so there’s not much point.

Truthfully, the only way you might be able to get some help is if you commit a substantial crime that warrants immediate prison time with a custodial sentence. Then at least you’d be in London. But obviously we can’t officially recommend this to you. But we’re “just saying”, we’re just trying to explain where we’re at with you, you know, “off the record.”

S: I don’t want to go to Plymouth.

P: Exactly. Right. That’s exactly what we thought.

S: Prison sounds good, it’s always been a logical and appealing option to me. But how would I be able to pay my rent if I’m in prison? Like, I’d lose my flat, wouldn’t I? And then when I get released I’d have no more help or psych support or meds and I’d be homeless again, so I’d be regressing straight back to July 2014? I had all those problems in July 2014 and tried to kill myself because of them. It’s a good short-term fix but I’d be fucked again when I got out. Vicious circle.

P: Yeah, I can see that.

S: Also, if I’m in Plymouth or prison, how would I be able to check on the scaffolding?

P: What?

S: I won’t know if or when the scaffolding comes down if I’m in Plymouth or prison.

P: *pauses for a moment too long*
That’s an excellent point. So we’re all agreed that in-patient isn’t suitable in this instance because the patient has a target which she wants to follow that she would not be able to experience if we were to place her on psychiatric hold?

Everyone: *nods* *makes notes*

P: Okay. So we’re agreed that you’re going to carry on as you are, living at home, taking your meds, reading, writing, drinking, wait, no, sorry, not drinking, no drinking whatsoever. And yeah, basically just trying to stay alive day-by-day, but we all know and accept there’s a great chance of you ending your life but that’s really beyond our reach and beyond our control. So we all just carry on, and see how we go. Is that okay?

S: Well, yeah, I guess so.

P: Great! And for the purpose of cogency in your paperwork, we’re going to record you as a “medium-risk suicide” rather than a “high-risk” because you have expressly stated that you don’t want to go to Plymouth so you’re not co-operating with the treatment plans we’ve offered you, and there’s nothing we personally can do anyway. It’s just easier to write “medium-risk”, less hassle for everyone.

S: *….*

P: Anything else?

S: Yeah actually, why am I only being given 5 days worth of meds at a time? It’s fucking bullshit.

P: Because, after your recent overdose, we don’t trust you to have your usual 28 day supply.

S: Even though it was an accidental overdose on none of my meds? Even though it’s a fucking nightmare for me? Even though getting my meds once a month causes enough stress and upset in my life, let alone fucking weekly?

P: Yeah, we know but it’s protocol.

S: So you follow this ridiculous, inappropriate safe-guarding protocol that you know is detrimental to my health but not the suicide-risk protocol that is in place to save my life?

P: Pretty much. It’s not that black and white, but yeah.

S: You ought to be more worried about me not taking my meds because I don’t have any, rather than being worried about me taking too many meds. You ought to be fucking terrified actually. I know I am.

P: We’ll see.

S: Indeed we shall.

P: See you in a month.

S: Will you?