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Wrap-around?

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“What can we do to offer wrap-around care to our patients?”

In the live Q&A at the end of the NCISH conference yesterday, this question was asked of the panel. The Chairperson directed it towards me. I can’t remember what I said. This morning I woke up with what I would have liked to say.

For wrapping, we need two things. One, the fabric which we are going to use to wrap and the person we want to wrap. Let’s discuss them one by one.

  1. The fabric

The fabric of Suicide prevention in Health-Care is made up of two things – people and systems. Let’s look at them a bit closely.

  1. People

What are the beliefs of the people?

I know of an ENT surgeon from another country who wanted to move to the UK and the only job he could find was in Psychiatry. So, he is now training to be a Psychiatrist. Is he interested in suicide prevention? Do Health-care professionals believe that suicides are preventable? Are they content that simply by treating mental illness they are doing their job?

What are the attitudes and abilities of the people?

When the Emergency department calls to say there is a suicidal individual waiting to be seen, how do they feel? Are they excited to have an opportunity to make a difference? Or is it a drain on the limited time and energy they have? Do they know how to build a compassionate connection with someone who has lost all hope? Have they received any training in Suicide Prevention? Do they have enough self-compassion to look after someone else well?

Do they have the resources and the knowledge to do a good job?

Do they have access to their past history? Do they have beds on the ward? Can they ask a colleague for a second opinion if they have a doubt about how to involve family or friends in their care? Do they know of other resources, like charities, activities and people that may help this person? Do they have comprehensive and informative leaflet they can share with them? Do they have the means to follow them up?

b. Systems

Does the system have capacity? Are the various parts of the system effective and joint-up enough to be able to hold the person they are trying to wrap or are there big holes in this part of the fabric? Do the various parts of the system share the same mental model, a shared knowledge, pre-suppositions, and beliefs that can be used to help achieve mutual goals? Are their practices evidence- based? Do they investigate deaths with a view to learn lessons and implement change? Do they look after the well-being and emotional health of their employees? Do they hold themselves accountable when things go wrong?

2. The person

Allowing space for them to express themselves. Help maintain their sense of agency. Inform them it is safer for them to involve other people who care for them. Equip them with resources. Give them the support they need. Ask them what would help them? Listen. Sit with their despair. Acknowledge it. Keep them connected with their life as they know it. Keep hope alive for them.

Know that the person at the centre of the wrapping is of great value.

Information is useful if it becomes knowledge. Knowledge is useful when it becomes wisdom. So, let us not stop at information.

Ref:

Reaching common ground: The role of shared mental models in patient safety : https://journals.sagepub.com/doi/full/10.1177/2516043518805326

Writing cues…

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I don’t like to gossip but…

I shouldn’t really say this but…

I’m really sorry but…

It’s none of my business but…

I don’t mean to be difficult but…

I know this sounds judgmental but…

I don’t mean to pry but …

I know it’s selfish but …

I don’t think you’re fat but …

I don’t mean this to be offensive but…

My husband is a real darling but…

I’m not a racist but…

I know it’s awkward but…

Everyone loves my dad but…

I think she’s adorable but …

It’s not about how old you are but…

So many years have passed but… I was invited to speak at a national conference last month. I said yes.

National Confidential Inquiry into Suicide and Safety in Mental health (NCISH) 11th Annual conference on the 8th of May 2025 at 10 am UK time. This year the focus is on people who had been in contact with Mental Health services within a year of their death. It’s free, short and online.

Registration : Here

Delegates booklet: Delegate Booklet 

Recent report: Recent NCISH Report.

Everything living on Earth is food for the Moon.

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So much of everyday life, including the innumerable religious festivals in India are dominated and determined by the lunar calendar. While the gross impact of the moon on water, especially the tidal waves is well known, the more subtle effects on humans and plants, less so. Biodynamic methods of farming acknowledge the cycles of the moon as fundamental to a good harvest as they incorporate cosmic energy to minimise disease and aid growth.  

At a recent Biodynamic meeting, I was fascinated to see a Planting Calendar based on the 6 cycles of the moon. I thought there was only one – Full to New and back.

Every 27.3 days, the Moon and Saturn are on opposite sides of the Earth. This is a great time for planting as their forces synergise to produce strong plants of high quality. Organic wine growers have been using this technique for a long time.

Like inhalation and exhalation, the Moon ascends and descends. The ascending phase is great for harvesting as the natural flow of energy is upward and the descending phase is a good time for transplanting saplings as the downward energy helps them take root.

Apogee is when the Moon is furthest from the Earth, a great time to sow potatoes. Perigee is the point in the orbit of the moon when it is nearest to the Earth. This means there is more moisture in the soil, making the plants more prone to fungus and insect attacks.

Nodes occur when the Sun-Earth-Moon are in line. It happens twice every month. It’s a bad time for any horticultural activity as the Sun’s beneficial influence is negated on these days.

As the Moon passes through various Zodiac constellations, it exerts different influences on different types of plants. At this point, my cognitive abilities were saturated, and I had to leave the rest for later.

I shall have mercy on you and stop here.

Splendiferousness from last night. I am sure Saagar would say something like,”Big-ass Moon. Innit?”

Dad, boys and crow.

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“Once upon a time there were two boys who purposefully misremembered things about their father. It made them feel better if they ever forgot things about their mother.

There were a lot of equations and transactions in their small family. One boy dreamed he had murdered his mother. He checked it wasn’t true, then a put a valuable silver serving spoon that his father had inherited in the bin. It was missed. He felt better.

One boy lost the treasured lunchbox note from his mother saying ‘good luck’. He cried alone in his room, then threw a toy car at his father’s framed Coltrane poster. It smashed. He felt better. The father dutifully swept up all the glass and understood.

There were a lot of punishments and anticipations in their small family.“

Eight years ago it was hard work and I could remember it only vaguely.

I read it for the second time this morning. It felt brand new, easy, fun and hearbreaking. Part memoir, part sound-poem. A bit more than 100 pages long. No more than 18 thousand words. The ‘missing’ in the life of a young family after the mother dies suddenly is palpable. In the background rings the sound of a crow flapping its wings. One big black feather has dropped on the ground. It lies near my right foot.  

PS: Losing a parent or a close relative or friend at a young age puts the young at a high risk of suicide.

It is February.

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In January, fourteen blog-posts rolled on to the page, inspired, with sparkling newness, a fresh resolve. Then twenty days sneaked past, and nothing appeared. Wonder why? What is it we can trust?

The body?

One of the most fragile things around, it aches and creaks, often deceiving itself with imagined abilities and fantastical visions. It morphs every day in its special small way, without a clue what happens next. Can we depend on its trustworthiness?

The mind?

It doubts to the point of debilitation, endlessly compares un-comparables, guards its ideas like a dog, but softens and changes its opinions when presented another point of view. Every now and then it simply loses itself, out of the blue. What can we do?

The Universe?

Sounds great. But what does that relationship look like? Seems rather theoretical.

So, what is constant? What can we trust?

The thing that is not a thing and yet, can be called everything. The thing that is nowhere but can be thought of as everywhere. The thing that appears as me but is in fact invisible. The thing that is localised in each of us but is colourless, featureless, unbound. The thing that is beyond stillness and movement, beyond light and dark.

Awareness. The one that knows. Not as a person but as an intelligence. A presence. An eternity in this moment. Here. That always was, is, and always will be. That can be trusted, not to get things done, but to know. Know every experience of being in this body, having this mind, perceiving the world through these eyes. This is how it is.  That knowing. Beyond sounds and beyond silence.