Beth is a 27 year-old married lady who was admitted to your psychiatric ward two days ago. She lives with her husband and children in a comfortable modern home in Bedford.

Beth reports that over the past two months she has wanted “to end it all’, saying she is always sad, feels guilty that she is a bad mother and feels ‘trapped’ in a loveless marriage to Jake. Last week she bought a number of packets of panadol and had hidden them in her bedroom but didn’t know when she would have enough time alone to take them. She says that on the evening she was admitted into hospital, she was frightening herself by thinking of ways that she could kill herself that day, without letting her children see. At one point she said she had “some clarity in her mind” and rang her mother to tell her how she was feeling. Her mother brought her into ED to be assessed by a psychiatric registrar because “she had never heard her daughter so distraught, desperate and depressed”.

After a comprehensive assessment, it was found that after the birth of her first child Nathan (3 years old) she was diagnosed by her GP as having post-natal depression. She was placed on anti-depressants for a period of 6 months and was not referred for any other treatment. Beth is coherent and orientated to time and place but is very teary almost all of the time.

Beth says that she got pregnant with her second child Alicja (6 months old) to try and save her marriage. She reports to being very unhappy in her marriage, saying she feels that her husband controls her every move, to the point that she has to report to him daily with every cent she spends on herself, or the children.

Beth is an only child and was adopted as a baby by her parents who she says “love her very much”. She does say however, that her mother adores her husband and would never support her leaving him, as it would be devastating for the children. Beth’s mother often helps Beth by baby sitting the children, especially when Beth attends the gym every second day for a Pilate’s class. Beth is physically active and very fit but has very few interests outside of the home, even though there are many recreational activities in her area to choose from. Most of her friends are single and have ceased regular contact with her since the birth of her first child.

Beth’s mother says that she thinks her daughter still has PND and isn’t thinking clearly regarding Jake. She says Jake is a loving and devoted husband and only controls things around the house because Beth hasn’t functioned properly since the birth of her first child. She admits that she has known that Beth has been very unhappy for a number of years but just thought that “it would settle” with a new baby in the house.

Jake works many evening shifts managing a restaurant that he partly owns. He says that he and Beth fight “no more” than any other couple although last week Beth physically pushed him, after accusing him of having an affair which he says is “just ridiculous”. Jake admits to controlling the money in the house and to ringing Beth constantly at home, but says it is because he is worried about Beth’s state of mind and the welfare of the children. He knows that Beth is really unhappy in their marriage but is adamant that if she just “got her head straight” everything would be how it used to be before they had children. He says that since the birth of their last child, the house is always messy. He says that she has “all the time in the world” to tidy up but just sleeps most of the day, leaving Nathan unattended in the house while he is awake. He says that even the kids look unkept unless his mother-in-law is around to help.

Other than an occasional glass of wine with her evening meal Beth denies using any other drugs.

Step 2: Rate Beth’s vignette