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I expect NHS bodies to act without delay … the prime minister and I have made mental health services a personal priority: from record spending, to our zero suicide ambition, to the new law on parity of esteem, we are seeing progress, but there is still more to do: any avoidable harm is simply unacceptable.
– Health and Social Care Secretary Jeremy Hunt quoted in ‘Hundreds of mental health patients died after NHS care failures’, Duncan, Campbell, & Bawden, 2018
The market is always in danger of disintegrating into a fragmented world in which there is an attempt to deny the interdependence between individuals, disciplines and clinical areas. Manic defences are employed in order to triumph over feelings of vulnerability, inadequacy and failure. These states of mind are then projected around the social system. The world starts to be divided between survivors and casualties, winners and losers in a paranoid schizoid position. This superior and defensive state of mind undermines the attitude required for reverie and learning through experience.
My first significant contact with someone in a suicidal state of mind took place when I was 21. I was working on the night shift at a hostel for homeless women when a resident talked to me for several hours about her disappointment with professionals and with her family, and her intention to kill herself. I have a vivid memory of travelling home on the bus the next morning through the incongruous, daffodilly spring sunshine, and feeling filled with confusion, concern for her and anxiety about my responsibility for acting on this terrible knowledge. I also remember being shamefully aware of feeling that something horrible had been done to me, or put into me; that I was a victim of something, when (as I saw it at the time) all of my concern and righteous, reparative wishes ought to be on the behalf of the resident. I had no clinical training then, and my supervision was irregular and focused on monitoring the com