A report and a film.

A report published last month by National Child Mortality Database (NCMD) identifies common characteristics of children and young people who die by suicide between 1st April 2019 and 31st March 2020. It investigates factors associated with these deaths and makes recommendations for policy makers.

Every child or young person who dies by suicide is precious. These deaths are a devastating loss for families and can impact future generations and the wider community. There is a strong need to understand what happened and why, in every case. We must ensure that we learn the lessons we need to, to stop future suicides.

Key Findings:

-Services should be aware that child suicide is not limited to certain groups; rates of suicide were similar across all areas, and regions in England, including urban and rural environments, and across deprived and affluent neighbourhoods.

(No one is immune.)

-62% of children or young people reviewed had suffered a significant personal loss in their life prior to their death, this includes bereavement and “living losses” such as loss of friendships and routine due to moving home or school or other close relationship breakdown.

(Saagar was unable to return to his life at University due to a new diagnosis of a mental illness.)

-Over one third of the children and young people reviewed had never been in contact with mental health services. This suggests that mental health needs or risks were not identified prior to the child or young person’s death.

(Saagar had been in contact with Mental Health Services but they discharged him as soon as he showed signs of improvement. They did not follow him up. His GP was unable to identify his high risk of suicide despite his Depression scores being the worse they could be for at least 4 weeks.)

-16% of children or young people reviewed had a confirmed diagnosis of a neurodevelopmental condition at the time of their death. For example, autism spectrum disorder or attention deficit hyperactivity disorder. This appears higher than found in the general population.

(Saagar did not.)

-Almost a quarter of children and young people reviewed had experienced bullying either face to face or cyber bullying. The majority of reported bullying occurred in school, highlighting the need for clear anti-bullying policies in schools.

(At his Primary school in Belfast, his peers called him ‘Catholic’. He didn’t know what it meant but he knew it was not right. This went on for more than a year before I found out. When I spoke to his class teacher about it, she denied any problem.)

The film ‘1000 days’ tells us about Saagar and what we have learnt from his life and death. I am not sure what or how much the policy makers and service providers have learnt or changed but we have learnt and changed a lot and here we talk about that. The film is presently available on-line at the Waterford Film Festival (Short Programe 6), till the 15th of November at the link below. Please take 20 minutes to watch it if you can. You will learn something too. Each one of us can make a difference.

https://waterfordfilmfestivalonline.com/programs/collection-jlvwfxb8ctq

Mum’s not the word.

He didn’t want to go. The new school was an hour’s drive from home. His bags were packed. Each piece of clothing had been labelled, “Baxter 289”. Each set had been neatly marked and packaged – rugby, cricket, football. He was getting ready to leave for the most prestigious Boarding school in town. Nothing less would do for a seven years old lad from such a good family as his. It was for his own good. This precious boy needed a proper education, even if he had to be separated from his sweet mum, wrenched away from his big house on the hill and the fields all around, his playground. This was unquestionably the right thing to do and it was being done. They would make a proper young man out of him. 

His mum knelt beside him in his room, combed his curly brown hair back from his forehead and kissed him there, gently. She looked at his freckled face and spoke apologetically, “I’ll see you at the weekend my darling.”

“I don’t want to go Mum.” He said, looking straight into her big blue eyes.

“I know sweetheart. But once you get there, you’ll have so much fun. You won’t want to come home” she said.

He looked at her face, his eyes now pleading. She felt an ache in her chest and looked down and away at the green Persian carpet.

“Don’t send me away. Please. I promise to be good.”

“My sweet, sweet child. Your dad only wants what’s best for you. Let’s not keep him waiting in the car.”

She held his hand and walked him out into the sunny afternoon of that last Friday in August. The sun was keeping the car warm even though all the windows were open. The day looked like it ought to be a happy one.

It was never the same again.

Forty years later.

He wanted to come home for Christmas. The Government had locked everyone in their homes because of the bugs. He lived in the big smoky town full of bugs. She still lived in her lovely big house on the hill in the open, clean and green countryside.

“It’s not as bad as they make it out to be Mum. We are well and strong and so are you. Nothing will happen. Don’t worry.”

‘I do worry darling. Let’s meet once this season of calamity is over.’

“I would really like to spend Christmas with you.”

‘Yes. That would be nice but I am not sure. The government has not given permission yet.’

“They really should. If they don’t, that would be more of a political decision than a scientific one.”

‘The Government only wants what’s best for us. Let’s not disobey the rules.’

That sounded familiar. He was seven again.

— — — — — — — — — — — — — — — — — — — — — — — — — —

Ref: How early maternal deprivation changes the brain and behavior? by Masa Cater and Gregor Majdic

EJN – 18 April 2021: https://onlinelibrary.wiley.com/doi/10.1111/ejn.15238

This night.

He was born when I was 28.

The monsters of pain took him in his 21st.

I was in my 49th.

Today, he would be in his 28th. I am in my 56th.

7 years ago, this night was his last in this house.

I am here tonight. Sleeping in his room.

7 years it takes for all my cells to be replaced.

7 chakras. 7 cycles.

7 colors. 7 musical notes.

7 days clumped into a week.

A bunch of random dates. Time as a thing.

Not straight. A mirage.

Revisiting.

Revolving. Rotating.

An illusion. A thought.

A future forgot.

Grow. Mature. Flower. See.

A constellation upon which I sit as fully me.

Push through the glass wall of Time. Release.

Rise and fall

free.

Ordinary people

Once upon a time there was an ordinary person. Making a living, being honest, spending time with the family, having a few friends and simple pleasures. Nothing special. Just ordinary.

Then they lost their child to the monster of unbearable pain. They carried on breathing and giving and receiving love. There was nothing ordinary about that. They couldn’t bear the thought of the same thing happening to anyone else. So, they went out to tell the stories of their angels to everyone. To exhibit the smithereens of their bleeding hearts. That was not easy or normal but they did it anyway. To say that there were other options that they wish their kids had been encouraged to explore. To give out the phone numbers of the good people out there who can help. To remind everyone that there was hope. There is hope.

These 3 dads were ordinary people. Now they are walking together for 300 miles over 2 weeks, making waves all over the country, connecting with people, smashing the stigma and sharing the stories of their lovely girls. Ordinary and beautiful. Just like you.

Please listen and take a look at what’s possible when love speaks and acts.

Not ‘them’ and ‘us’. Just ‘us’.

It has been a dream to be face-to-face, talking about Saagar with the Psychiatric community. In the past 7 years that has not really happened. On Wednesday, the 15th of September, I got as up close as possible with an entire department of roughly 100 psychiatrists and Therapists at differing levels of experience and practice. They were in New York and I was here, in London. The Grand Round was organised by a colleague, Prof Mike Myers, who gave it the title:

‘Losing a Son to Suicide: How One Mother is Opening Hearts and Minds Around the World’

After a cordial ‘meet and greet’, the film ‘1000 days’ was screened. It was followed by complete silence. Same as the previous time it was screened. And the time before. Each time the audience was left speechless.

After a long minute I gently stepped in with the assurance that this was a normal response. I invited questions and comments. I thanked them for the work they do and acknowledged how difficult it is for the profession to deal with such losses. I shared my hope that the film will deepen their insights into the human element of such deaths and the value of forging partnerships with bereaved families.

What followed was a fulsome, creative and holistic exchange of ideas.

“What led you to make this film and share your life in this way?” one young Resident asked me.

“I could only work with what I had and do what was in front of me. When I could write, I wrote. When I could speak, I spoke. When I could learn, I learnt. From the moment I heard the news of Saagar’s death, my only intention was that this must stop. No one should have to suffer the way Saagar did or the way I and his friends do. This film came about because it’s time we recognize that these lives are worth talking about, that the desire to end one’s suffering is a normal human desire and that we all have a role to play.”

Winner – BEST DOCUMENTARY – Swindon Independent International Film Festival
Winner – Brighton Rocks Film Festival – Spirit Award
Winner – Compassion Film Festival Colorado – Reflections of Love People’s Choice Award
Nominee – Morehouse College Human Rights Festival Atlanta (winners yet to be announced) 
Semi Finalist – Gold Coast International Film Festival – New York 
Nominee – Long Story Shorts International Film Festival 

Upcoming festivals where the film can be watched starting 23rd September 2021. Tickets available now.

‘1000 Days’  
Morehouse College Human Rights Film Festival – fosters ongoing discussions about human rights and social and political issues.
September 23 – 25 https://morehousehumanrightsfilmfestival.com/2021-film-guide/

‘1000 Days’ at Women Over Fifty Film Festival:
WOFFF is an inclusive, international film festival celebrating women over 50 in front of, and behind the camera.
25 Sept – 2 Oct – tickets on sale
https://wofff21.eventive.org/films/61379c142c09f100b90ae7c4

Comments:

”Bringing people closer and keeping them deeply connected despite social isolation.”

“Keeping the silk threads of human bonds as strong as ever.”

I hate my shoes.

(‘A pair of leather clogs’ by Vincent Van Gogh 1853-1890)

“I am wearing a pair of shoes.

They are ugly shoes.

Uncomfortable Shoes.

I hate my shoes.

Each day I wear them, and each day I wish I had another pair.

Some days my shoes hurt so bad that I do not think I can take another step.

Yet, I continue to wear them.

I get funny looks wearing these shoes.

They are looks of sympathy.

I can tell in others eyes that they are glad they are my shoes and not theirs.

They never talk about my shoes.

To learn how awful my shoes are might make them uncomfortable.

To truly understand these shoes you must walk in them.

But, once you put them on, you can never take them off.

I now realize that I am not the only one who wears these shoes.

There are many pairs in the world.

Some women are like me and ache daily as they try and walk in them.

Some have learned how to walk in them so they don’t hurt quite as much.

Some have had to wear the shoes so long that days will go by before they think of how much they hurt.

No woman deserves to wear these shoes.

Yet, because of the shoes I am a stronger women.

These shoes have given me the strength to face anything.

They have made me who I am.

I will forever walk in the shoes of a woman who has lost a child.”

  • Author unknown.

One death by suicide is one too many. On World Suicide Prevention Day, today, let us start by

  1. believing that suicides are preventable.
  2. knowing that we all play a part, however small, by being aware, educated and resourceful.
  3. being kind and courageous enough to ask the ‘S’ question, listen and respond.

Yummy!

It would be a bit much to say they are friends. But they are very fond of each other and meet up as often as they can which is about twice a year. They both care deeply for young people and support each other’s work. One is a dedicated mother of five. Keeps a beautiful house and garden. Cooks the best food. Sews gorgeous clothes and looks amazing. The second woman has one child who stopped living a few years ago. She doesn’t care much about her house or garden. Can’t use a sewing machine. Doesn’t pay much attention to her appearance.

The second woman appreciates the first one’s invitation to lunch. They sit at the dining table on top of which appear five large aromatic dishes straight from the oven – roasties, grilled carrots and broccoli, kale chips and baked salmon marinated in exotic spices.

As they settle down with their plates, the first woman starts “My Anne has been challenging since she was little. When she was six and we lived in South America, she got it in her head that she wanted to make a cloth tent. We went to the shops and she chose the materials in the green colour she likes. I put it together the best I could and then she wanted buttons and ribbons to go on it and I did all of that. When the tent was ready, I put it up in the living room before she returned from school with great anticipation. She took one look at it and declared “I no like.” She kicked it. It went lopsided and she went up the stairs to her room.”

“My Mike is dreadfully over-confident. He can charm anyone into telling him their secrets. He can make anyone laugh ….. And my Noel! He’s a big architect in Leeds and I love his girl-friend. She is so down-to-Earth. I am so glad they found each other …. And when they asked me what I wanted for my birthday …. And when we all went on a holiday ….. And when they got engaged …. And my Lisa! She is such a good designer. She comes up with original patterns for her tops and I stitch them for her. She carries her dresses like a model …. And my youngest… Oh! He’s full of ….”

The second woman places her attention on the delicious meal. She has no invitation to speak.

Same story

“Three weeks before that day he was at a bridge and he called his friend who called the police. They came out but just told him to call the GP. One week before that day he called another friend saying he had a panic attack. The friend picked him up. Four days before that day they told the GP what was happening. She gave him a prescription for anti-depressants and said it would take 3 weeks for a referral. 4 days later my brother was dead. At no point did anyone tell the family.”

That day was sixteen days ago.

I wonder if anyone sat down with him to listen to what was going on with him. Two friends, one GP and the Police – none of them could put him in touch with his life and keep him safe. Yes. Ultimately it is up to him but I wonder if he was told that it might be helpful to get in touch with his sister, his brother, his mother, his father – the people who had known him all his life. That he could choose someone who he had a deep connection with, someone he trusted, and let them know how fragile he was at present. Someone who truly cared.

I wonder if you’ve seen this recent advert from St John’s ambulance where a dad is desperately trying to save his son. It encourages lay people to learn First Aid, in case of a physical health crisis. It’s a good one.

Save the boy”

Let’s put this in the context of doctors not knowing how to give First Aid to someone in a Mental health crisis.

The police not knowing that this is life-threatening, that there are resources in addition to the GP, like A&E, Maytree, Papyrus, Samaritans, CALM, their community, their family.

The GP not knowing that this is life-threatening, that there are things in addition to antidepressants that help, like having a proper conversation, exploring the suicidal ideation, informing them that it would be in their best interest if they included a family member or a friend of their choice in their care, giving them details of helpful Charities, giving them compassion and hope, drawing up a Safety Plan, getting in touch with the local Mental Health Crisis Team and  being aware that antidepressants can make things worse for young people in the short term.

Over-medicalisation of suicidal thoughts and behaviours in a setting where most medics are uneducated and unsupported in managing these crises.

Save the boys and girls by insisting on education for all professionals in medicine, nursing, law-enforcement, prison service, youth services, social work, for schools universities, hair-dressers, cab-drivers, students, parents, teachers, managers and everyone else is the only way to get it right – A multi-agency approach to Suicide Prevention.

In the USA, ‘legislation’ was recognised as essential to Suicide Prevention(SP) in 2012. At present, 10 states have legally mandated training for all health care professionals.

ASIST Training (Applied Suicide Intervention Skills Training):

The Office Guy

Once upon a time, trains in London used to be stuffed with people. Every now and then one found one’s head in some random person’s armpit. That Friday evening, my train was not too full.  Every other seat was taken and a few people stood by the door.

He boarded at London Bridge and sat opposite me. We sat facing each other at either end of the long rectangular window, looking out at the dusk, in the typical way Londoners show consideration and give space to one another. I was on my way home after work. The skies were moody. I was glad to be released from the hospital after a long windowless day.

As my gaze shifted from the sunset outside the window to the seat across from me, I saw the young office guy with his neat brown hair, parted on the left side. Crisp white shirt and well-pressed grey trousers. Tense jawline. Fixed steely eyes staring through glass panes. Two vertical frown lines just above the bridge of his nose on a smooth white forehead. He looked sharp, a tense energy encompassed him like a taut canvas. It was palpable. He was, as if a statue with serious internal whirings.

The train was on the move now. My station was six stops away. I had noticed something I couldn’t ignore.

I wasn’t sure if I should do something. If yes, what?

If I did nothing would I regret it? Yes.

Could I fully trust my instinct? I wasn’t sure but probably.

Did it matter if I made a fool of myself by saying something? No.

He could get off the train at any moment so I had to make up my mind pretty quick.

Two stops had now gone by and he was still there. This was my chance. I leant in, my head closer to his, caught his gaze in mine and softly said – ‘Whatever it is, it will pass. I promise. It will.’

I went back to admiring the sunset as if nothing happened.

I didn’t look for a response in anyone. Nothing.

I left it there, feeling like a crazy old woman on the train who talks to strangers, my heart beating in my ears.

One stop later, from the corner of my eye I saw him get up to leave. I brought my eyes back into the coach and chanced looking at him as he stood by the doors. He met my gaze and gave me an acknowledging nod, his frown lines gone. I could have cried. I think I smiled and nodded back.

I was finally learning to trust myself to do the right thing.

CHIME

132 billion pounds = money saved for the UK by unpaid carers.

6.5 million = number of carers in the UK.

6000 = number of people who become carers every day.

1 in 8 adults are unpaid carers for a family member or friend.

Carers UK call them ‘The Second NHS’.

Yet, do we or the Health Service truly value them? Listen to them? Include them? Give them a voice? Understand their concerns? Treat them as an ally? Respect their abilities and contributions? Answer their questions? Educate them? Empower them? Support them? Partner with them as well as we could? Sadly not.

In my experience and that of many other families of individuals with a mental illness, the power imbalance between the health care providers and the service users does not allow for an equitable relationship. Hence, denying the patient the best chances of recovery. There is national and local evidence that proves that carer engagement saves lives.

Triangulation of services is essential for best outcomes for patients and professionals. Risk averse practices may help reduce risk in the short term but may increase risk in the long term. A recovery approach to risk and development of a “life worth living” may have longer lasting benefits through rebuilding relationships, increasing service-users skills and confidence in collaboration with carers.

Norfolk and Suffolk Foundation Trust (NSFT) have developed a program called “Stepping Back Safely” up-skilling staff, carers and service-users. It is based on five main drivers of Recovery: CHIME

  • Connection
  • Hope
  • Identity
  • Meaning
  • Empowerment

NSFT are offering free training in Stepping back Safely in July 2021 on-line. Having heard many stories where a life could have been saved only if there was a meaningful and effective communication between the three parts of the Triangle of Care, I think this training is most relevant and essential. I shall be taking it as I am sure it will deepen my understanding of the subject. If you or anyone you know might like a point of contact, here it is: catherine.phillips@nsft.nhs.uk