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Mental melancholy

Phil's had a good run, but now faces his first sectioning for years – and he's depressed

Phil's had a good run, but now faces his first sectioning for years – and he's depressed

My luck has run out at last. Today, I had to section a patient. It's six years since I last had to do this. Most GPs are nowhere near so lucky. Of all the tasks we are occasionally burdened with, this seems the most unpopular, time-consuming and depressing.

On the previous occasion, I was called to the patient's house, in company with a psychiatrist and two policemen. The gentleman had been living in his mother's utility room on a bare mattress for three months, and had barricaded himself in with a cassette player and a kitchen knife. He had been playing the same Britpop compilation tape for three weeks before his mother called the authorities in sheer desperation. She could not bear to hear 'Parklife' by Blur any more, and I have every sympathy. It's a good record, but not that good.

'Brian! Come out with your hands up!' I negotiated. Brian opened the door and tried to look intimidating by passing the knife rapidly from one hand to the other, ninja-style, but basically he was a hopeless little weed and he dropped it. I picked up the knife and handed it to one of the policemen, who was lounging against the wall, languidly waiting to see how the situation would resolve itself. We banged him up. As far as I know, he's still there.

On this most recent occasion, at least my patient was already in the psychiatric ward. She's a bright young professional woman with two children, and we've struggled with her postnatal depression for five years now. Last week her husband told her he'd had enough and she should consider herself separated. She considered herself persona non grata and the ambulance crew should be congratulated for getting her down off the balcony of the Wearmouth Bridge.

It's a long time since I've visited our local mental hospital. It used to be a big sprawling place, a halfway house for fragile souls re-entering society at their own pace. Those places are long gone and the inmates are now care in the community punters, in lonely council flats, seeing us if they are organised enough and seeing nobody if they aren't.Now the hospital is just two wards running at full capacity. Just to enter them is to breathe in depression. There is a fug of stale cigarette smoke and the patients wander up and down the corridor, leaving grubby trails with their shoulders against the wall. There is no privacy, no space for anything.

Our conference takes place in what was obviously once a cupboard. A nurse opens the door six inches (the maximum physically possible) and asks how long we will be. They have a lot of reviews to get through. Some of the paperwork is missing but there's no way of finding it just now so we agree to lock up my patient until she's better.I go out and find her; an angry young woman sitting at a trestle table between two locked-in women who are rocking and keening. She has a book but she is obviously not reading it.

'I'm sorry about this but I really think it's better for you in the long run,' I tell her, but I don't really believe it and I think she can tell. We've got on well in the past but now she shoots me a look of pure hatred. I excuse myself and eventually I find someone who will unlock the door for me.

I go outside. It's a lovely day. I take a deep breath and get into my car and drive away back to my wife and my children.

Dr Phil Peverley is a GP in Sunderland – he is MJA Columnist of the Year

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