Fred’s first presentation to adult mental health services followed the breakdown of his marriage.

He was forty years old and had been married for twenty-one years. His wife had been having an affair with her boss and planned to leave Fred, taking their two children with her. Fred is a man with strong family values and traditional views about marriage. He was seen in accident and emergency after a serious suicide attempt by taking an overdose. Core beliefs triggered were "I am useless" and "others cannot be trusted". He presented as restless and agitated, crying, not sleeping, irritable, hard to concentrate, preoccupied, helpless, numb empty and despairing.

Over the next 20 years, he attempted suicide another three times. Each attempt was serious. He was admitted to the acute adult ward on multiple occasions. He was prescribed a range of different medications over the years and received a variety of diagnosis including depression, personality disorder, psychosis, alcohol dependence. Fred often presented as quite negative and appeared reluctant to engage in therapy. He found it very difficult to talk about his ex-wife and was too proud to ask for help, seeing it as a sign of weakness. He attended the day centre and attended a various therapy groups for anxiety, depression, psychodynamic, occupational. Eventually he was referred for individual cognitive behavioural therapy. He responded well to a structured CBT approach and then attended The Decider Skills 10 week course. He attended The Decider Skills Graduate Group each month for a couple of years. Fred has not been admitted for more than three years. He recognises the early signs of relapse and is able to request help.

"The Decider course was something new. Over the years I had tried every group, every medication offered, every therapy going and although some things helped, it was the skills and the regular refresher groups that helped to cement my improvement" Fred

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