"I've been negotiating with the Tate. I'm going to curate a room." So clearly he's quite mad. And I can see the way you're looking: you think I'm about to play this man for laughs. My second-favourite patient. You absolute scumbags. You underestimate me. The truth is so much more sinister.

I love patients with mania, because they make me feel alive. It's depression's glitzy alter ego, way off the end of the happiness scale and into sheer beaming grandiose wonderfulness: born on Broadway, destined for the stars, the world at its feet, mania can take you anywhere, but usually into debt and depression. Like when you remortgage the house to buy that 30ft yacht you deserve, and then come down and realise what a big fat mess you've made. Mania took Phil on a mission to London.

"Yeah, the Tate are pretty keen on me." He crosses his legs professionally and puts his hands behind his head. "And they want me to curate a room." Sounds great. He's got the biggest smile on his face. "No really. It's true. I've counted, right, and they've got six of those big monochrome paintings. Six! The ones that are just huge big rectangles of colour, right? Six! Spread around all over the building. Six!" He waves his arms around and breathes hungrily.

"So they're getting me to do this room, right," he holds his finger up, "and I'm going to stick them all in together. All in one room! Next to each other, you know, all together! All those monochrome pictures, all next to each other!" He smiles cheekily, and I smile back: he can tell I think it's the best commentary on modern art I've ever heard. "It's going to be fucking hilarious! I'll be a made man!" I start laughing with him. God knows why I'm feeling so happy. He's off the scale, and if we don't bring him down he's going to make a serious mess of both our lives.

And this is where it gets sneaky. Because alongside the laughs, I've got an agenda: to make an accurate assessment of him at his worst, and that means whipping him right up into a frenzy. Hang him with his own rope. That sounds great, I say. I bet they must be paying you loads, with your talent. "Yes! Exactly!" He launches into a full force gale of self-promotion and grandiose flights of fantasy, delighted that I asked, like nobody else wants to listen and I'm the only person who really understands and believes in his inestimable powers. Which is kind of almost true. Only he's spent four grand in the past week without sleeping a wink, his girlfriend's kicked him out, and it looks like someone punched him square in the face fairly recently.

So I suppose he needs big doses of something to slow him down a bit. More importantly, here we have a very ill man who needs senior input, and my consultant, as ever, is off pretending to be at a conference. Doubtless with bathroom sound effects in the background. I call Conrad, my perfect predecessor and trusty saviour.

"No." What? "No more informal advice. I want you to phone your consultant, and repeat after me." Oh, Conrad. "Dr Bloch. I feel under-supervised, this is my first job in psychiatry: I need consultant input to manage this patient. It is not safe for me to run a whole clinic on my own."

But if I say that, Conrad, he will give me a bad reference. And then I will be a failure. For the rest of my life. Stop playing around. Let's botch. It's fine. "What do you mean a bad reference: he's a bloody locum. Who cares what he says?"

What do you mean he's a locum? He's been here for three years. Nobody ever tells me bloody anything. "Jesus, Mike. A third of UK consultant psychiatrist posts are unfilled, nobody wants to do the job anywhere: why should anybody want to do it in this provincial cesspit? Who wants to work in a specialty where you end up feeling responsible, rightly or wrongly, for the actions of hundreds of potentially violent and suicidal patients? The money's shit, the service is falling apart, and everyone thinks the patients are horrible. We'd know otherwise of course." My patient's great. Oh shit. I left him in the other room.

"Look, Conrad. Just tell me what to do with this guy, OK?" "OK. Private consultation, Dr Foxton. Keep him in your office." Sounds good. "And then while you spend half an hour walking all over the department trying to find your consultant's pager number, he can call his sister in Canada on your mobile, like he did to me last time. Kerching! One hundred pounds please. Goodbye."