Diary: ‘I manage a single toilet break during my first shift’

A mental health social worker describes a high-stress and pressured first week in a new role

Photo: WavebreakMediaMicro/Fotolia


I start a new job in a hospital crisis team. It strikes me that the team itself is in crisis. Some of the mental health nurses have been re-banded which has affected their incremental pay scale yet are still expected to do the same job. I am questioned by one nurse about my experience and my age. It feels like an interview.

I’m given the role of duty worker for the week to ‘ease me‘ in gradually, apparently. The phones don’t stop all day. Lots of calls are from GPs and regulars; those who are well known to the team and who rely on our support. I book assessments for patients to come the hospital and speak to the team. The diary fills quickly. I manage a single toilet break before running back to answer phones for the rest of the shift.


The team manager introduces herself. She has recently joined the team from elsewhere in the trust. One of the nurses talks me through my role, rather than the team manager. The atmosphere is tense; everyone is over-stretched and feels unsupported. I manage a quick conversation with the only other social worker who briefs me about the team and its dynamics.

I am introduced to the psychiatrists and shown around the Psychiatric Intensive Care Unit (PICU) and the section 136 suite.


I receive a call from a woman well-known to the team. She feels depressed and suicidal, and asks if she can come in to see someone. The diary is already full but I juggle appointments as much as I can to fit her in without causing too much disruption. I spend an hour talking to her but other calls stack up around me and my desk is rapidly covered with post-it notes about other calls. I feel like I’m sinking.

I meet the CAMHS psychiatrist, who comes in weekly to review referrals for children needing assessment. I don’t warm to her; I find her cold and brusque. She only has three slots each week to see patients, yet we have at least fourteen referrals waiting. We both try to prioritise, but it’s difficult because I don’t know any of the patients we are discussing.


I talk to a newly-qualified GP who is concerned about one of his patients; he’s not been sleeping, he has recently lost his job and reports feeling hopeless. We arrange for him to come in to see us later that day.

I have a conversation with a young woman with chronic health needs. She is isolated and depressed. The stream of calls is relentless; one is about a 14-year-old boy making threats to kill his parents. A colleague contacts the parents and my manager rings around for CAMHS  beds. I stay late to write up my notes and hand over to the overnight nurse on duty.


I speak to a young man just out of prison who reports hearing voices. He says he is at the end of his tether and is asking for help. I contact his probation officer for more information and organise an appointment for him to come in.

We get a call at 3pm from the local police, who are bringing a patient in under section 136. We gather information and make calls about bed vacancies, a rather fruitless exercise because there are no beds within 100 miles of the hospital. The patient arrives but immediately breaks loose and legs it across the car park. Two police officers catch up with him and he is frogmarched back to the suite. My shift is over and I hand over, gratefully, to my (more experienced) colleague.

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2 Responses to Diary: ‘I manage a single toilet break during my first shift’

  1. Sounds familiar March 2, 2017 at 10:01 pm #

    I have recently started a new role within a crisis team and although I was lucky enough to have a full supernumary induction, as soon as I was in the numbers I immediately felt the full pressure of the job. Too few staff, too little time, driving up to 40 miles in a shift fitting in 4 visits and assessments of people in mental health crisis and trying to find the time and space to write up the notes. People do a fantastic job but I am quickly seeing the pressure and the toll it places on people. Staff are quitting left right and centre, those who are staying are talking about quitting and the morale plumits with this. I would like to hope the future of social care is going to improve, but I know that is a naive thought and with future budget cuts it will only get worse.

  2. Longtime SW March 9, 2017 at 10:08 am #

    My thoughts are with you.

    Though this is an unkind thought and not something to be flippant about I fantasise about how politicians would respond if they found themselves suddenly vulnerable and in need of a service, for either themselves or loved ones, children or adults, with the sudden realisation that the impact of the few having it all with the rest fighting over the scraps makes us less human.

    Said it before, will say it again – they should hang their heads in shame – except they have no shame while they and their vulture privatisation cronies are destroying the welfare safety net in a better society that millions fought and died for in 2 world wars.